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Objective The objective of this teaching/facilittion plan is to have teaching session with the family members of Chronic kidney disease patient. Client will be able to manage a patient with CKD who live a long time. Client will be able to change lifestyle and important measures to reduce risk of CKD patient. Client will able to understand dietry restrictions. |
Content Topic There is no such treatment for chronic kidney disease. The last stage of CKD requires dialysis or transplantation to maintain life. Because of the high cost and problems with the availability of rapid treatment in India, only 5-10% of patients received dialysis or kidney transplants, while the rest die without receiving sufficient therapy. Until recently, the same situation was in the Russian Federation, and if in the major cities of Russia the problem of access to dialysis is solved, then access to the PTA is still limited in rural areas and small towns. Thus, early detection and conservative treatment is the only possible and less costly way to treat CKD and delay the need for dialysis or transplantation.
Complications of chronic renal failure require early diagnosis and immediate treatment. The main complications that require attention are heavy fluid overloads, high potassium levels in the blood (potassium> 6.0 meq / L), and severe effects of kidney failure on the heart, brain, and lungs. Making changes in lifestyle and general measures These measures play an important role in reducing the overall risk: • Cessation of smoking. Treatment of infections and depletion of the volume is very useful in chronic kidney disease. • Maintain a healthy weight, regular exercise and physical activity on a regular basis. • Restriction of alcohol consumption. • Compliance with the principle of healthy eating and reducing salt intake. • Reception of prescribed medications. Adjusting the dose of the drug taking into account the severity of renal failure. • Continuous adherence to treatment by the directions of the nephrologist. Depending on the type and severity of kidney disease, CKD requires dietary restrictions (discussed in detail in Chapter 27). • Salt (sodium): To control high blood pressure and edema, salt restriction is recommended. The restriction of salt includes: cooking without salt, not adding salt to the food at the table and avoiding salt-rich foods such as fast food, pickles and minimizing the use of most canned foods. • Fluid intake: A decrease in the volume of urine in patients with CKD can cause swelling and in severe cases even shortness of breath. Thus, fluid restriction is recommended for all patients with CKD with edema. • Potassium: A high level of potassium is a common problem in patients with CKD. In turn, it can have a serious impact on the function of the heart. To prevent this limit the consumption of food |
Time Frame 15 min 10 min 30 min 30 |
Teaching Strategy There are three strategies for chronic kidney disease: therapeutic (conservative) treatment, dialysis or a kidney transplant (Lorig, Laurent, Plant, Krishnan & Ritter, 2014). • All patients with chronic kidney disease receive conservative treatment first (medications, dietary recommendations, and monitoring). • Severe damage to chronic kidney disease (terminal stage of kidney disease) requires dialysis or transplantation. It is most effective to begin proper therapy in the early stages of CKD (Doolan-Noble, Gauld & Waters, 2015). Most patients feel very good in the early stages of CKD and, with proper therapy, do not have symptoms. Because of the absence of symptoms, many patients and their families do not recognize the severity of the disease and stop taking medications and dietary restrictions (Mercer, O’brien, Fitzpatrick, Higgins, Guthrie, Watt & Wyke, 2016). Discontinuation of therapy can lead to a rapid deterioration in kidney damage and in a short time such patients may need such expensive treatment as dialysis or a kidney transplant (Allen et al., 2015). Chronic kidney disease is a progressive condition that can not be cured. The goals of conservative therapy are: 1. The slowdown of disease progression. 2. Treatment of the causes that led to the disease and provoking factors. 3. Relieving symptoms and treating complications of the disease. 4. Reducing the risk of developing cardiovascular diseases. 5. Delayed the need for dialysis or transplantation. What are the treatment strategies for different stages of CKD? Treatment strategies and recommended actions at different stages of chronic kidney disease are presented in the table (Allen et al., 2015). |
Evaluation method Nine stages of the treatment plan for CKD 1. Treatment of underlying disease Identification and etiologic treatment of underlying primary diseases are given below. Control and treatment Chronic kidney disease is not completely curable, but early onset of therapy is very effective for secondary prevention. Causes of CKD can delay, prevent or reverse its progression. • Diabetes mellitus and hypertension. • Urinary tract infection or obstruction. • Glomerulonephritis, Renovascular diseases, analgesic nephropathy, etc. 2. Strategies for slowing the progression of CKD In chronic kidney disease, important and effective measures to slow the progression of the disease are: • Strict blood pressure control and therapy with ACE inhibitors or angiotensin II blockers. • Protein restriction. • Therapy with lipid-lowering drugs and correction of anemia (Doolan-Noble, Gauld & Waters, 2015). 3. Supportive and symptomatic therapy • Diuretics, to increase the volume of urine and reduce edema. • Drugs for the control of nausea, vomiting, and discomfort in the stomach. • The appointment of calcium preparations, phosphate-binding drugs, preparations of the active form of vitamin D and others to prevent and eliminate CKD associated with bone disease (Mercer, O’brien, Fitzpatrick, Higgins, Guthrie, Watt & Wyke, 2016). • Correction of low hemoglobin (anemia) with preparations of iron, vitamins, and erythropoietin. Treatment of the underlying disease delays the progression of CKD (Doolan-Noble, Gauld & Waters, 2015). • Prevention of cardiovascular diseases. Start a daily intake of aspirin if it is prescribed by a doctor. 4. Control over reversible states It is necessary to search for and treat reversible conditions, which can aggravate the degree of renal failure (McKinlay, McBain & Gray, 2009). By correcting them, it is possible to improve kidney function, and kidney function can return to a stable initial level (Insel & Sahakian, 2012). Common reversible causes and conditions: • Reduction of blood volume and extracellular fluid. • Renal failure due to adverse drug side effects (non-steroidal anti-inflammatory drugs – NSAIDs, contrast agents, aminoglycosides, antibiotics). • Infection and congestive heart failure. • Infection. • Congestive heart failure (Solotaroff, Devoe, Wright, Smiths, Boone, Edlund & Carlson, 2005). |
References:
Allen, D., Badro, V., Denyer-Willis, L., Ellen Macdonald, M., Paré, A., Hutchinson, T., … Cohen, S. R. (2015). Fragmented care and whole-person illness: Decision-making for people with chronic end-stage kidney disease. Chronic Illness, 11(1), 44–55. https://doi.org/10.1177/1742395314562974
Doolan-Noble, F., Gauld, R., & Waters, D. L. (2015). Are nurses more likely to report providing care plans for chronic disease patients than doctors? Findings from a New Zealand study. Chronic Illness, 11(3), 210–217. https://doi.org/10.1177/1742395314567479
Lorig, K., Laurent, D. D., Plant, K., Krishnan, E., & Ritter, P. L. (2014). The components of action planning and their associations with behavior and health outcomes. Chronic Illness, 10(1), 50–59. https://doi.org/10.1177/1742395313495572
Mercer, S. W., O’brien, R., Fitzpatrick, B., Higgins, M., Guthrie, B., Watt, G., & Wyke, S. (2016). The development and optimization of a primary care-based whole system complex intervention (CARE Plus) for patients with multimorbidity living in areas of high socioeconomic deprivation. Chronic Illness, 12(3), 165–181. https://doi.org/10.1177/1742395316644304
Insel, T. R., & Sahakian, B. J. (2012). A plan for mental illness. Nature. https://doi.org/10.1038/483269a
McKinlay, E., McBain, L., & Gray, B. (2009). Teaching and learning about chronic conditions management for undergraduate medical students: Utilizing the patient-as-teacher approach. Chronic Illness, 5(3), 209–218. https://doi.org/10.1177/1742395309343812
Solotaroff, R., Devoe, J., Wright, B. J., Smith, J., Boone, J., Edlund, T., & Carlson, M. J. (2005). Medicaid programme changes and the chronically ill: Early results from a prospective cohort study of the Oregon Health Plan. Chronic Illness, 1(3), 191–205. https://doi.org/10.1177/17423953050010030301
Solotaroff, R., Devoe, J., Wright, B. J., Smiths, J., Boone, J., Edlund, T., & Carlson, M. J. (2005). Medicaid programme changes and the chronically ill: early results from a prospective cohort study of the Oregon Health Plan. Chronic Illness, 1(3), 191–205.
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