Introduction
The chronically ill group identified for the current care plan included individuals with chronic kidney disease (CKD). This group was chosen for the care plan because of the increased attention to the illness as well as the negative impact it has on people’s lives. According to Healthy People (2016), expensive treatment and the lack of available donor organs in cases when transplantation is required are factors that call for the composition of the care plan targeted at addressing the issues (para. 1).
Nursing Diagnosis
The three nursing diagnoses associated with chronic kidney disease (chronic renal failure) are the following:
- Decreased cardiac output that occurs due to the reduced circulating volume, myocardial workload, and systematic vascular resistance (New Health Advisor, 2014, para. 5).
- Impaired skin integrity that occurs as a result of lack of mobility and physical activity, lack of hydration, presence of toxins, along with the problems like edema, anemia, and ischemia (New Health Advisor, 2014, para. 10).
- Ineffective protection of the organism that is predominantly caused by conditions like decreased RBC, increased fragility of capillaries, abnormal changes in clotting factor, or irregular blood profile (New Health Advisor, 2014, para. 9).
To diagnose chronic kidney disease, a nurse should review the patient’s medical history and then conduct an examination with some tests such as biopsy, ultrasound, urine and blood tests, and CT scan. Based on the identified conditions and diagnosis, a nurse then implements a range of suitable interventions.
Assessment of Data
According to the survey conducted by the Centers for Disease Control and Prevention (2016), 4.5 million of the adult population in the United States suffers from chronic kidney disease, which makes two percent of the entire country’s population (para. 2). Furthermore, chronic kidney disease does not only occur in isolation, although it is possible. Individuals suffering from CKD often exhibit symptoms of hypertension, which is common because the majority of them are of older age. Some other diseases that accompany CKD include chronic pain, anemia, ischemic heart disease, diabetes, and thyroid disorder.
The subjective assessment data is associated with the increased attention to diseases that transfer through infection; thus, there is limited knowledge about the severity of CKD and its impact on the overall health rates. Patients with CKD rarely visit the doctor in time, which leads to further complications and the increase in the costs of treatment. Lastly, CKD is a physical condition that negatively impacts the psychological condition of patients that may develop depression. Therefore, addressing the negative impact chronic kidney disease on the overall health of patients is of the highest importance.
Interview Results
According to the conducted interview on chronic kidney disease with a patient (Mr. X. S.), the two dominant causes of the disease were high blood pressure and diabetes, which are the conditions that often accompany each other. Mr. X. S. went through similar experiences as many, for instance, he noticed the alarming symptoms fairly late, which contributed to the complications associated with CKD. The interviewee’s doctor advised him to maintain a diet with low phosphorus content and regularly take vitamin D supplements. Furthermore, the interviewee received psychological support from his family that was educated on the importance of good nutrition to prevent the disease from developing further.
One of the most prominent points in the interview is that Mr. X. S. developed a particular coping strategy necessary to accept the disease and find a range of alternative solutions. While in the past Mr. X. S. tried to avoid the disease to fulfill his other desires, after being diagnosed and educated on the suitable solution for his disease, he started to employ a coping strategy of distraction that helped him to care about others while still trying to deal with his condition. Therefore, Mr. X. S. showed an excellent example of the adaptive behavioral strategy necessary for patients to deal with conditions like chronic kidney disease.
Desired Outcomes
The desired outcomes of chronic kidney disease directly correlate with the identified diagnoses of decreased cardiac output, impaired skin integrity, and ineffective protection of the organism. Regarding decreased cardiac output, the desired outcome is to maintain the cardiac output that will correlate with patients’ blood pressure as well as heart rate.
When it comes to the risks associated with ineffective protection of organism, the desired outcome for patients with CKD is to reduce or eliminate cases of hemorrhage and bleeding alongside with improving the overall laboratory values (Vera, 2014, para. 7). The third diagnosis of impaired skin integrity should be followed by the desired outcome of maintaining healthy characteristics of skin and avoiding skin damage and injury (Vera, 2014, para. 10).
Evaluation Criteria
Evaluation of chronic kidney disease first involves the evaluation of chronicity, such as the review of past and presents glomerular filtration rates (GFR); review of present and pasts measurements of albuminuria and proteinuria; examination of urine samples; fibrosis and atrophy examination (National Kidney Foundation, 2013, p. 37). Once the criteria of chronicity have been identified, it is important to evaluate the criteria of CKD causes by using ultrasound, serum, and urine electrolytes, and strip reagent urinalysis. Furthermore, it is important to evaluate the criteria of GFR separately.
Evaluation criteria associated with the patient’s lifestyle should also be taken into consideration because many aspects of one’s lifestyle can contribute to the development of the disease. As seen from the example with Mr. X. S., mental health and family support are aspects of one’s life that may positively or negatively impact the development of CKD depending on their nature and quality. The evaluation of the mentioned criteria will play an integral role in the development of appropriate interventions targeted at resolving the issue of chronic kidney disease.
Actions and Interventions
Interventions targeted at addressing the problem of chronic disease span across some nursing areas. First, nurses should pay attention to homeostasis sustainability, sequela aversion, health literacy increase, adaptation support, and boosting self-esteem and health awareness of patients. As a holistic nursing practice, nurses should pay extra attention to whether patients exhibit signs of weakness or fatigue to develop a plan of activities targeted at reducing the fatigue. Because many patients with chronic kidney disease, including Mr. X. S., exhibit signs of negligence, nurses should support patients’ mental needs and educate the family about the importance of such support on their part.
The three identified diagnoses of decreased cardiac output impaired skin integrity, and ineffective protection should be addressed by implementing the following medical interventions:
- The risk for decreased cardiac output should be resolved by monitoring patient’s heart rate and blood pressure indicators; checking the signs of hypertension; taking chest X-rays; monitoring the heart and lung sounds (New Health Advisor, 2014, para. 10).
- Ineffective protection of the organism should be addressed through providing required assistance in cases of skin damage or bleeding; monitoring behavioral changes; reviewing relevant lab reports; monitoring patients’ ability to perform various tasks.
- The risk for impaired skin integrity should be resolved through regular skin inspections that pay extra attention to its color, turgor, as well as vascularity. Frequently changing positions, padding the bony parts of the body with special protectors, and dressing in soft clothing may also be effective (New Health Advisor, 2014, para. 16).
Evaluation of Patient Outcomes
Outcomes of the care plan for patients with chronic kidney disease will depend on the effectiveness of physical and psychological rehabilitation that will be predominantly holistic (Backman, 2013, p. 41). The evaluation of the outcomes should be conducted through the comparison of initial diagnosis and testing results with the results attained in the course of assigned interventions. A beneficial outcome for patients with chronic kidney disease will be the decreased rate of mortality and morbidity.
When it comes to expected outcomes, it is expected that education of patients with chronic disease will lead to their increased awareness of the issue and the ability to exhibit effective coping strategies, similar to the example of Mr. X. S. Also, it is expected that the rate of conditions associated with CKD will decrease with the implementation of interventions involving regular testing of blood pressure, chest X-rays, improving the condition of the skin, and a range of strategies for improving the ineffective protection of the organism. To conclude, positive outcomes expected at the end of the care plan will result from combining psychological support and physical treatment and testing to decrease the negative impact CKD has on patients.
References
Backman, M. (2013). The psychology of the physically ill patient. New York, NY: Springer.
Centers for Disease Control and Prevention. (2016). Kidney disease. Web.
Healthy People. (2016). Chronic kidney disease. Web.
National Kidney Foundation. (2013). KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease. Official Journal of the International Society of Nephrology, 3(1), 1-163.
New Health Advisor. (2014). Nursing diagnosis for renal failure. Web.
Vera, M. (2014). 6 Chronic renal failure nursing care plans. Web.