Assignment Help on Chronic Kidney Disease
Supporting Self-Management of a Chronic Kidney Disease Patient
Introduction
Chronic Kidney Disease (CKD) is a global health concern, with 10% of the world’s population suffering from it and millions dying from it (National Kidney Foundation, 2015a). CKD is a progressive disease featuring various degrees of renal failure from mild, moderate to severe. If unmanaged, CKD may progress to end-stage renal disease (ESRD) as increased renal impairment disables the kidney to maintain the body’s fluid and electrolyte balance (Malkina, 2018). Patients with CKD are also more susceptible to cardiovascular risks apart from other health risks (Bryant & Knights, 2014). Therefore, it is advisable to prevent CKD progression into ESRD and its associated risks of infection and psychiatric problems. Managing CKD essentially means slowing down the progression of the disease and lowering risks. The patient’s high-level involvement is necessary in order to manage CKD in the long term (Peng, et. al., 2019). Hence, supporting the self-management of CKD is extremely important for nurse practitioners.
CKD: Causes & Pathophysiology
Kidney malfunctions can happen due to various physiological circumstances, however, CKD is primarily caused by diabetes and hypertension or high blood pressure. Increased BP and diabetes comprise more than half of the preconditions behind CKD (National Kidney Foundation, n.d.). When blood glucose levels increase, it causes diabetes and begins to damage various organs of the body, including the kidneys. When blood pressure increases, it often causes the various arteries near the kidneys to weaken, constrict or harden, thus leading to reduced blood flow to the renal tissues and consequent damage (American Heart Association, 2016). Other less common causes of CKD include – glomerulonephritis (inflammatory disease damaging kidney’s filtration), polycystic kidney diseases (kidney cysts damaging tissues), malformations at birth, immune system disorders, kidney stones/tumours and repeated urinary tract infections (National Kidney Foundation, n.d.).
Initially, when the renal tissues are affected or damaged, some abnormalities are noticed because the other tissues adapt to the situation and over-perform. This often leads to fluid and electrolyte imbalance and kidneys lose their ability to concentrate urine. Consequently, the levels of phosphate, potassium and acids increase in the body. CKD is diagnosed when kidneys are clearly damaged or when the glomerular filtration rate (GFR) falls below 60 mL/min/1.73 m2 over a period of 3 months (Arora, 2019). In advanced CKD, the GFR further drops to ≤ 15 mL/min/1.73 m2 and the kidney loses its ability to process urine (Malkina, 2018). Urea and creatinine levels soar and cause systemic manifestations or uraemia. Hyperparathyroidism is a common manifestation of this CKD condition (Malkina, 2018; Arora, 2019). Hence, the parathyroid hormone (PTH) monitoring is extremely important.
CKD: Signs & Symptoms
There are many signs and symptoms of CKD, some are more common, while others less. The symptoms include, but are not limited to, the following (National Kidney Foundation, n.d.):
- Sleeping problem (insomnia)
- Poor appetite
- Fatigue or lethargy
- Dry, itchy skin
- Increased tendency to urinate
- Focusing or concentrating problem
- Swollen feet and ankles
- Eye puffiness, particularly during mornings
- Muscle cramps/muscle weakness
- Losing lean body mass
- Restless legs
- Reduced cognitive and immune capabilities
Impact on Patient/Family
CKD affects the patient’s caregivers as much as the patient. Not only emotional stress, but the patient’s caregivers are challenged by time and physical effort too (Fresenius Medical Care, n.d.). Although CKD should not be necessarily considered a negative experience, families and health professionals close to a CKD patient need to support the patient with time and patience. If the CKD patient needs dialysis twice or thrice a week in some healthcare facility, the families need to manage time within their daily activities to accommodate these. Balancing usual schedules with that of the CKD patient in the family requires efficient time management. Also, the families and caregivers have a role to play in ensuring that the patient is ready for treatment and is complying with the treatment regimen. Sontakke, et. al. (2015) have clearly observed in their study that nonadherence to the treatment lowers the health outcomes for CKD and any other chronic diseases.
The impact of CKD on the patient’s family is huge as they have to ensure that the patient is receiving appropriate treatment, complying with it, is able to deal with emotional distress and is well-informed about the disease and its treatment so that he/she can take part in the decision-making process (National Kidney Foundation, 2015b). Without an effective support plan, the management of CKD is difficult to achieve. And in chronic disease cases such as CKD, self-management has well been established as a helpful strategy towards treatment (McManus, et. al., 2014; Pillay, et. al., 2015). Self-management of CKD can prevent disease progress into ESRD and other complications.
Self-management Support of CKD
Self-management of any disease attempts to foster a patient’s own ability to manage his/her conditions with certain lifestyle changes and treatment/medication compliance (Richard & Shea, 2011; Peng, et. al., 2019). Self-managing CKD, therefore, means enabling the patient to slow down disease progression into ESRD, infections and cardiovascular complexities. It also means controlling the risk factors of CKD, which are diabetes and hypertension (Peng, et. al., 2018). Apart from pharmacotherapy, the risk factor control is very important to prevent or reduce the chances of more renal damage. Interestingly, more and more patients have expressed their eagerness to be actively part of their care. This makes providing self-management support a potentially effective strategy for better health outcomes. In fact, if CKD is to be managed for a longer time, the patient’s involvement is pivotal to its success (Peng, et. al., 2019). Not only would patients need to be self-managing their conditions, but they must also be participating in important decision-making regarding their care.
According to Grey, et. al. (2015), self-managing CKD should include:
- Addressing the disease needs (awareness, skills, treatment compliance, confidence, etc.),
- Identifying and accessing the relevant people and resources, and
- Acceptance of the situation (not remaining in denial, learning to cope with reality).
Therefore, all self-management support plans should focus on these three broad aspects. However, every self-management support plan should be tailored to the varying needs and situations of the CKD patients, and also to the specific healthcare context within which the patient functions (Novak, et. al., 2013).
Broadly speaking, self-management support for a CKD patient would mean adequately educating the patient and his/her family, providing access to all disease-related information/resources, offering counselling, instilling self-worth and active patient engagement. The nurse practitioner responsible for self-management support should ensure that the CKD patient is not a passive recipient of the education or treatment, but is actively responsible for his/her disease condition. An overall behavioural change is required to this end. Unless the behaviours and attitudes of the patient change over the course of self-management interventions, they will not be fully ready for their self-care in the long term.
Self-management support should cover the following aspects in a CKD patient:
Nutritional management
According to the National Institute of Diabetes and Digestive and Kidney Diseases (n.d.), the primary dietary modifications required in a CKD patient are – (i) decreasing sodium intake to control blood pressure, (ii) decreasing excessive protein intake and (iii) managing diabetes. The support plan must, therefore, include education and awareness around maintaining good nutritional status. Since the kidney plays a major role in the maintenance of fluid and electrolyte balance, excreting metabolic wastes and regulating various metabolic and hormonal pathways, a decreased functionality of the kidneys would naturally mean dietary adjustments. A dietary chart is always helpful to support the self-management of CKD patients. It is a cost-effective support that can be kept handy. Kalantar-Zadeh (2017) felt that patient-centric, cost-effective nutritional management measures improves longevity and prevents disease progression in CKD patients. Poor nutrition poses high risk for the patients and nutritional management can restore immunocompetence and anabolism (Levett-Jones, et. al., 2016).
Monitoring Vitals
As CKD patients are prone to cardiovascular risks, it is important to monitor the vitals (heart rate and blood pressure) regularly. Increased heart rates or tachycardia may cause heart failures and even death (Gopinathannair & Olshansky, 2015). Also, as Levett-Jones, et. al. (2016) pointed out, drastic changes in vitals are indicative of fluid imbalance and are warning signs.
Medication Compliance
A very important aspect of self-care support is delivering sufficient knowledge about the importance of medication adherence. Medicines are crucial in chronic diseases to keep the vitals within range and reduce other risks. For example, non-adherence can cause stroke (Lee, Jang & Park, 2017). Even Nagasawa, et. al. (2018) noted that medication non-compliance in patients with chronic diseases automatically increases mortality. Wright, et. al. (2011) found in their study that the majority of CKD patients had gaps in their knowledge about the disease and its treatment. This ignorance manifests itself in medication non-compliance. Therefore, self-management support in CKD must ensure that the patients and their families/caregivers are sufficiently aware of the consequences of medication nonadherence.
Access to Information
Access to information is yet another vital aspect of self-management support. When patients can easily access relevant information about their chronic conditions, it empowers them and builds their confidence. It is an effective mechanism whereby patients can clarify doubts, concerns and address needs. Knowledge about the disease and treatment regimen decreases anxiety and depression (Levett-Jones, et. al., 2016). Wright-Nunes, et. al. (2012) found that high BP awareness among CKD patients resulted in controlled BP. Research holds that more and more patients are inclining towards online resources for accessing medical information. CKD patients are no exception. Diamantidis, et. al. (2013) observed this trend among CKD patients. The self-management support can direct CKD patients towards more such reliable sources of information for self-learning and confidence building.
Hire Expert Writers at Affordable Price
WhatsApp
Get Assignment Help
