Assessment, Management, And Evaluation Of Chronic Kidney Disease In Glenda

Assessment of Glenda Medical Condition

Assessment of kidney functions

Discuss about the Assessment of Glenda Medical Condition.

Chronic kidney disease abbreviated as CKD is also referred to as the chronic renal failure and it is responsible for most cases of mortality and morbidity in the elderly in Australia (Wen et al., 2014). Moreover, CKD is associated with reducing the significant role of the kidney through causing damages and blockage (Vassalotti et al., 2016). Research shows that the period it takes for CKD to cause complete renal failure depends on the stages of CKD and the nursing interventions in place (Tonelli and Wanner, 2014). Notably, it should be made clear that chronic kidney disease has no cure, but early identification and application of nursing intervention as per Levett-Jones clinical reasoning cycle will help slow the progress and improve the patient’s symptoms. As of the year 2005, the NHS reported that chronic kidney disease is at an alarming rate as most of the hospitals in the region reported to have increased renal replacement surgery (Gatchel et al., 2014). Also, according to Hung et al., 2014 are of the opinion that chronic kidney disease increases the chances of cardiovascular complications. Again, a report by the WHO indicated that there would be high chances of chronic kidney disease in Australia for the next ten years and the likelihood of the cases leveling off are dismal due to the lifestyle of locals (mostly the native Australians) who are reluctant to seek medication from public hospitals (Collins et al., 2015). The underlying factor towards the behavior by most natives is cultural-based. The residents feel left behind regarding development and that the foreigners are interfering with their way of life (Tong et al., 2015).

With that in mind, the case focuses on describing the care, management, and assessment interventions for Glenda, a 46-year-old woman who presents with chronic kidney disease. The previous medical history indicates the following symptoms generalized swelling of the face, hands, feet, and ankles. Also, she finds difficulty in walking due to stiffness and pain in her knee and elbow joints. Her current medical condition indicates increased body temperature of 38.8 degrees Celsius and increased blood pressure of 180/100 mmHg which relates to the high number of cigarettes consumed daily. As such, Glenda is taken to the emergency renal ward at Darwin hospital where she undergoes an X-ray, EUC, and ECG. After inserting a vas catheter, Glenda is scheduled for surgery in a week’s time to have fistula formation in her left arm.  The condition makes Glenda admitted for almost twelve months a situation that makes her daughter Roseen uncomfortable. Later, the nurses, family, and friends organized a meeting and ensure Glenda is discharged and receives medication from her home in Tiwi Island and undergo her dialysis at Renal Dialysis unit at Wurrumiyang clinic. As such, ideas in this article seek to critique the care, management, and assessment for Glenda at each stage of her chronic kidney disease. Notably, the paper will set a discussion on the evaluation of renal function. Furthermore, the article will offer a succinct summary of the ideas concerning the thesis statement as shown below.

Assessment of stages of chronic kidney disease for Glenda

When Glenda first attended Wurrumiyanga clinic at her home in Tiwi Island, the doctors had to screen her kidney to identify any symptoms of chronic kidney disease due to the physical symptoms she presented (Diamantidis nd Becker, 2014). Also, Wen et al., 2014) are of the opinion that screening helps in prescribing medical intervention for CKD at stages 1-3 hence appropriate procedural processes in combating the condition. That said, the following test helped the doctor in assessing the renal functioning and impairment for Glenda: urinalysis-the test makes use of urine, and with the inclusion of a urine dipstick the nurses can determine the presence or absence of bacteria and casts on a microscope. Urinary protein excretion-the model analyzes urine after every 24 hours to measure the albumin-creatine ration abbreviated as ACR.

An increase in the ACR shows a high risk for cardiovascular complications. Renal imaging-the technique pays attention to the shape of the kidney and checks the presence of cysts (Fang et al., 2014). Notably, the assessment model is of significant role in patients with CKD stages 4 and 5. Also, patients with stages 1-3 ought to undergo an ultrasound in case of reduced eGFR. Finally, renal biopsy a patient with stages 4-5 CKD is advised to undergo the assessment to check the level of proteinuria. Britt et al., 2013 are of the opinion that renal biopsy is of great value as the histological analysis provides nurses with information to know when and how to diagnose the impaired kidney failure.

There are five stages of chronic kidney disease that Glenda is diagnosed with: ranging from stage 1-5. The evaluation model follows the in-depth analysis of Glenda’s medical history which reveals her physical symptoms: swollen face, feet, and hands, social life showing her smoking and drinking habits, and her family history which records no case of CKD (Angeli et al., 2014). The post-Streptococcal Glomerulonephritis diagnosis at Royal Darwin Hospital indicates that there was thickening of the membranes due to the accumulation of protein in the glomeruli hence need for checking the blood glucose levels (Tonelli and Wanner, 2014). Moreover, it is important to control the blood pressure to reduce the risk of proteinuria. In addition, Glenda’s medical history at the time of admission indicates hypertension as blood pressure beyond 140/90 mmHg is considered hypertensive.

Stage of CKD	Investigations	Assessment
Stages 1-2 eGFR more than 89/ml/min/1.73m2 but is not less than 59ml/min/1.73m2 (albuminuria included)	Urea and electrolytes including eGFR. Urine ACR recorded after 24 hours. Annual blood pressure.	Scheduled clinical and laboratory assessment. Also, the nurses in charge offer advice on lifestyle practices.
Stages 3-5 When the eGFR is less than 59ml/min/1.73m2	Urine ACR is randomly collected. The inclusion of dipstick in the sample of urine collected to test for urinalysis for proteinuria. Regular checking of blood glucose levels. Analysis of full blood count to check the level of Parathyroid hormone (Levey et al., 2015).	Exclusion of acute renal failure. Also, the nurse reviews medical history and administers new medication which acts as an anti-inflammatory medication. The collected urine is assessed to check for urinary symptoms, heart failure, and hypovolaemia (Levey et al., 2015).

For efficient management of the different stages of CKD, it is of significant value to first identify the symptoms associated with chronic kidney disease. What is more is that the clinical signs for CKD remain unrecognized until there is acute renal failure (Stevens and Levin, 2013). That is to say that a patient can be asymptomatic at an advanced stage of the condition. Therefore, early identification sets a platform for integration of early interventions which aim towards assessment and management of the state. As such, the symptoms of CKD include but are not limited to loss of appetite, nausea, minor ankle edema, change in urine pattern, and fatigue (Jha et al., 2013). Also, it is wise for Glenda to have a balanced diet characterized with enough proteins.

Health condition	Treatment
Smoking	Cessation
Hypertension	Regulate the blood pressure to less than 135/80mmHg. Besides, inhibitors can be induced to slow the effects of renal deformity. Notably, when the eGFR reduces to less than 25% of the baseline value, it is important to cease the ACR inhibitor and refer Glenda to a Nephrologist (Mills et al., 2015)
Physical apathy	Schedule a workout program starting with walking the progressively to jogging and running: aim at improving the aerobic rate.
Alcohol	Monitor the drinking patterns of Glenda. First, start with reducing then progressively rehabilitate her by stopping the supply and access to alcohol.
Flu vaccination and pneumococcal vaccination	During admission, Glenda needs to hydrate t avoid dehydration. Also, the nurses in charge can describe an antiviral medication. After being discharged Glenda can as well as use prescribed cough suppressant.
Diabetes-Type II diabetes	Reduce the consumption of sugary coca cola drink from 500ml a day to 250ml then after some time you cut short and provide safe source of sugars such as
Nutrition	Drink a lot of water to avoid thirst. Ensure Glenda consumes less salt: especially adding raw salt to the food at the table. Reduce the intake of coca cola and later cut short.

Management of chronic kidney disease

Significantly, the End-Stage Renal Disease abbreviated as ESRD is the term used to refer to patients who are responding to the treatment from acute renal failure (Wen et al., 2014). Also, ESRD is commonly known as stage 5 of CKD. What is more is the availability of shared ideas between amongst nurses, patients, and their families: the ideas help in making informed decisions aimed towards treating stage 5 CKD (Locatelli et al., 2013). As such, the table below provides a description to types of treatment for stage 5 CKD.

Treatment	Types	Mechanisms/practices involved	Outcomes
Transplant	Living and deceased donor	If it is critical it may call for surgery. Also, the period may wait for up to 6 years in case of deceased donor	Glenda will be free to work and live a normal life. Moreover, Glenda has increased rate of survival after the transplant is done.
Home Peritoneal Dialysis	Continuous Ambulatory Peritoneal Dialysis(CAPD) Automated Peritoneal Dialysis (APD)	During the day four bags are changed by the nurse the APD entails the overnight exchange of bags by a machine	The treatment ensures Glenda has the freedom to work without disturbance of the urinary tract: due to the PD catheter. The CAPD allows for ample time during one-week training. The APD allows the nurse on duty to rest.
Non Dialysis Supportive Care	Requires no dialysis or transplant. It can be managed at the community level (Wurrumiyanga clinic). Again, the model is supported by palliative care	Emphasizes on mediation and balanced diet.	Non-dialysis supportive care increases survival chances in elderly patients thus increased life expectancy (Model, 2015).

The nurse in charge of Glenda is working extra hard to avoid further complications of the conditions. Therefore, educating Glenda, her daughter Roseen and the community as a whole will ensure the sustainability and ease of combating CKD (Diamantidis and Becker, 2014). Notably, the primary risk factor identified is the danger of reduced cardiac output. The condition is associated with inadequate pumping of the blood to the heart to facilitate metabolic processes. The related risk factors include but are not limited to: first, fluid imbalances resulting in a lapse in the current volume and heart workload (Mills et al., 2015). Second, there is the risk of increased deposits of urea and calcium phosphate blocking the baseline membrane. Thirdly, lapse and alteration in electrolyte balance. The nurse can prescribe medication after observing and assessing the presented physical symptoms. To establish desired outcomes for Glenda the table below shows the nursing intervention and the possible justification.

Nursing intervention	Justification
Analyze heart and lung sound to evaluate presence of peripheral edema and cases of dysponea.	Diagnosed with flu hence wheezes, edema, and dysponea
Assess the degree of hypertension and blood pressure	Renal dysfunction causes hypertension. Also, orthostatic hypertension occurs due to imbalances in the intravascular fluids.
Assess the presence of chest pains paying attention to the location and degree of pain	Lack of potential risk of pericardial effusion associated due to home dialysis.
Assess heart sounds, blood pressure, and temperature	Narrow pulse pressure, temperature above 37.5 degrees Celsius, and presence of irregular hypotension.
Assess and evaluate the physical activity	Dormant nature alludes to HF and presence of anemia
Need to monitor and assess lab and diagnostic results
Potassium, calcium, and magnesium electrolytes	When imbalanced they affect the heart functioning by altering the electrical transmission
Chest X-rays	Used in identification of soft-tissue calcification
Administering antihypertensive drugs such as Apresoline: a hydralazine	Useful in reducing vascular resistance and tension hence reduce myocardial workload. Also, useful in preventing HF.
Preparing home dialysis	Reduce accumulation of urea. Again, corrects the electrolytes and fluid imbalances.
Pericardiocentesis	To exclude the pericardial sacs as it may result in cardiac arrest through myocardial contractility.

The burden of CKD led to the longer hospitalization of Glenda, and it is important to include multidisciplinary care clinics to improve service delivery (Gatchel et al., 2014). The approach integrates different health professionals and family members to offer long-term support to Glenda as shown below.

Interdisciplinary	Role
Nephrologists	Assess and evaluate etiology of Glenda’s CKD to determine the care plan (Diamantidis and Becker, 2014)
Dietitian	Offer advice on nutritional intake and manage the intravascular fluid
Pharmacist	Provide education to Glenda regarding effectiveness of modern medication and herbal treatment
Social work	Substitute Roseen on transporting the mother to hospital
Transplant team	Educate Glenda about transplant before the surgery (Davison et al., 2015)
Advanced Practitioner	Provides education regarding CKD and acute renal failure. Also, coordinates care with Glenda’s family and the locals.

Less attention has been paid to monitor the role awareness has to CKD patients. Although early identification proves to be a mechanism to slow the progression of CKD and ESRD, there is a growing need for the establishment of a customer-oriented platform for nurses to exercise to administer patient-center to patients such as Glenda (Papademetriou et al., 2015). Also, encouraging Glenda to attend guiding and counseling sessions in Tiwi Islands will help boost her morale and change her perception of life. And it is known that once the mind is stimulated so does the endorphin hence the body relaxes. The model will allow Glenda get back to her feet and provide for her family.

Conclusion

In nursing, providing care, assessing, and management of diseases is a plan that allows nurses to incorporate Levett-Jones cycle of clinical reasoning: a period that allows for an understanding of the patient’s past medical history and ethnic background before commencing with data collection and administering medication. As for Glenda the condition grows and gets of hand hence the inclusion of interdisciplinary team approach to offer long-term support emotionally, physically, and medically. To that end, it is possible to discern that CKD cannot be treated, but approaches as integrating family members and the community help to slow its progress.

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