Written Assessment – Clinical Case Study Report
Length: 2000 words ± 10%
The objective of the clinical case study is to gain a comprehensive knowledge and understanding of chronic kidney diseases (CKD) within Australia. As a Registered Nurse, you will need to identify people at risk and manage people with CKD.
In this case study report of Glenda you are required to integrate practice and theory, so that you can relate theoretical concepts to real-life practical/professional situations. This written report enables you to integrate practice and theory. To assist you in setting the scene for CKD in Australia you will need to know the incidence/ prevalence and main causes of chronic kidney disease in Australia. This will help you identify the risk factors of CKD for Glenda and how to assist Glenda to reduce her risk of CKD and improve her kidney health. It is important to consider Glenda's remote environment/community and culture within the management of each stage of her CKD to ensure that your case report is relevant to her (person centred). Focus on the stages of CKD for Glenda including the assessment and management of each stage. Within the Moodle unit HSNS265 “Case: Glenda; Glenda is from the Tiwi Islands.
Your assignment needs to be structured according to the conventions of academic writing following American Psychological Association (APA) - 6th Edition - commonly referred to as APA 6 and include an introduction, an integrated conclusion. You must write this case report in an essay style: do not use dot point format.
Your response needs to be supported by recent evidence based resources. This could include information from your texts or from other peer-reviewed sources.
In this case study report you will present the clinical case of Glenda and discuss her kidney disease and management at each stage of her chronic kidney disease; this will include:
The assessment and management of each of the stages of Glenda’s chronic kidney disease. Consider for each stage of her kidney disease; the pathophysiology, health priorities, interdisciplinary team approaches, health promotion strategies, health concerns and communication strategies that you would apply to Glenda, her family and wider community.
Rationale (Based on Unit Learning Outcomes 1 – 5)
This activity will allow you to demonstrate your ability to:
1. demonstrate an understanding of the renal system including related anatomy and physiology, pathophysiology, diagnostics, pharmokinetics, pharmodynamics, the quality use of medicines and complementary therapies;
2. demonstrate and apply comprehensive renal assessment and evidence based clinical reasoning skills in theory, clinical and simulated environments;
3. demonstrate the capacity to integrate and relate principles of ethical and legal practice within a team approach to person centred care;
4. learn and apply reflective practice and intra and interprofessional communication strategies that facilitate the delivery of safe and effective quality care across diverse settings;
5. plan and implement person centred primary health care and health promotion strategies related to renal health and wellbeing.
This assignment is important because it will enable you develop a greater understanding of the stages of kidney disease, as well as, apply a patient centred care approach to undertaking the assessment and management of each stage. You are also required to apply your critical thinking skills to the case study and show your capacity to identify, interpret, and critically analyse issues raised by the case study.
It should contain the following sections:
Introduction - Set the scene for chronic kidney disease, Glenda's chronic kidney disease.
Provide a Case Description- Provide pertinent information about Glenda - This usually begins with presenting signs and symptoms, medical history, (family history, if relevant), social history, medications, results of physical examination and/or nursing assessment, final diagnosis, treatment, nursing care provided, and outcomes.
Discussion - Critique the care, assessment and management for Glenda at each stage of her chronic kidney disease. You may include any care that may not have been effective within the case study and provide any recommendations that would have improved her care. Incorporate the relevant literature within your discussion. You can discuss any unusual aspects of the case and the care that is/would be provided to assist Glenda to manage her condition.
Conclusion - A succinct summary of the information provided to draw the case study to a close.
Reference list - APA 6 referencing style must be used. References should be as current as possible. As a general rule of thumb, literature published before 2008 will not attract marks. However, older research literature can be used for the review where necessary, if you can justify the importance of the seminal work to be included. Follow the link at the top right of the page for further information and examples.
Rubric can be found under the assessment guidelines - you do not need to attach the rubric to the assignment as an electronic rubrics has been set up through grade book.
Follow the instructions below to upload your completed assignment file and submit it for marking.
The School of Health Extension Application form is downloadable from the link at the top right of this page. It includes information about when and to whom extension applications must be submitted, and guidelines about reasons considered acceptable for seeking extension and the evidence required with an extension application. Extensions must be sourced the last working day before the due date.
There are two types of extension available;
There are several chronic disease and one is Kidney disease identified as kidney failure. The filtration of kidney in body’s output and other wastage from blood are later discharged in the urine. It is found that when chronic kidney illness developed to the Set advantage process stage, unsafe levels of the fluid, electrolytes and leftover waste can be established in the body (Webster, et al, 2017). In the initial stages of this health issue, the patient might have rare outcome. This kidney failure issue might not found to be seeming until the body part kidney considerably diminished. It has been identified that in Australia nearly 1.7 Million young individuals have certain signs of CKD in 2011-2012, and one in ten people had this health issue. One in nine deaths had CKD as the underlying and/or related cause of deaths in 2014. The indigenous people in Australia five times more probable to be admitted in the hospitals due to CKD and 4 time more probable die from this kidney problem (Luckett, Luckett, et al., 2017). In this particular essay, the clinical case will be discussed including the pathophysiology, sign and symptoms, assessment, diagnosis and treatment of the diseases.
Glenda is the 45 years old lady admitted to the hospital for the kidney-related problem. She is from Tiwi Island, she has been living alone on her own after the death of his husband. She has two daughters who are living in another city and used to visit her once a year. From last some days, she has developed symptoms like nausea, vomiting, loss of appetite, sleeplessness, frequent urination, reduced mental sharpness, persistent itching, and breathing issues. Her weight is 80 kg and eating outside food most of the time and smoke 4 to 5 cigarettes daily. Her viral sign shows high blood pressure, augmented respiration rates, fluctuating heart rate, and increased temperature. She has a history of diabetes type 2, and her mother had kidney and diabetes problems too. Her physical examination shows glomerular filtration rate is 43mL/min/1.74m2,high density lipoprotein cholesterol is 93 mg/dL. She is socially isolated and hardly talks to the people around her and most of her time spend inside the house after her office hours. Glenda's total serum cholesterol levels are 180 mg/dL. She has been provided with metformin medicine.
Glenda is suffering from chronic kidney disease generally need complete support from the nurses and quality care. Glenda also has a history of diabetes, therefore, she must be provided with holistic nursing care. The disease has five different stages that range from the very mild stage (stage 1) to complete failure of the kidney (stage five). Glenda diagnosed with stage 3 and have a high risk of developing stage five CKD.
Nurses can play a key role in providing effective care to Glenda as they are the core member of any team assigned for Glenda. They are highly skilled and educated in a specific area of patient care (Chen et al., 2015). Firstly they must develop a therapeutic relationship with Glenda by using effective communication skills. As Glenda is suffering from different health issues and at risk of developing mental issues like depression, stress and anxiety, nurses must deal with her or him carefully. They must address the client with respect and empathy. They should listen to the client what effectively to develop a healthy relationship (O’Hare et al., 2016). This will help them to assess Glenda easily as most of the patient feels uncomfortable to discuss their health issues with the stranger. Nurses can take care of that the peaceful environment should be provided to Glenda, and provide psychological support whenever required. At the first stage of CKD Glenda requires support from nurses to manage blood sugar as she or he also has diabetes issue.
The blood pressure must be maintained by using prescribed medicines and maintain a healthy weight. Controlling Glenda’s blood pressure in renal illness is supposed to help protect long-standing kidney function and reduce progression. Individuals are frequently uninformed of the connection between kidney illness and hypertension, and as such needs education to understand how to lower blood pressure can safeguard their kidneys from additional impairment. In stage 2 the eGFR is between 60 to 89 and Glenda require nursing care in receiving a healthy diet and reducing blood sugar. At stage 3, Glenda may develop symptoms like swelling in her hand s and feet, back pain, and fluctuation in urine excretion. At the stage, 3Glenda can be provided with the management of blood sugar or glucose in the body to avoid deterioration of kidney problem (Nihat et al., 2016).
As Glenda has been provided with metformin and other medicines for CKD, nursing must take off any side effects that may arise after the administration. Glenda should be assessed for the vital signs that are blood pressure set signs, heart rate and other symptoms Certain of the physical examination must also be carried out regularly for example kidney function test to assess the kidney function eGFR tests to analyze eGFR value on every stage. Repeating the eGFR tests within 2 weeks is suggested to eliminate other causes of severe deterioration (Silva et al., 2016). Nurses must also assess Glenda for cholesterol level, and blood sugar levels regularly according to the physician's recommendation. As diabetes is also associated with heart-related issues, there is a possibility that Glenda may develop hear the problem, therefore the cardiopulmonary system must also be assessed, for example, fluid retention may collect in the myocardium, leads to the stress on Glenda’s heart and the lungs. Nurses must listen for the friction rub and the pulmonary crackles or mobbing (Wanner, et al., 2016). As the discussed above Glenda is living alone after the death of her husband, and manage things on her own, therefore there is a possibility that Glenda may develop depression related issues. Thus nurse must assess Glenda for such issues by communicating with Glenda. Glenda must also be assessed for the peripheral pulses, capillary refill, sensorium or mentation, and level of physical activity.
Although Glenda has been provided with effective treatment in the healthcare setting, the diuretic treatment was not very effective due to this Glenda might get effective treatment through antihypertensive therapies due to the increased sodium intake. Glenda has been prescribed with the Thiazide which generally ineffective in case of Glenda due to her reduced eGFR. The limits of sodium should have managed within the limit that is 1500 mg/d. to avoid these issues Glenda could have provided with the loop diuretics two times in a day (Guideline Development Group et al., 2015).
Management of High blood pressure by medications: Glenda is suffering from chronic failure of kidney and found to be suffering from deteriorating blood pressure high (Kanji, et al., 2015). Increased blood pressure medicines can originally reduce kidney function and alter levels of electrolyte, so they might need recurrent blood tests to maintain Glenda’s condition. The physician will probably also prescribe with the water pill (diuretic) and a diet with low salt.
Determined medications to decrease found cholesterol level: The expert doctor may prescribe several levels of medications such statins to reduce Glenda's cholesterol. Persons suffering from Kidney failure (Chronic kidney disease) frequently experience cholesterol issues which might upsurge the risk of issues related to the heart (Alicic, Rooney & Tuttle, 2017).
Medications to manage anemia: In different situations, the doctor might prescribe hormone erythropoietin supplements, occasionally with additional iron. Supplements of Erythropoietin support in the creation of more RBCs, which might release fatigue and faintness related to anemia.
Medications to relieve swelling: The kidney failure issue in patients is being considered, thus might retain fluid in blood.. This particular problem can results in inflammation in the legs, in addition to increased blood pressure. Medicines termed diuretics can benefit from maintaining the balance of body fluids (Liyanage et al., 2015).
Medications to bone protection: calcium and different vitamin D supplements can also be provided to Glenda to stop weakening of bones and reduce Glenda’s risk of bone fracture. Glenda can also be prescribed with medicine to reduce the phosphate amount in her blood and save the blood vessels from impairment by calcification.
Diet of low protein contain to reduce waste products in blood: As the human body produces protein from foodstuffs, it generates leftover items that the kidneys have to make filtration from the blood. To decrease the impact on the kidney, Glenda might be recommended to consume low level of protein. All the doctors might refer Glenda to meet with the expert who could give advice to some ways to reduce protein consumption of Glenda (Kalantar-Zadeh & Fouque, 2017).
Last stage treatment
Dialysis: Dialysis insincerely eliminates the bad products and additional or excess blood fluid in kidney of Glenda cannot be make it process. In hemodialysis procedure machine is being used to make the filteration of the blood in human body. Subsequently, after some time, the solution of dialysis is drained from the body, containing the waste in it (Guideline Development Group et al., 2015).
Kidney transplant: the kidney transplant procedure will include surgically replacing a donor’s healthy kidney into Glenda’s body. The Transplanted kidneys can be taken from the dead or living givers. Glenda will be asked to take medicines for the rest of her life to retain her body from refusing the donor’s organ. The dialysis is not required to go through the kidney transplantation (Alicic, Rooney & Tuttle, 2017).
Aim for the healthy weight
Being weighty makes Glenda’s kidneys work tougher and might damage her kidneys. The nurse and physician can work collaboratively to improve Glenda weight management. Nurses can help Glenda to perform exercises recommended by the physician or physiotherapist (Palmer et al., 2017).
Get sufficient sleep
Glenda must be recommended to get enough sleep and must Aim for around 10 hours of siesta for the body recharge. Getting sufficient sleep is significant to Glenda’s complete physical and psychological health and effectively help her to meet the blood pressure and levels of blood glucose.
As mentioned in the case study Glenda is a smoker and smoke 4 to 5 cigarettes daily, which can make the damage to the kidney worse. Leaving smoking might help her to meet the optimum BP, which is surely good for her kidneys, and can reduce the probabilities of developing a heart attack (Small, et al., 2017).
It is considered that kidney disease is defined as the illness that causes loss of kidney failure. The patient mentioned has been suffering from the stage CKD and also has diabetes related issues. She has admitted to the hospital with sever symptoms and diagnosed with stage CKD. The nursing care necessary in her case includes using effective communication to develop therapeutic relationship with the patient, maintaining the peaceful environment. She must be assessed for vita sign, side effects of medicines, eGFR levels, cholesterol levels, and blood glucose levels. Her health issues can be managed by using medicines like ACE inhibitors, vitamin supplements, statin etc. Lifestyle changes must also be considered such as Weight management, stop smoking, and consuming protein less food.