Question

Question

Mrs. Nygyen is a 60-year-old patient who has been diagnosed with chronic kidney disease. Mrs. Nygyen's past medical history includes diabetes mellitus type 2, osteoarthritis, and hypertension.

1.      When performing an initial assessment, which body systems does the nurse recognize are impacted by chronic kidney disease (CKD)? List 3 body systems and explain how CKD impacts each.

Upon intake assessment, the nurse notes that Mrs. Nygyen has very dry skin and mucous membranes, mild ecchymosis to the lower extremities, and lung crackles bilaterally. Vital signs include blood pressure of 160/90, pulse 90, respirations 22, and temperature 99.0° F.

2.      What assessment data collected by the nurse would indicate that Mrs. Nygyen's neurological system has been impacted by chronic kidney disease? Please list specific assessment findings likely to be identified.

The following day, the nurse performs another assessment. At that time, Mrs. Nygyen's skin assessment includes yellowish discoloration, mild ecchymosis to the lower extremities, urea crystals on eyebrows, dryness, decreased turgor, and rash to the groin area.

3.      Which finding(s) alerts the nurse to the development of advanced uremic syndrome? Please explain why your finding(s) has or have occurred.

4.      Please name 5 interprofessional team members that should be considered as part of Mrs. Nygyen's plan of care? Please explain how each member can be a beneficial member in assisting the patient.

Answer 1

Q. 1

Hypertension is the traditional cardiovascular risk factor which contribute cardiovascular risk associated with CKD. Diabetes is associated with adverse outcome in all stage of CkD moreover lower fasting plasma glucose and glycated hemoglobin level are associated with lower risk of all cause mortality and reduced cardiovascular death of borderline significance in patient with moderate to severe renal impairment. The presence of left ventricular hypertrophy a complication which increase in relation to progressively lower level of GFR is also a cardiovascular risk determining in CKD patients.

As patient progress in ckd nutritional requirements are alter and metabolism of protein, water and salt , potassium and phosphorus are affected these changes lead to ineffective changes generation despite adequate intake of protein and carbohydrates substrates. In more extreme manifestations these alteration in nutrition utilization cause "uremic malnutrition " a syndrome that is distinct from malnutrition caused by inadequate nutrients intake

CKD associated anemia :- anemia is defined as reduction one or more of the major red blood cell measurements, hemoglobin concentration, hematocrit or red blood cell count. It mainly occurs in CKD due to erythropoietin hormone deficiency which is secreted by kidneys.

Patient with Ckd are frequently aflicted with neurological complications. These complications can potentially affect both the central and peripheral nervous system . Common neurological complicationsn include stroke, cognition dysfunction , encephalopathy , peripheral and autonomic neuropathies.

Q. 2 Decrease kidney function leads to decreased cognitive function. Uremic neuropathy may initially manifest finally with predominantly sensory system involvement resulting in loss of touch, pinprock and vibration sensation and later involvement of motor system as well, subsequently leading to weakness in distal muscle. Uremic myopathy affect proximal muscle specially around the hip.

Autonomic dysfunction :- the disorder is highly prevalent in dialysis patients and may result in importance and gastrointestinal symptoms. Sympathetic outflow has been shown in these patient.

Asterexis is also an important sign for the neurological involvement.

Other assessment findgs are :-

Weakness and fatigue

Confusion

Inability to concentrate

Disorientation tremors

Seizures

Restlessness of legs

Burning of the sole of feet

Behaviour changes

Q. 3 Your kidney filter the waste and extra fluid form your blood and your body get rid from them through urine if your kidney don't work well those things can stay in your blood the condition is called uremia or uremic syndrome.

in advancement of uremic syndrome nurse can get following finding in patient :-

Feel nauseated

Feel itchy

Lose of appetite and taste from some foods

Feel more tired than usual

Lose weight

Have trouble in concentration

Feel pain, numbness and cramp in legs

It can also cause brain damage which show in altered behaviour and cognitive process.

All these findings are due to build up of waste in the blood which affect various system of the body specially CNS.

Q. 4

1. Nephrologist :- the team leader in many medical facilities are also called kidney doctor.

Nephrologist are Doctor Who have advanced training in treating kidney disease. They are responsible for medical care during dialysis treatment and also before, during and after the renal transplantation.

2. Advance practitioner :- your team may also include advance practitioner. Nurse practitioner, physician assistant collaborate with the doctor in care for the kidney patient both in medical office and dialysis unit.

3. Nephrology nurse :- these are licensed , registered nurse who have specialized experience in the care of patients with kidney diseases. She coordinate care with other team members. Some of them are qualified to educate the patient about home dialysis , continuous abmbulatory peritoneal dialysis and Automated peritoneal dialysis.

4. Renal nutritionists :- He had special degree in dietics and must be registered. They know what food are right for the kidney patient and they can help you plan your meals.

5. Patient care technician and renal. Technologist :- there are two kind of technician in renal dialysis facilities.: patient care technician and renal technologist. Both work under the supervision of Nephrology nurse and neurologist.