Nursing Management of Chronic Renal Failure - Coursework Example

Nursing Management of Chronic Renal Failure Name Professor Course Date Introduction Chronic renal failure refers to a progressive decline of functional renal tissues to an extent that the remaining kidney mass cannot sufficiently maintain the body in its internal environment (Al-Mosawi, 2010). Chronic renal failure (CRF) can develop over many years internally within the renal system. Consequently, it can result from recurrence of an episode from which the patient had not yet fully recovered. The incident of chronic renal failure has greatly increased over the years. A research performed in 2002 revealed that about 37000 patients got renal replacement therapy in the UK. Consequently, out of this number, up to half of them got renal transplant. The number of victims suffering from this problem has been reported to increase over the years nearly at a rate of 7% in the UK. Causes that lead to the widespread of this disease involve a number of things. These may include pathological organ dysfunction caused by some primary disease e.g. diabetes mellitus. Other causes may include intrinsic pathological processes like the effects of uraemia. Uraemia in this case refers to the effects that result when the body is unable to excrete products of amino acids and proteins metabolism. Relevant pathophysiology The human urinary system normally consists of two kidneys and two ureters, a single urethra and one urinary bladder. The kidneys play a very important role in the human body; they are the major excretory organs apart from the liver, skin, intestines and lungs. Basically, the kidneys are the major excretory organs and without them, these others cannot work efficiently. Normally, the renal disorder impairs glomerular filtrate hence resulting into fluid overload. When the fluid volume gets excess, the hydrostatic pressure gets higher than the normal pressure hence pushing the excess fluids into interstitial spaces. When at the venous end, the fluid is not reabsorbed hence leading to overload of the lymph system. As a result, the patient will develop edema, pulmonary congestion and weight gain among other conditions (Atkins & Leonard, 2008). The nephron gets hyperthrophized hence leading to decline in the ability of the kidneys to concentrate urine hence leading to oligura. Researchers have also proven that most pathophysiological changes normally affect major organ systems. In this case, the affected parts are the renal arteries. As a result of magnitude caused by the sickness, the patients suffering from chronic renal failure face the greatest challenges in most hospitals. They need special care and close attention to enable them gain quick recovery or improvements. Nurses have the greatest responsibility of ensuring that these patients get the utmost attention to facilitate quick recovery. Nursing Assessments This intervention greatly touches on the nurses who hold a great responsibility of caring for the patients. They interact with these patients more often than the other medical practitioners hence giving them the fore step in management of chronic renal failure. This therefore allows for more and thorough intervention, assessment and a great chance to develop a more effective therapeutic relationship with both the clients as well as their family. A good relationship between the nurse and the client will offer a strong basis for the assessment and adaptation with their family. Adaptation in this case refers to a process of coping and responding to environmental changes positively. The Roy’s adaptation model shows the general system approach that study’s how individuals relate to their environment. The underlying assumption behind the Roy’s adaptation model is promoted by nursing activities performed during the process. The roles played by nurses are very relevant and hold the greatest magnitude. Some of the major roles that nurse play include clinical assessment, nutritional review, blood pressure management, virology review and immunization, medication management and pathology review among other roles. The nurse practitioner will always work within their stipulated roles in accordance to the scope provided by the body in charge of nursing. In order for the nursing process to be successful, there are certain protocols that need to be closely observed and followed to ensure that the right results are got. A nursing process is necessary for the success of this intervention. Nursing process can be defined as a systematic and scientific approach to a nursing care. Its main aim is to meet the nursing needs and healthcare of the clients. This is always considered a very crucial element to nurses since it helps them adapt to various challenges in the face of ever changing nursing roles. The nurse needs to apply various theories and concepts when managing this health condition of chronic renal failure. Most of these theories and concepts are got from nursing study, physical, behavioral, and biological sciences and provide the best rationale for making decisions and judgments. Nursing diagnoses The application of the nurse process is a chance through which nurses can demonstrate their levels of accountability to their clients who are the chronic renal failure patients (Wright, 2009). The nursing process has a series of components that offers guidelines to nurses on the best way forward. Here are a few components of the nursing process and their relevance to the entire process. a) Assessment The assessment process involves collecting data and other related information from the client. The aim of acquiring this information is to ensure you fully understand the problems faced by the client. This in turn will facilitate and create good grounds for better planning of the entire activities and processes (Perkins & Kisiei, 2005). The data collection methods used here includes interview, observations, examination and consultation. Also during this process, a number of frameworks such as the Maslow’s hierarchy of needs are used. During the assessment stage, the nurse checks on things like the patients comprehensive history about the disease and general health. After this, they can perform physical assessment of the patient to see the extent of disease spread. Psychosocial assessment is also done to understand the individual’s perceptioins about the sickness and the manner in which their families perceive the illness. Further details like the history of medication as well as allergies are also placed into consideration at this point. Finally, the nurse seeks further information relating to their lifestyle to allow for a much more comprehensive report. b) Nursing diagnosis This is a combination of various health problems that by the virtue of their trainings nurses can easily diagnose and treat. The health problems in this case involve the results attained at the assessment stage of this nursing process. Potential health problems encountered at this stage include those that were developed as disease complications or from earlier attacks (Strauch, 2012). It is thus paramount to develop preventive measures that will help counter these problems effectively. c) Planning At the planning phase, activities such as determining what should be done and how is considered. It is at this point, where all the necessary resources that may be needed are placed into consideration. In addition, alternatives are developed at this point to help curb any disappointment that may arise during implementation. The nurses set priorities and establish various criterions that will be used to execute the desired mission. For instance, in the case of chronic renal failure, the nurses must plan a course of action and the subsequent steps to be taken through the entire course of action. The nursing care plan developed at this stage will act as guideline for the entire process. d) Nursing intervention( implementation stage) These are now the activities that the nurses indulge in to help the chronic renal failure patients. At this point, a professional nurse will take over, control and coordinate the activities performed by other professional nurses. Such may include providing healthcare for both the patient and the family; one thing that needs to be greatly emphasized is that the health care has to be adapted to the situation in which the client is going through and must be given a holistic approach (Tanguay et al, 2007). This is the major stage in nursing process and should be performed exemplarily. e) evaluation stage This is the stage of assessing the progress of the entire intervention. The professionals in charge sit down and review the objectives set for the project. After which, they check those that have been achieved and those that have not yet been. Basically, this evaluation process tackles areas such as resources e.g leadership, staffing and physical resources used in the project (Wright, 2009). Others include the processes involved in offering the care and the outcomes achieved in terms of recovery or any form of health improvement. There are certain conditions that require patients to get referred to emergency departments. After examination and the nurses notice any of these, they need to call for emergency response for such patients. Conditions of this nature include possibility of life threatening situations Symptomatic evidence of preceding unidentified decreased or decreasing function of the vital organs of the body. Dialysis access Problems relating to kidney disease infection. Comorbidities of kidney diseases like cardiovascular complications. Rapid and unexpected deterioration. Appropriate nursing interventions and rationales. Intervention procedures are very important; it is through these that patients gain recovery from their conditions. Nurses need to know how to diagnose the presence of chronic renal failures and the best response to these conditions (Murtagh et al, 2006). One type of intervention that needs to be performed for such a patient is the assessment type of intervention. Here you can note the urine output. During the process, check the quantity and the characteristics of the urine. The rationale for doing this is to have proper knowledge of the functionality of the kidneys. If the urine is concentrated, there may be an implication that the patient is not getting adequate fluids in the body. Suppose the urine looks cloudy or dark, that means there is a likelihood of an infection. Also if the urine has an odor or some foul smell, there could be an infection. Another intervention that is necessary for the patients may include therapeutic intervention. Here, the patient is given plenty of fluids through the mouth. This helps in elimination of waste through the bladder. It helps in flushing out the things blocking the bladder. At the same time, you can offer a teaching intervention through which the patient is taught about the importance of taking plenty of fluids. This helps in enlightening of the patients about the various ways of controlling their health (Curtis & Williams, 2009). The above interventions are normally given in cases where patients are not in very critical conditions. The interventions can be accompanied by treatment to ensure total elimination of this condition. One of the most common treatments for this disease is hemodialysis. During this process, blood from the patient is sent through dialyzer and then returned to the body system after all the toxins and excessive fluids have been removed (Nahas & Anderson, 2010). It is normally performed thrice a week, each treatment lasting an average of 4 hours. After the process, the patient may experience adverse body reactions which include cramps, nausea, light headaches, vomiting and electrolyte imbalances. Another form of medical intervention that can prove productive is the use of peritoneal dialysis. Here, the patient blood is filtered without being removed from the body. Instead of taking the blood from the body, dialysate is administered in the peritoneal space, where electrolyte and fluid exchange takes place (Lai, 2009). After the process, dialysate gets drained through the peritoneal catheter. This procedure is effective and can yield excellent results in cases where the CRF had not grown into complication. The alternative relief method is transplantation. This is normally used when other options have proved to void. It is however, the most effective form of medical intervention for these patients (Faber & Klein, 2009). Replacing the diseased kidney and putting in place a healthy one can restore the body back to its normal functionality even in cases where the patient had experienced complete kidney failure. Normally, the diseased kidney is left and the new one transplanted just beneath it in the lower part of the abdomen (Brien, 2008). The kidney normally begins functioning about 24 hours after the surgery. The kidney functionality needs to be closely monitored with immunosuppression procedures in place. These are done to prevent graft rejection by the body. Offering of emotional support to the patient and the family can also help a great deal. The CRF patient needs to come to realization that someday the renal replacement therapy will permanently form part of his/ her life (Paterson, 2009). The diagnosis process plus the notion that dialysis is not a complete cure may result into frustration, anger, depression, hopelessness and anxiety to the patients. It is thus important to give them hope and encouragements that one day they will gain stable health conditions. Nurses need to do this both for the patient and the family to enable them stay in hope. Conclusion Nursing plays a very important role in the management of chronic renal failure. Nurses therefore have a responsibility of taking good care of the patient and ascertaining that they get the medical attention deserved (Blomqvist et al, 2010). Since nurses spend more time with these patients more than any other person, they stand a better position to offer the greatest assistance to the patients. Assessing the condition of the patient periodically from the beginning of treatment to the end will ensure patients experience quick recoveries (O'Dwyer, 2008). They must thus be on the forefront to educate patients on how to manage their health conditions. References Perkins,, C., & Kisiei, M. (2005). Utilmng physiological knowledge to care for acute renal failure. British Journal of Nursing, 14(14), 770. Al-Mosawi, A. J. (2010). The Conservative Management Of Nonterminal Chronic Renal Failure. Therapy, 3(2), 305-306. Tanguay, T. A., Jensen, L., & Johnston, C. (2007). Predicting episodes of hypotension by continuous blood volume monitoring among critically ill patients in acute renal failure on intermittent hemodialysis. CACCN, 18(3), 19. Atkins, R., & Leonard, C. D. (1971). Management of chronic renal failure. Chicago, Ill.: Year Book Medical Publishers. Blomqvist, K., Theander, E., Mowide, I., & Larsson, V. (2010). What happens when you involve patients as experts? a participatory action research project at a renal failure unit. Nursing Inquiry, 17(4), 317. Brien, P. G. (2007). Medical-surgical nursing: assessment and management of clinical problems : study guide (7th ed.). St. Louis, Mo.: Elsevier Mosby. Curtis, J. R., & Williams, G. B. (2009). Clinical management of chronic renal failure. Oxford: Blackwell Scientific. Faber, P., & Klein, A. A. (2009). Acute kidney injury and renal replacement therapy in the intensive care unit. British Association of Critical Care Nurses, Nursing in Critical Care, 14(4), 206. Paterson, J. G. (2009). Implementing end of life care for patients with renal failure. Nursing Standard, 23(53), 35. Lai, K. N. (2009). A practical manual of renal medicine nephrology, dialysis, and transplantation. New Jersey: World Scientific. Murtagh, F., Donohoe, P., & Higginson", J. (2006). SYMPTOM MANAGEMENT IN PATIENTS WITH ESTABLISHED RENAL FAILURE MANAGED WITHOUT DIALYSIS. 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