Acute Renal Failure and Hospital Readmission Essay

Introduction

In the contemporary world, healthcare providers’ main role is to ensure patients get quality care. Hospital readmissions are some of the issues that affect the delivery of care. As shown in the care, although the patient was treated and discharged, he was readmitted after three weeks with conditions that could have been avoided. For example, the patient was reported to have lethargy and unresponsiveness. To avert the situation, the providers introduced feeding tubes. The case study indicates that the hospital lacks interventions to prevent the readmission of patients. On the other hand, the case reveals that long-term care does not have measures to ensure that patients eat the required diet and engage in appropriate activities to protect their well-being. Therefore, health providers must ensure that patients are treated effectively.

The Patient’s Development of Acute Renal Failure

Dehydration

Acute renal failure is the loss of kidney function that increases blood levels of nitrogenous waste and impairs fluid. One factor contributing to the development of acute renal failure is dehydration (Ronco, Bellomo & Kellum, 2019). This is caused by not drinking enough fluid or losing more water through vomiting. As shown in the case scenario, the patient had a poor skin turgor with obvious tenting, indicating severe dehydration that requires quick treatment. In addition to not drinking enough water, the patient did not like taking a diet of pureed liquids. Dehydration that lasts for some time damages the patient’s kidney, leading to acute renal failure. In addition, a lack of adequate water in the body may result in a decline in blood flow to the kidney, which may injure the tissues and cause failure.

Infection

Infection is among the most common causes of acute renal failure. Patients with severe infections have lower blood pressure, which reduces blood flow to the kidneys and leads to ischemia (Skube et al., 2018). As indicated in the case, the patient has a blood pressure of 96/50, which is considered low. With this pressure, renal tubules are prone to damage because they are extremely sensitive to decreased blood flow. Although white blood cells are an important part of the immune system, too many of them are usually a sign of an infection or inflammation. As shown in the scenario, a microscopic exam of the urine shows that white blood cells are too many to count. A positive leukocyte esterase and positive nitrite are signs of urinary tract infection. Therefore, the patient’s renal failure was due to overwhelming infection, damaging the tissues.

The Improvement of Patient’s Renal Function with Conservative Measures

Yes, it was reasonable at the inception to anticipate that the patient’s renal function would improve with conservative measures. This involves various therapies to alleviate symptoms, restore functions, and avoid intrusive measures such as surgeries and other invasive procedures (Castro, 2018). Conservative management is based on patient assessment and ultrasound findings. As indicated in the case scenario, poor skin turgor was observed in the patient, which demanded intravenous hydration with normal saline. A kidney ultrasound revealed no other signs of hydronephrosis or structural abnormality. As a result, since the most probable cause of acute renal failure is dehydration and infection, conservative measures are crucial treatment methodologies to ensure that the kidney functions normally.

The Available Actions to The Treatment Team

The first action that the team would have considered is the insertion of a percutaneous gastrostomy tube (PGT). This is a medical procedure where a flexible feeding tube is inserted into the stomach through the abdominal wall (DeLegge, 2018). PGT makes it possible to avoid the mouth and esophagus and put nutrients, fluids, and drugs directly into the stomach. This action would have ensured that the patient had adequate fluid intake and nutrients to prevent dehydration, which caused renal failure. As shown in the case, on the second emergency department visit, the patient was unresponsive and had lethargy. This is a natural response to lack of sleep or poor eating habits. Thus, the team would prevent readmission of the patient three weeks after discharge to a long-term care facility.

The second action was for the team to ensure that the patient maintained a healthy routine. The team should have developed a schedule for the nurses working in long-term care to ensure that the patients eat a balanced diet, have an adequate sleep, exercise, and adhere to the medication given. The initial treatment did not consider managing the lifestyle of the patient and making sure that the previous issues leading to renal failure were not repeated. For example, it was evident that the patient had a problem taking fluids leading to severe dehydration. Based on this, the health team would have developed a way to ensure that the patient improves their lifestyle to increase energy. Therefore, a post-treatment plan and follow-up would have prevented the patient from returning to the emergency room.

The Safeguards in The Long-Term Care Setting to Protect This Patient

There are several safeguards that the long-term care setting should adopt to protect patients from health problems. Firstly, the setting should have ensured that there are trained nutritionists. They guide patients on diet, well-being, and personal health issues. Nutritionists organize, coordinate, and oversee various nutritional programs to enhance clients’ health and well-being and educate them about nutrition. In addition, with skilled nutritionists, the patient would have had a good sleep, balanced diet, and exercised well. As a result, having a team of nutritionists in the setting would have protected the patient from lethargy and being unresponsive.

Secondly, long-term care facilities should have supervised meal times. Apart from aiding the residents during meal-times based on their care needs, the nurses in the facility can use this opportunity to examine each person. This would assist them in determining whether they can hold the cutlery. Some persons may benefit from modified cutlery or other supports to eat independently. In addition, some patients would refuse to eat due to tonsils or throat ulcers. Having a supervised meal time ensures that the patients’ eating challenges are determined and effectively addressed. Therefore, being around the residents during meal-time would have protected the patient from being readmitted.

The Use of a Feeding Tube on The Patient

Yes, using a feeding tube was appropriate because the patient had lethargy and was unresponsive. Lethargy may be due to the failure to eat a balanced diet as per the direction of a physician and inadequate sleep. Since the patient was unresponsive, it was challenging to administer natural feeding to give the client supplement to restore their energy. The feeding tube was introduced because the patient had reduced oral food intake and episodes of dehydration, leading to acute renal failure. If this happens again, the kidney injury will be badly damaged, leading to chronic renal failure and even death. Therefore, the feeding tube was used to ensure that patients take something to boost their energy.

The Implications of the Case Study on The Setting

The implication is that the case scenario has revealed that the setting lacks a patient monitoring program after discharge. This indicates that the facility does not have adequate interventions to reduce readmission. Based on this, the lack of strategies to prevent readmission resulted in the patient’s second visit to the emergency department. For example, if the setting had followed up, they would have realized the issues that might affect the patient health and well-being and advised the caregivers at the long-term care facility on the precautions. The setting should adopt effective management after discharge, which involves the providers calling the patient or caregivers to follow up and determine the well-being of the patients. Therefore, the case has shown that the hospital lacks patient monitoring intervention after discharge.

Conclusion

Hospital readmissions are one of the issues affecting care delivery. The primary responsibility of healthcare providers is to ensure that patients receive quality care and are not readmitted. Although the patient was treated and discharged, he was readmitted three weeks later with conditions that could have been avoided, as evidenced by the care. Feeding tubes were introduced to alleviate the situation. According to the case study, the hospital lacks interventions to prevent patient readmission. On the other hand, the case demonstrates that long-term care does not have measures in place to ensure that patients eat the proper diet and participate in appropriate activities to protect their well-being.

References

Castro, M. C. M. (2018). Conservative management for patients with chronic kidney disease refusing dialysis. Brazilian Journal of Nephrology, 41, 95-102.

DeLegge, M. H. (2018). Enteral access and associated complications. Gastroenterology Clinics, 47(1), 23-37.

Ronco, C., Bellomo, R., & Kellum, J. A. (2019). Acute kidney injury. The Lancet, 394(10212), 1949-1964.

Skube, S. J., Katz, S. A., Chipman, J. G., & Tignanelli, C. J. (2018). Acute kidney injury and sepsis. Surgical infections, 19(2), 216-224.