Question

You are a Practice Nurse in a small rural medical centre.

Mr Stuart Murray is a 48-year-old Indigenous man living with his family in a small rural town in NSW. Mr Murray has a medical history of type 2 diabetes, obesity and hypertension. Mr Murray drinks at least five schooners of beer and smokes up to 20 cigarettes daily. He is currently suffering from tiredness, breathlessness on exertion, swollen ankles, nausea, itchy skin and aching bones and joints. He passes about 400 mL of urine in 24 hours.

Mr Murray presents to his local medical centre saying he was not feeling well. Mr Murray’s regular medications are metformin and ramipril. You assess Mr Murray and reviews the pathology tests the doctor ordered.

• His blood pressure is 167/95mmHg, pulse 92bpm, respiration rate 24.
• Blood biochemistry reveals: Sodium 132 mmol/L, Chloride 92 mmol/L, Potassium 5.7 mmol/L
• Bicarbonate 20 mmol/L, Urea 27.6 mmol/L, Creatinine 428 umol/L, Hb 82g/L, eGFR 20   
• HbA1c 8.6%

Question

You are concerned that Mr Murray is at risk of, or is, developing Chronic Kidney Disease (CKD). Based on the scenario above, list the risk factors for CKD that are applicable to Mr Murray.

Question

List the three recommend tests that form the kidney health check, to determine if Mr Murray is developing CKD.

Question

Based on the physical assessment and the pathology test results, what stage of CKD is Mr Murray currently experiencing?

Question

Mr Murray’s doctor prescribes the following dietary modifications and additional medications.  

• Sodium bicarbonate tablet 500mg tds
• Calcium carbonate tablets 600mg tds
• Erythropoietin injection 40,000 units SC weekly   
• 1500 mL fluid restriction
• Low potassium and 70-gram protein diet

As the Practice Nurse in the medical centre, you explain to Mr Murray how each of these treatments are related to his failing kidney function, how they will improve his health, and how he should take them. Outline your explanation for each.

Question

The doctor tells Mr Murray that he will need to go to the nearest large town for a specialist consultation and treatment. Mr Murray is not sure that he wants to go.

1. What cultural concerns may be raised for Mr Murray by this possibility?
2. Briefly describe strategies that could be implemented to help maintain Mr Murray’s autonomy.
3. Briefly describe strategies that could be implemented to help maintain Mr Murray’s cultural safety.

SORRY FOR POSTING 5 QUESTIONS BUT ITS ALL BASED ON THE SAME SCENARIO

Could you use Australian standard

Answer 1

The risk factors for CKD applicable to Mr. Murray are:

Increased susceptibility to kidney damage as seen in

• Low income or educational level.

Factors initiating kidney damage

• Diabetes mellitus (type 2)
• Hypertension

Worsening kidney damage

• Smoking
• Poor glycemic control in diabetes (alcoholism)

Three recommended tests that form the kidney health check:

1. A blood test: this calculates the estimated Glomerular Filtration Rate eGFR.
2. A urine test: this detects the amount of albumin in the urine which shows the function of the kidneys.
3. A blood pressure test: hypertension and kidney disease are related to each as kidney disease may lead to hypertension and hypertension may also lead to kidney disease.

Based on the physical assessment and pathology test results Mr. Murray is in the stage 4 of chronic kidney disease where a severe decrease in kidney function is seen as his eGFR is 20.