NURSING MANAGEMENT

Nursing Management Of The Physical And Psychological Aspects Of The Patients With Chronic Kidney Disease

Nursing Management Of The Physical And Psychological Aspects Of The Patients With Chronic Kidney Disease

The purpose of this assignment is to critically analyze the statement that “nursing management of the physical and psychological aspects of the patients with chronic kidney disease, with an emphasis on reducing the rate of renal deterioration.” With improvement in medical facilities and increasing life expectancy, non-communicable diseases viz. hypertension, diabetes and coronary artery disease are on the rise. These diseases predispose to renal involvement and there has been a disproportionate rise in patients with renal diseases among all age-groups.

Does The Patient Have Kidney (Renal) Disease?

This is the first and foremost question. It is necessary to establish the existence of kidney disease. Besides, it is important to ascertain whether the kidney involvement is secondary to some other illness which if catered to and controlled may result in improvement of the kidney disease itself. (Wingen 1997 1117-1123)

It is not uncommon to see a requisition being asked for blood urea and serum creatinine to establish a diagnosis of renal disease. It is obviously not wrong, and although most of our patients present to us when these parameters are deranged; we should realize that these alterations in creatinine and urea occur when GFR falls to 50%. Another thing of importance to note is that patient may be totally asymptomatic or may experience only mild vague symptoms of listlessness or malaise during this period. This is one of the main reasons why we genuinely miss patients of early renal involvement. Urine albuminuria may be considered to be a better predictor and more so microalbuminuria (urinary albumin excretion rate-20-200microgram/l; can be detected by Micral II dipsticks which also provide semiquantitative estimate) is an early tool to predict future nephropathy. (Schreiber 2003 179-193)

It is only when the GFR starts declining below 50 ml/minute, there is increasing symptomatology. Also, the general practitioner should remember that diseases like diabetes mellitus, uncontrolled hypertension and urinary tract abnormalities can cause minimal symptoms despite progressive renal damage. This is more dangerous, since patients in these groups tend to present in moderate to severe renal insufficiency when it is too late because the case is of irreversible renal failure. (Ramage & Harvey 1999 231-236)

A rough estimation of the glomerular filtration rate (GFR) can be made by a simple calculation as under-

GFR (in ml/minute) = 100 divided by S. Creat.(in mg/dl)

i.e. if the serum creatinine is 5 mg/dl, the GFR is 100 divided by 5 = 20 ml/minute.

A more accurate, but cumbersome formula is calculation of the Creatinine Clearance Rate (CCR) which closely resembles GFR.

CCR = [140 - Age (yr)] x weight

S. Creat x 72(Ramage 1999 249-252)

Is The Kidney (Renal) Involvement Acute Or Chronic?

Once we establish a diagnosis of kidney disease, it is pertinent to establish whether the patient has acute or chronic kidney disease.

Acute renal failure- It is characterised by sudden and reversible loss of renal function; usually precipitated by loss of ...