Diabeteic African American Women

Diabeteic African American Women

A Case Analysis

A 54-year-old single lady, who lives with her family. She gave up her studies due to haemodialysis treatment, resulting in feelings of isolation, loneliness and depression. She's mother is very supportive and also copes remarkably well with two disabled daughters. She is 53.5 kgs, 5'5 inches tall, thin, pale and tires easily due to her anaemia. Before commencing haemodialysis in September 2002 her haemoglobin was 9.9 g/dl. She has been an insulin dependent diabetic since 1980 and has developed end stage renal failure as a result of diabetic nephropathy. She was diagnosed with retinopathy in 1990 and has undergone laser treatment in 1991.

Apart from uncontrolled blood sugars, She has rarely been unwell. In December 2001, she consulted her General Practitioner with occasional vomiting and shortness of breath upon exertion and bipedal leg oedema. On examination it was discovered that her blood pressure had risen from 140/85 mmHg to 150/90 mmHg. Normal blood pressure is 120/80 mmHg (www.detecting-hypertension.com). Urine testing showed proteinuria (+3) and blood sampling showed a gradual increase in creatinine from 686 umol/L to 783 umol/L. She was commenced on Frusemide 80 PO mg daily. Her local General Practitioner had referred She to the Nephrology Team. She attended the Renal Clinic who discovered that there was a deterioration in her kidney function and that Renal Replacement Therapy would be required. Regular hospital appointments and the general effect of her treatment interfered with her studies in the University. She attended both the Nephrology and Pre-Dialysis Clinic where she was informed about the various treatment modalities. Dialysis in the form of Haemodialysis and Continuous Ambulatory Peritoneal Dialysis were the treatment options open to She. She decided that haemodialysis would be the best treatment option for her.

An Arterio-venous fistula was formed last June 2002. She's blood was monitored monthly and her serum creatinine had risen from 408 to 701 mmol/l. A referral to the Renal Dietician was made and advice given to her regarding the appropriate diet.

Her left brachial arterio-venous fistula had an excellent thrill and bruit. Due to her increasing serum creatinine and serum urea, the medical team decided to start her on haemodialysis. She's dialysis was started last September 2002 and the arterio-venous fistula was needled successfully using 17g dialysis needles. She is worried about her AVF increasing in size and the effect it might alter on her body image.

She's Renal Failure is managed by the medical team in the Dialysis Unit but her multiple care needs must also be identified. The focus of my assignment is to discuss three different areas of care based on the specific problems presented by She.

1. Body Image Disturbance and Psychosocial Aspect of Care

2. Anaemia

3. Diabetes

Furthermore, I will discuss the delivery, organisation and evaluation of care given to She and her family during a specified time frame. The evaluation is focused on the care given and its effectiveness, and the role and responsibility of the renal nurse and other key personnel ...