Question

Mrs. G is a 61-year-old female who is being seen as part of ongoing care. During her assessment, she tells the nurse that she has been feeling much worse over the course of the past 2 weeks. Her skin is very dry and itchy, she has headaches, and she complains of feeling exhausted. Mrs. G was diagnosed with type 2 diabetes 8 years ago and has developed chronic kidney disease, in which she takes diuretic medications and has a modified diabetic diet that is low in protein. Her last GFR was checked one month ago and was 28 mL/min. The physician orders lab work and diagnostic testing. Her lab results are as follows: Hgb: 3.8/mcl, Platelets: 100,000 mnl, BUN: 32mg/dL, Creatinine: 3.8 mg/dL, Na: 131 mEq/L, K: 3.7 mEq/L, Glucose: 166 mg/dL. Her urinalysis shows that she has excess protein and glucose in the urine. Her GFR is 14 mL/min. The nurse notes that Mrs. G seems very fatigued and appears disoriented at times throughout the assessment.

1. Describe how chronic renal failure differs from acute renal failure.

2. At what point is a person with chronic renal failure considered to be in end-stage renal disease.

Based on Mrs. G’s lab results and symptoms, the physician has determined that the patient’s kidney disease has progressed and now she is in a state of end-stage renal disease (ESRD). The nurse receives the following orders for medications to give the patient: Epogen 100 units/kg SQ Periactin 4 mg PO tid

3. Describe why these drugs would be ordered for Mrs. G’s condition.

4. What signs or symptoms would the nurse expect to see that would indicate that these medications are working?

Following administration of the medications, the nurse receives further orders to prepare Mrs. G for hemodialysis. The patient has not undergone dialysis in the past and she does not have an access port for the procedure. She is scheduled for placement of a vascular access device and then will receive her first round of dialysis in her hospital room upon them.

5. What information should the nurse include as part of teaching about the vascular access device and dialysis?

6. Explain how a vascular access device works to use for dialysis.

7. Describe the basic process of hemodialysis.

Mrs. G has returned from the cath lab with a vascular access device in place and is started on hemodialysis. Her first treatment takes place in her hospital room with a portable machine but she will later need ongoing dialysis when her condition stabilizes. The nurse reviews information with the patient about lifestyle changes and self-care now that she has ESRD.

8. Explain what medications the patient would most likely need on a routine basis now that she will need regular hemodialysis.

9. What are the patient’s options for receiving hemodialysis once her condition stabilizes?

10. What follow-up tests would be necessary to ensure that hemodialysis is working?

11. What is a primary nursing diagnosis for Mrs. G and why?

Answer 1

ANSWER 1: DIFFERENCE BETWEEN CHRONIC AND ACUTE RENAL FAILURE:

CHRONIC RENAL FAILURE	ACUTE RENAL FAILURE
Its onset is weeks to several months	its onset is days to weeks
it is irreversible	it is reversible
its progression cause end stage renal disease	its progression cause chronic renal failure
needs dialysis for treatment	do not require dialysis
require renal transplantation	no need of transplantation
it has specific gravity low	specific gravity is low
more severe symptoms	less severe
low haemoglobin level	normal
serum creatinine very high and irreversible	elevated but reversible

ANSWER 2: Chronic rena failure changes to End stage renal disease when:

• There is gradual loss of kidney function
• GFR is less than 15ml/min
• 10 - 15 percent of kidney is functioning only

ANSWER3:  EPOGEN:

• Patient is recieving this medication to increase the number of red blood count as patient is anemic and hb is 3.8/mcl

PERIACTIN: it is an anti allergic or antihistamine drug.

• As patient is having itching over full body and dry therefore doctor prescribed this drug.

ANSWER4: sign and symptoms that shows patient is improving:

• IMPROVED RBC COUNT AND INCREASE IN HAEMOGLOBIN LEVEL
• REDUCED FATIGUE
• DECREASED IN EPISODES AND INTENSITY OF ITCHING AND IMPROVE IN HYDRATION STATUS OF SKIN.

ANSWER 5:  vascular access device:

1. nurse needs to clearify all the doubt of client and provide adequate knowledge regarding vascular access device and dialiysis and about care of fistula
2. Vascular access device is making arteriovenous fistula for dialysis.
3. it provides adequate blood flow to dialysis machine for puring the blood and remove toxic substance.
4. fustula care is must, avoid measuring BP from that side, never wear tight clothes, use aseptic tecnique and never give injection that side.

Dialysis: nurse should teach the patient about dialysis:

1. when patient reaches to end stage or chronic stage of disease they require dialysis.
2. dialysis is the treatment that filters and purify the blood and remove toxic substance and metabolic waste.
3. dialysis act as an artificial kidney.
4. It maintains the electrolyte and fluid balance.

ANSWER 6: Vascular access device helps the blood to reach to the dialysis machine for purification and filteration.

• After cleaning the site, by maintaining sterile technique soft and flexible tube is inserted into flistula that attach from dialysis.
• fistula has one vein and one artery.
• artery carries oxygenated and purified blood from dialysis machine to patient and veins carries blood from patient to dialysis machine for purification.

ANSWER 7: PROCESS OF HAEMODIALYSIS:

1. This process takes 3 to 5 hours and need dialysis 2- 3 times in a week
2. 2 needles are used and inserted to fistula and secured it with tape that attach to dialysis machine.
3. dialysis machine has number of membrane and acts as filterate called dialysate
4. this dilysate pumps the blood through memberanes which filters by using principle of ultrafileration and diffusion passes the blood to second needle that is attached to artery and send blood back to patient and tissues.

ANSWER 8: medications need on regular basis are:

1. antihistamine drugs
2. erythropoetin
3. iron
4. vitamin d
5. phosphate binders
6. vitamin b complex
7. after dialysis patient will need antihypertensives and diuretics

ANSWER 9: once patient condition is stabilize she has options like:

1. peritoneal dialysis
2. home based care and can come for dialysis or can do dialysis at home
3. continous ambulatory peritoneal dialysis

ANSWER 10: test done to know status of patient on haemodialysis:

1. urea level
2. albumin level
3. CBC include haemoglobin, platelet count
4. serum electrolytes
5. calcium, iron, ferretin level.
6. kidney function test to know BUN level, creatinine level, GFR
7. urine analysis
8. body weight

ANSWER 11: nursing diagnosis can be:

1. excess fluid volume related to dysfunctioning of kidney
2. imbalanced nutrition intake; less than body requirement related to food restrictions
3. activity intolerance related to low level of haemoglobin
4. disturbed carbohydrate metabolism related to less production of insulin
5. risk of bleeding related to low platelets count
6. risk of low self esteem related to disease condition