End Stage Renal DiseaseTerm Paper

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End Stage Renal Disease

End-Stage Renal Disease


This study addresses a patient named 'George White', born 7/15/1950. He is married to Donna White, born 1/5/65, and has two children: Jamal (male), born 9/25/92, and Rasheeda (female), born 7/11/97. Mr. White has a 2nd daughter and two grandchildren. His oldest child Kia, from prior relationship, was born 10/23/70, and she has 2 children: Kijay, born 6/18/90, and Quadir, born 8/14/96.

Summary of health problems/disease:

Medical history of patient George White: (a) Diabetes Type 2; (b) Hypertension; (c) Congestive heart failure; (d) Chronic hepatitis C; (e) end-stage renal disease (analysis topic); and (f) patient has been on Hemodialysis treatment since June, 2011.

Medical history of Patient

diabetes type 2


congestive heart failure

chronic hepatitis C

currently he has end stage renal disease (Which will be the subject of our analysis)

The patient is on Hemodialysis since June of 2011

End-Stage Renal Disease & Pathophysiology

End-stage renal disease (ESRD), also known as chronic renal failure, consists of irreversible and progressive deterioration of kidney (renal) function that is inevitably fatal for the individual. In ESRD, the patient has severe azotemia and/or uremia, retention of nitrogenous waste products such as urea in the blood due to the failure of the renal system to filter out waste products, occurring concomitantly with the failure to maintain electrolyte, fluid, and metabolite balance.

There are a variety of potential physical origins from which ESRD may develop. This may be the result of chronic and systemic disorders, of which the leading cause is diabetes mellitus. It may also arise as a consequence of exposure to and intake of toxic agents; can result from medications, infections, and vascular disorders; and may be a consequence of polycystic kidney disease and concomitant hereditary lesions. Other possible physical disease states that may lead to ESRD include: hypertension; obstruction of the urinary tract; inflammation of the renal pelvis, or pyelonephritis; and as a consequence of chronic glomerulonephritis. In addition, other health conditions may contribute to the high mortality rate for individuals having end-state renal disease (Finnegan-John and Thomas, 2013).

Factors influencing the pace at which renal failure progresses are both dependent upon, and related to, the rate of protein excretion in the urine, extent of concomitant hypertension, and the nature of any underlying disease state. As reported by Finnegan-John and Thomas (2013), end-stage renal disease may develop at a faster rate for those patients who are hypertensive, as well as those excreting large amounts of protein as compared with patients who are not hypertensive or displaying symptoms of proteinuria.

Adult origins of ESRD vary. Health conditions that may result in ESRD include: Alport syndrome, glomerulonephritides, lupus nephritis, obstructive uropathy, diabetic glomerulopathy, complications from kidney transplant, chronic pyelonephritis, and polycystic kidney disease. As well, renal failure may be the result of exposure to occupational and/or environmental compounds such as the heavy metals chromium, lead, mercury, and cadmium. Uremic syndrome, regardless of origin, consistently presents as a loss of the individual's renal system to maintain and regulate body fluid composition.

Uremia may result in a variety of other health complications. Cardiovascular complications may include: capillary fragility, congestive heart failure (CHF), pericarditis, arrhythmias, and hypertension. As well, there may be effects upon the lungs, such as pleural effusions and pulmonary edema. The nervous system may become involved as well, with altered mental states that can vary widely, from coma to simple lethargy, as well as peripheral neuropathy and diverse other psychological changes, including depression. Alterations of the musculoskeletal system include metastatic calcifications, renal osteodystrophy, and generalized muscle weakness.

Without dialysis, untreated end-stage renal disease can produce imbalance of important electrolytes (calcium, potassium, magnesium, and phosphorus), leading to increased and excessive intravascular volume, acidemia, and the potential of involvement of other organ systems in what is called secondary dysfunction. In terms of hematology, uremic effects include a shifted oxy-hemoglobin dissociation curve, anemia, and platelet dysfunction. Other symptoms include intestinal disorders, vomiting, nausea, and ulceration of the gastro-intestinal tract. Impaired cellular immunity may be observed, along with general depression of the immune response. Given the diversity of untoward symptoms, dialysis or kidney transplant may be the only effective options, and generally dialysis will reduce many of these symptoms as well as improving the patient's sense of physical well-being (Finnegan-John and Thomas, 2013).

Nursing theorist

Regardless of the age of a patient, dialysis is useful and effective in correction of toxicities (Finnegan-John and Thomas, 2013). Indeed, either kidney transplantation or dialysis may ultimately become a necessity in order for the patient to survive. Uremia development in end-stage renal disease results in a worsening of many of the symptoms. Proteinuria occurs as well, when the kidneys no longer function to excrete end-products of protein metabolism. As waste products increase (azotemia/uremia) the general symptoms worsen (Finnegan-John and Thomas, 2013).

Quality of Life

Quality of Life, and the extent to which this is impacted will be examined in this study, which may potentially assist in future understanding of how renal disease affects the individual patient, as well as their family, friends, and associates. In the United Kingdom (UK) the NICE National Institute for health and Care Excellence has established guidelines to address psycho-social issues for patients with physical health problems that may result in depression. This will obviously be pertinent to individuals having end-state renal disease. The data presented herein will focus on quality of life, as addressed by Skevington (1994). However, findings presented here may not apply in future to all patients with end-stage renal disease. This will be a major limitation of this work, even with respect to the framework of Quality of Life. The guidelines established by the NICE national institute for health and care excellence suggest treatment of depression in adults having chronic health problems, which would obviously include end-stage renal disease (Nice, 2009).

Care Management Analysis


When a patient presents with end-stage renal disease, there are numerous concerns and complications for Nurses, some of which may result in an approach that is necessarily collaborative in nature. Examples of conditions that may exacerbate ESRD include: (a) Anemia; (b) Hypertension; (c) Bone disorders; (d) Hyperkalemia; and (e) Pericarditis. Each of these conditions may have additional origins and symptoms. Anemia can result from blood loss during hemo-dialysis, from decreased erythropoietin production, from toxin-induced GI-bleeding (gastro-intestinal tract), from ulcer formation, and from decreased red blood cell life span. Hypertension may arise as a consequence of malfunctioning of the aldosterone-angiotensin-renin system, as well as from water and sodium retention. Bone disorders may arise from elevated aluminum levels, low serum calcium levels, abnormal metabolism of Vitamin D, and from vascular calcifications originating in phosphorus retention, as well as metastatic bone disorders. Hyperkalemia (elevated potassium) may arise due to excessive fluid intake and/or retention just from daily fluids as well as from medications and diet, as well as from altered patterns of excretion, catabolism, and metabolic acidosis. Pericarditis, as well as pericardial tamponade, and pericardial effusion can occur as a result of inadequate dialysis and/or retention of uremic waste products.

Medical management

Medical management of end-stage renal disease has as its goals the maintenance of kidney homeostasis and function for the longest period of time achievable. While management is primarily achieved through provision of appropriate dietary therapy and pharmaceutical regimens, it is the goal of the medical staff, and particularly the Nurse, to identify, address, and treat as many ESRD contributory factors as possible. One focus is to specifically address reversible factors such as any obstruction. Control of azotemia/uremia may require hemo-dialysis to control electrolyte balance as well as to lower the uremic toxins in the blood.

Plan for Patient Care

In cases of renal failure, the plan for patient care should include: complete medical history; physical examination; and specific diagnostic evaluation for the state of renal health.

The latter should consist of: (a) Kidney biopsy, in which either a surgical procedure or a needle is used to remove kidney tissue samples for microscopic examination, to check for abnormal and/or cancerous cells; (b) Blood tests, to examine levels of kidney function by measurement of electrolyte levels, protein in the blood, toxins such as uremic waste, and blood cell counts; (c) Sonography (ultrasound examination of the kidneys), using a transducer, this non-invasive test produces sound waves that transmit a picture of the kidney to the operator, and may reveal the presence of kidney stones, cysts, or other obstructions; (d) Urine tests; and (e) CAT scan, also known as computed tomography or CT. This method uses a combination of computer technology and X-rays to produce views of the kidney; dyes cannot normally be used in cases of kidney disease.

Subsequent to the completion of initial diagnostic protocols, treatment will be established depending upon the diagnosis that is established. In the case of end-stage renal disease, treatment may include: specific dietary requirements; hospitalization; diuretic therapy including pharmaceuticals to increase urine output (diuretic drugs) and increased fluid intake, both orally and by administration of IV (intravenous) fluids to ameliorate depleted blood volumes; medications to control/avoid hypertension; and… [END OF PREVIEW]

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