Introduction
The case in question features a patient who has been having difficulties performing peritoneal dialysis in the confinement of his home despite the provided health education and the relevant resources. The idea of managing renal failure with the help of peritoneal dialysis represents a recent innovation compared to the more common yet less effective in the short term hemodialysis (Ronco et al., 2022). By introducing an appropriate support system, namely, constant assistance of a nursing expert, risks such as infections or imbalance in the patient’s electrolytes will be successfully avoided.
Reasons and Rationale
The main reason for introducing the proposed intervention concerns the adverse effects that the patient may suffer unless relevant measures are taken. Specifically, given the current state of the patient, the risks associated with the failure to implement the steps necessary for the dialysis may result in a fatal outcome or, at the very least, the effect detrimental to the patient’s health. Furthermore, given the patient’s current mental state, the lack of self-care and proper hygiene is likely to affect his swell-being significantly, simultaneously impeding his ability to perform peritoneal hemodialysis as well. Thus, t5here is a pressing need to introduce an urgent intervention.
Expectations and Case Objectives
It is expected that the proposed course of actions will lead to the further improvement in the patient’s well-being. Additionally, the proposed care plan will allow for the further education of the patient and the development of the skills needed to perform peritoneal dialysis in the home environment. Therefore, an overall improvement of the current situation is expected to be observed as a direct result of the proposed intervention. Thus, the core objectives of the case include implementing the steps needed to address the patient’s current status and contribute to short-term needs’ management, while also creating the basis for effective long-term self-care.
Applied Physiology and Pathophysiology
In order to approach the issue at hand, the relevant physiological and pathophysiological issues will have to be considered. Specifically, the core factors driving the process of renal malfunction and the resulting failure must be scrutinized further to encompass the entire range of threats to the patient’s well-being and introduce the necessary solutions. Thus, physiological and pathophysiological processes leading to the kidney failure must be discussed further.
Disease Process and Management
The phenomenon of chronic renal failure (CRF), or chronic kidney disease (CKD), represents a major health issue with significant complications. CRF is typically defined as the “persistent failure of kidney function,” meaning that the patient experiences a rapid and uncontrollable increase of serum creatinine for at least three months (National Institute of Health, 2022).
Related Anatomy and Pathophysiology
Examining the development of kidney failure as a massive health issue will require considering both anatomical and pathophysiological aspects thereof. First, one must mention that the causes of CRF, or CKD, vary extensively and may include a variety of factors. For instance, the National Institute of Health (2022) states that, among core causes of CRF, or CKD, diabetes types I and II, hypertension, primary glomerulonephritis, chronic tubulointerstitial nephritis, hereditary or cystic diseases, secondary glomerulonephritis or vasculitis, plasma cell dyscrasias or neoplasm, and sickle cell nephropathy should be listed. The specified issues cause the destruction of nephrons, which are the structural units of a kidney having relevant and specific functions.
The specified process leads to a drop in phosphatic excretion and a rapid drop in the production of Vitamin D3 (Ronco et al., 2022). In turn, the rise in phosphatic excretion and the decomposition of nephrons entail hyperparatrhyroidism, which causes the overproduction of parathyroid hormone (Ronco et al., 2022). As a result, kidney stones start being developed in a patient’s kidneys, the process being exacerbated by the calcium deposits caused by the drastic lack of Vitamin D3 (Ronco et al., 2022). Consequently, the development of hypocalcaemia and the associated failure of the kidney’s; core functions occurs (Ronco et al., 2022). The observed change can be managed with the help of the relevant interventions, specifically, the introduction of tools that will allow the patient to manage the required procedures more effectively, as well as the techniques that will introduce him to better self-care and a proper understanding of his current health-related needs.
In turn, the related anatomy issues need to be considered closer as well. Specifically, according to the case details, the patient has been experiencing prerenal azotemia (Ronco et al., 2022). The specified condition implies a complete drop in the amount of extracellular fluid (Ronco et al., 2022). As a result, the intra-capillary pressure that is typically maintained at the necessary level with the help of the regular kidney function decreases drastically, entailing an immediate rise in the severity of the patient’s condition (Ronco et al., 2022). The associated process of afferent arterioles dilating and the efferent arterioles being obstructed severely also suggests an immediate impairment of the crucial functions, aggravating the problem and minimizing the recovery probability.
Patient Care Plan
In order to manage the needs of the patient in question fully, the integration of an appropriate holistic model is required. Specifically, the Nursing Process Approach will be integrated into the treatment process. The specified framework incorporates five crucial elements that allow for the most effective identification of core issues and the most accurate assessment of the patient’s needs, while including patient-oriented, culture-specific strategies. These are the assessment, diagnosis, planning, implementation, and evaluation (Ronco et al., 2022). By integrating the specified components into the nursing framework, one will be able to address the observed issue of CRF and introduce the appropriate strategies for patient education and further self-management of the dialysis process.
Holistic Care and Collaboration
In order to meet the needs of the patient in question, an all-embracing approach to patient carte will be required, with a storing emphasis on interdisciplinary collaboration. Tre specified need arises from the obstacles that the patient is currently facing on the way to implementing self-directed care. Specifically, in addition to the relevant services and treatment options provided by the advanced practice nurse, the use of services of nurse educators and therapists will be required to address the current lack of health literacy and the problem of managing personal health needs in the patient.
Individualized Care Plan
Patient Profile
Social and Demographic Data. The patient is an adult Hispanic male of 43, who has been divorced for seven years. The patient does not have any children and works at a local company as a member of the office staff. Over the past couple of years, the patient had to transition from working in the office setting to the environment of remote work, which has reduced his quality of life noticeably. Specifically, the patient confesses to have become significantly lazier and less concerned with his appearance and responsibilities. The specified demographic information places the patient in an at-risk category due to the increased exposure to several core threats, particularly, reduced access to healthcare options. Furthermore, the fact that the patient has been experiencing difficulties concentrating on his workplace performance indicates that certain mental health issues may have emerged. Specifically, the risk of anxiety and depression as a response to the current socioeconomic situation can be suspected in the described scenario (Ronco et al., 2022).
Past Health History. The patient has a rather extensive history of health issues, primarily, due to his diabetes. The patient suffers from diabetes mellitus type 2, which, in turn, can be seen as the product of his poor dieting choices, low rates of physical activity, and his weight issues. Specifically, the patient has been overweight for a substantial part of his life. The presence of diabetes exacerbates the current situation noticeably since it enhances the risk of hypoglycemia and, therefore, aggravates the condition (Ronco et al., 2022). Therefore, appropriate changes to the patient’s diet must be made as the means of managing the current situation.
Clinical Information. The patient’s current health status can be described as critical. Due to the continuous CRF issue, he is experiencing a major health complication exacerbated by the presence of edema. The patient’s inability to perform peritoneal hemodialysis on his own has led to the rap-di deterioration of his condition and the development of massive health risks. Specifically, the threat of infections as one of the core concerns should be mentioned in the case under analysis due to the misplacement of the catheter and the environment in which the patient presently lives. Additionally, the high probability of fluid overload and the associated concerns ranging from edema to the heart failure and tissue decomposition (Ronco et al., 2022). Thus, an immediate response must be provided to address the specified concerns and prevent the patient from experiencing further deterioration of health.
Nursing Assessment
Comprehensive Nursing Assessment. The nursing assessment outcomes indicate that the patient’s current status is critical. The patient’s vital signs, particularly, his tension levels and his breath per minute rate, indicate that he is experiencing a rapid rise in his blood pressure. The described symptoms are emblematic of the CRF (Ronco et al., 2022). Therefore, the introduction of strategies for relieving the patient of the accumulated fluid, as well as the associated health issues, must be provided.
Nursing Diagnosis
Currently, several nursing diagnoses can be identified in the described scenario. Specifically, the failure to implement the peritoneal dialysis has resulted in the fluid overload, the emergence of an increased risk of infections, and the rapid shift in electrolytes balance. When combined, the specified issues represent particularly high risk to the patient’s well-being, which suggests that the required treatment must be administered immediately.
Fluid Overload. The problem of fluid overload as one of the more obvious effects of kidney failure must be placed among the core diagnoses that can be observed in the case under analysis. Specifically, due to the kidney failure, the performance of the specified organ is mostly impeded, which is why the fluid within the patient’s body is expected to accumulate to a significant extent. As a result, edemas are expected to occur; specifically, the phenomenon of interstitial edema is quite common for patients with a kidney failure (Ronco et al., 2022). Therefore, the buildup of fluid and the development of the associated issues, such as the damage to the endothelial glycocalyx layer and the resulting injuries, must be prevented to ensure that the patient’s health issues do not exacerbate.
Infection Risks. The patient is currently facing significant infection risks due to the failure to implement the relevant dialysis procedures accordingly. Specifically, the failure to perform the peritoneal dialysis process in a proper fashion may lead to significant complications caused by the failure to align with the set hygiene standards. In turn, according to the information provided by the patient, his current home environment can be described as rather unsanitary due to the patient’s poor hygiene and the associated issues. Namely, the exposure to gram-positive bacteria such as Staphylococcus epidermidis and Staphylococcus aureus is bound to lead to a significant increase in health risks associated with infections when performing peritoneal dialysis (Ronco et al., 2022). Combined with a notable drop in the performance of the patient’s immune system caused by the renal failure, the described issue represents a major risk of developing comorbid issues such as peritonitis due to the obstruction of the dialysis process and the possible dislocation of the catheter (Ronco et al., 2022). Specifically, the threat of internal jugular vein cannulation may emerge (Ronco et al., 2022). Therefore, the infection risks associated with the failure to perform peritoneal dialysis at home in a clear environment should be accounted for first.
Imbalance: Electrolytes. Another concern to be examined thoroughly in the case under analysis is linked to the issue of electrolyte imbalance. Presently, the lack of balance in the amount of electrolytes ion the patient’s blood is caused by the kidney failure (Ronco et al., 2022). In turn, performing dialysis is expected to assist in addressing the described issue. However, due to the patient’s failure to implement the necessary procedures, his progressing disease will lead to a rapid disruption in the electrolyte balance within his blood (Ronco et al., 2022). In turn, the described change will entail dire co0nsequences, including the issues such as fatigue, confusion, digestive problems, increased heart rate and the associated risks of CVD, and other severe health problems (Ronco et al., 2022). Therefore, the current problem of electrolyte imbalance must be introduced as one of the core diagnoses and a massive health issue to be addressed.
Evaluation of Care: Progress and Plans
The current progress rate indicates that the patient has rather high chances for recovery if the appropriate measures are taken promptly. Specifically, the patient’s vital signs show that the proposed solution will allow for a notable improvement in the current situation. Namely, by introduction immediate solutions that will reduce the extent of fluid accumulated in the patient’s body, one will contribute to a drop in the threat of the further development of a heart condition caused by the fluid overload, as well as other health impairments that the specified concern may entail. Similarly, the problem of electrolytes’ imbalance will be managed as the patient’s bloodstream receive intravenously the required amount of fluids such as sodium and the necessary medications needed to rehydrate him. Furthermore, a long-term treatment process involving the reintroduction of the peritoneal dialysis procedure into the patient’s healthcare routine will allow addressing the issue in question successfully.
In turn, the risk of infections, as well as the associated concerns, will have to be addressed by providing the patient with the required cognitive behavior therapy aimed at changing his present attitude and habits. Specifically, the issue of the lack of motivation and the relevant concerns will have to be addressed as the core obstacle on the way to ensuring that the patient’s quality of life and the efficacy of the treatment provided to him remain high. For this purpose, the use of the CBT framework geared toward replacing the current distorted perspective with a more adaptive and adequate one. Additionally, the patient will have to be screened for the presence of a depressive disorder and the associated mental health concerns (Ronco et al., 2022). Thus, the opportunity to identify and address major causes of the unwillingness to change behaviors will become possible.
Related Pharmacology and Procedures Involved
Actions, Usage, and Side Effects
It is strongly suggested that the medication for addressing the current edema issue should be administered to the patient. Thus, the retention of fluid in his system will be temporarily managed while the kidney failure is treated accordingly.
Nursing Implications and Health Advice
The core nursing implications to be expected in the case at hand concern the opportunity to introduce the patient to the concept of self-care and educate him about the management of his health issue. As a result, premises for long-term management o the disease will be created. Furthermore, the proposed solution will improve the patient’s quality of life.
Learner’s Knowledge
Introducing appropriate learning opportunities for the patient also represents a crucial part of the plan. Namely, the patient should be highly encouraged to develop a profound and nuanced understanding of his current condition and the threats that he will face unless he follows the prescribed course of action. For this purpose, tools that include relevant visual fata and the essential information represented in a palatable and clear manner must be incorporated into the proposed framework for managing the patient’s needs.
Conclusion
Conclusion and Recommendations
Overall, it is currently crucial to introduce the patient to the core principles of self-care while ensuring that his present condition is addressed properly. For this purpose, a combination of an immediate medical response as the means of preventing core health risks and the introduction of long-term therapy will be utilized. Presently, it is vital to ensure that the patient’s behavers are corrected accordingly, and that he receives the required health education for the further self-management of the dialysis process. The proposed intervention coupled with the essential medical assistance for addressing his current health concerns, primarily, those assisted with his kidney malfunction and diabetes type 2, is expected to produce a vastly positive outcome. Namely, it is expected that the patient will build a thorough and accurate understanding of the essential principles of self-directed care, as well as the relevant health education and health literacy.
Furthermore, the suggested intervention will introduce the patient to an example of how his present health concerns should be addressed, namely, how the peritoneal dialysis procedure should be implemented. With the specified knowledge and the provided range of relevant resources, the patient will be able to implement the necessary self-care strategies to maintain his routine associated with the dialysis process. Finally, the current mental health issues will be addressed accordingly.
Evidence of Reflective Learning
The case under analysis has demonstrated the importance of ensuring that the patient receives the necessary information regarding the health issue, the crucial resources for addressing it, and the much-needed guidance. Furthermore, the case at hand illustrates the drastic outcomes of failing to prompt motivation and health education in the patient. Finally, the significance of addressing mental health concerns that may impede the process of recovery and the further management of the patient’s health condition has been recognized when considering this case. Therefore, the specified assessment has played an important role in understanding the nuances of treating clinical concerns.
References
National Institute of Health. (2022). Renal failure. NCBI NIH. Web.
Ronco, C., Manani, S. M., Giuliani, A., Tantillo, I., Reis, T., & Brown, E. A. (2020). Remote patient management of peritoneal dialysis during COVID-19 pandemic. Peritoneal Dialysis International, 40(4), 363-367. Web.