Chronic Kidney Disease Patient Nursing Care Plan

Topics: Disease, Nursing, Nursing Care Plan Words: 1678 Pages: 7

Target Group: CKD Patients and the Healthy People 2020 Objectives

Patients with renal failure are the target population the needs of which will be addressed in the course of the study. Particularly, adult representatives of low-income Hispanic families will be considered during the analysis. The identified goal aligns with one of the primary objectives of the Healthy People 2020 initiative, which states that it is crucial to “reduce new cases of chronic kidney disease (CKD) and associated complications, disability, death, and economic costs” (Healthy People, 2017).

Furthermore, the paper pushes the envelope by encouraging patient education as one of the primary tools for managing the incidences of CKD among low-income members of the community. The reason for choosing the topic in question is rather basic; although not being as discussed in media as other health threats, CKD remains one of the primary health concerns and is a “global health burden with a high economic cost to health systems and is an independent risk factor for cardiovascular disease” (Hill et al., 2016).

Holistic Plan of Care for Patients with CKD

When designing a holistic plan of care for Hispanic patients with CKD., one must bear in mind that the accessibility to care is very low among the target population members. Ttherefore, the plan of care will have to include the tools that will allow for efficient communication between the nurse and the community. Moreover, the issues associated with patient education need to be addressed. Finally, the necessity to carry out regular assessments of the patients’ condition will need to be recognized. Therefore, the following steps will have to be taken to meet the needs of the target population:

Careful assessment of the patient’s condition;
Development of the patient education strategy based on subverting the common myths about CKD;
Promoting communication between a nurse and a patient;
Encouraging the family members to support the patient;
Carrying out a kidney imaging study;
Providing the patient with the necessary treatment and administering the required medications.

Compiled Report: Summary, Retrospect, and Analysis

The analysis of CDK management among middle-aged Hispanic patients coming from low-income families shows that the awareness rates about the threats of CKD, its key symptoms, and the ways of managing it are disturbingly low among the target population. Furthermore, the further patient assessment has shown that there is a need to promote an enhanced communication between the target population and a nurse so that the quality of services could be improved significantly. Particularly, the promotion of patient independence and the provision of the necessary information to the specified demographics are crucial steps toward improving patient outcomes.

Particularly, the overview of the subject matter indicated that there was an urgency in developing a care plan. The case study analysis pointed to the typical issues that middle-aged low-income Hispanic patients are likely to have when developing the condition. Finally, the support need analysis allowed understanding what tools could be used to address the situation. Thus, the significance of enhanced communication was explored.

Nursing Diagnoses

When managing the needs of the patients that have reached the third stage of the CKD progression, one should keep in mind that comorbid conditions may have emerged over the course of the disease development. Therefore, it is imperative that the CVD issues should be addressed as well when managing the needs of the target population. Similarly, the problems associated with patient education and the management of their psychological needs has to be addressed. As the case under analysis shows, patients may fail to develop the appropriate coping strategies. The identified outcome is likely to result in comorbid psychological issues such as anxiety or even depression (Lee, Kim, Cho, & Kim, 2013). Thus, the following diagnosis need to be considered:

Low cardiac output;
Anxiety;
Inefficient breathing patterns (Chawla, Eggers, Star, & Kimmel, 2014).

Assessment Data (Objective and Subjective)

Objective Data

Neurologic. The patient shows the propensity for a drop in attention levels, occasional fatigue, and sleep problems.
Cardiovascular. There is a threat of an increased heart rate and blood pressure levels due to the rise in the fluid volume. Anemia should also be addressed accordingly.
Musculoskeletal. General weakness, nausea, and vomiting can be deemed as the primary characteristics of the condition.
Renal. Protein, blood, and particles can be observed in the patient’s urine.
Skin. The patient’s skin tends to be dry, with a slight change in color (yellowish) and the development of uremic frost.
Reproductive. No effects on the reproductive function of women can be observed. Foe men, the threat of erectile dysfunction becomes plausible.
Serum electrolytes. A drop in sodium and calcium can be observed.
CBC. A drop in hemoglobin levels can be witnessed.

Subjective Data

The patient is likely to complain about the instances of fatigue and sleep issues. In the case under analysis, anxiety was also reported as one of the reasons for concern. Coupled with the fear of miscommunication due to the differences in the patient’s (Hispanic) and the nurse’s (American) ethnic backgrounds, the lack of awareness about the severity of the issue triggered a rise in anxiety levels.

Interview Results

The interview aimed at detecting possible issues associated with the management of CKD among the target population (i.e., Hispanic people from low-income backgrounds) showed that there is currently a tendency among the target population to discard the significance of the disease and its symptoms, therefore, leading to the gradual aggravation of the issue. Most of the patients are middle-aged people from low-income backgrounds.

Furthermore, the interview also showed that the specifics of the cultural background of the target population define their attitude toward CKD, its severity, and treatment to a considerable degree. Particularly, the respondents that belonged to the Hispanic community showed the tendency to underrate the gravity of the problem (78% of the participants). Thus, there is a need to introduce the tools for enhancing patient education. Particularly, the promotion of knowledge and skills acquisition should be carried out by using consultations and social media as the means of convincing the target population about the gravity of the issue (Stevens & Levin, 2013).

Desired Outcomes

It is expected that the introduction of the identified approach will lead to a rapid increase in positive outcomes among the target population. Furthermore, the active acquisition of the relevant knowledge and skills among CKD patients is expected. Finally, the enhancement of family support is viewed as an important outcome.

Evaluation Criteria

The rate of CKD-associated problems among the target population will be used as the key criteria for the assessment. For instance, a drop in the development of heart issues among CKD patients will be viewed as one of the signs that the strategy has proven to be efficient. Similarly, the acquisition of the necessary behaviors and skills among CKD patients (e.g., the management of the urine bag) will be incorporated into the assessment.

Actions and Interventions

Seeing that the care plan is aimed at meeting the needs of the patients that are currently at the third stage of CKD, it will be necessary to introduce the tools that will allow determining the signs of possible kidney cancer development. Therefore, a more intense approach toward managing the patients’ needs is strongly recommended. Particularly, the following steps will have to be incorporated into the nursing care plan (NCP):

Determining the rate of the disease progression;
Addressing the associated risk factors (in the specified scenario these are: high blood pressure, the lack of the relevant knowledge, the absence of coping skills, and possible financial issues (e.g., the necessity to buy bags for the dialysis));
Retrieving the data from a detailed kidney imaging study and regular update on the patient’s condition (e.g., computer tomography (CT) or ultrasound (US));
Providing the patient with extensive information about the condition, the means of detecting the symptoms showing the aggravation thereof, the development of coping strategies, the acquisition of the relevant skills, etc.;
Offering the patient psychological help so that the appropriate coping strategies could be developed and that the patient’s vulnerability (i.e., the ethnicity and the challenges that cross-cultural communication entails) could be managed successfully (Ovrehus, Zurbig, Vikse, & Hallan, 2015);
Encouraging family support for the patient.

As the care plan provided above shows, not only essential nursing services for addressing the patient’s condition but also the tools for promoting active patient education must be incorporated into the process. The identified goal can be attained by encouraging consistent communication between a nurse and a patient. The specified objective, in turn, will be met by incorporating social media and other IT tools into the framework as the means of keeping the target population updated on the latest and the most important information about CKD (Campbell et al., 2016). Monitoring the patient’s condition is another crucial objective of the care plan.

Apart from blood pressure and the development of ulcers, the management of potassium levels must be viewed as a necessity due to the effect that diuretics have on the potassium levels in the patient’s body (Pitt et al., 2015). Furthermore, consultations must be provided along with training sessions so that patients could develop the skills such as managing their urine bag, identification of the possible health changes based on the color of the urine (e.g., purple or red as a result of the urine discoloration (Sriramnaveen et al., 2016)), etc. Finally, the significance of family support as the means of convincing the patient to continue the treatment and accept the suggested behaviors is crucial. Therefore, a nurse must also provide detailed instructions to the family members during consultations.

Evaluation of Patient Outcomes

The patient outcomes will be assessed based on the incidences associated with CKD (e.g., the development of comorbid conditions such as a heart disease due to an increase in the heart rate). Furthermore, the progress in acquiring and utilizing the knowledge and skills related to CKD will be included in the assessment as an important step in patient education. Finally, the assessment will include the information about the patients’ objective and subjective data. Thus, a comprehensive overview of the changes that the specified strategy will supposedly trigger will become a possibility.

References

Campbell, Z. C., Stevenson, J. K., McCaffery, K. J., Jansen, J., Campbell, K. L., Lee, V. W. S., & Webster, A. C. (2016). Interventions for improving health literacy in people with chronic kidney disease (protocol). Cochrane Database of Systematic Reviews, 2(CD012026), 1-13.

Chawla, L. S., Eggers, P. W., Star, R. A., & Kimmel, P. L. (2014). Acute kidney injury and chronic kidney disease as interconnected syndromes. The New England Journal of Medicine, 371(1), 58-66. Web.

Healthy People. (2017). Chronic kidney disease. Web.

Hill, N. R., Fatoba, S. T., Oke, J. L., Hirst, J. A., O’Callaghan, C. A., Lasserson, D. S., & Hobbs, D. R. (2016). Global prevalence of chronic kidney disease – A systematic review and meta-analysis. PLoS One. 11(7), e0158765. Web.

Lee, Y. J., Kim, M. S., Cho, S., & Kim, S. R. (2013). Association of depression and anxiety with reduced quality of life in patients with predialysis chronic kidney disease. International Journal of Clinical Practice; 67(4), 363-268. Web.

Ovrehus, M., Zurbig, P., Vikse, B. E., & Hallan, S. I. (2015). Urinary proteomics in chronic kidney disease: Diagnosis and risk of progression beyond albuminuria. Clinical Proteomics, 12(1), 21. Web.

Pitt, B., Bakris, G. L., Bushinsky, D. A., Garza, D., Mayo, M. R., Stasiv, Y.,… & Weir, M. R. (2015). Effect of patiromer on reducing serum potassium and preventing recurrent hyperkalaemia in patients with heart failure and chronic kidney disease on RAAS inhibitors. European Journal of Heart Failure, 17(10), 1057-1065. Web.

Sriramnaveen, P., Reddy, Y. S., Sridhar, A. V. S. S. N., Kishore, C. K., Manjusha, Y., & Sivakumar, V. (2016). Purple urine bag syndrome in chronic kidney disease. Indian Journal of Nephrology, 26(1), 67-68. Web.

Stevens, P. E., & Levin, A. (2013). Evaluation and management of chronic kidney disease: Synopsis of the kidney disease: Improving global outcomes 2012 clinical practice guideline. Annals of Internal Medicine, 158(11), 825-830. Web.