Nursing and Kidney Failure Term Paper

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[. . .] In addition, age should be a modifying factor, especially in moderate kidney impairment. These changes would allow identification and treatment of clinically relevant disease and avoidance of what can seem exaggerated prevalence estimates." (Bauer, 2008) These insights are showing how the inability to accurately screen for the condition is compounding the problem. To deal with these challenges, a new approach must be taken. This will help to improve the accuracy of test results and identify the possible impacts on patients.

Relationship to Individual Advanced Role

This problem relates to advanced practice nursing, as these individuals are quickly becoming the primary care provider for the patient. This means that they will help with screening the person and discussing the condition with them / their families. During this process, the nurse will serve as mentor, coach, educator and healthcare professional. Their job is to identify their condition as early as possible, discuss the long-term ramifications and educate the patient / caregivers about the importance of making changes in their lives. When this happens, they can effectively intervene and prevent their condition from becoming worse. (Roy, 2014)

A good example of this can be seen with insight from Miller (2006) who said, "Chronic kidney disease in adults is associated with complications that require nursing interventions in both the inpatient and outpatient settings. Given the progressive nature of the disease and the complexity of the treatment regimen, it is important that nurses be comfortable implementing acute and preventive care strategies and facilitating the coordination of care. In addition, the need for multiple therapies can be distressing for patients and their families, further supporting the role of the nurse in patient and family education and decision making regarding the plan of care." (Miller, 2006) These insights are showing how healthcare professionals must have greater amounts of flexibility in working with patients. This means that they need to understand what the patient is going through and be prepared to help them in the long-term. It is at this point, when they can be effective in reducing the chances of the patient having complications.

Critical Analysis of Relevant Literature

In general, most intervention strategies focused on having the patient receive specific treatment options such as dialysis and insulin. According to a study conducted by Mehran (2004), these strategies have been shown to be successful to a certain extent with him saying, "Chronic kidney disease (CKD) is a frequent complication of diabetes mellitus. However, the role of CKD in outcomes of patients with diabetes who have undergone percutaneous coronary intervention (PCI) has not been studied specifically. Therefore, we investigated the impact of CKD on prognosis of patients with diabetes who underwent PCI. Of 1,575 diabetic patients who underwent PCI, 1,046 (66%) had preserved renal function, 492 (31%) had CKD (baseline serum creatinine >1.5 mg/dl or estimated glomerular filtration rate <60 ml/min/1.73 m2) without dialysis, and 37 (2.3%) were dependent on dialysis. Patients with CKD vs. those without CKD had more in-hospital complications, including mortality (2.6% vs. 0.5%, respectively; p <.0001), neurologic events (3.1% vs. 0.6%, p = 0.0001), and gastrointestinal bleeding (2.9% vs. 0.9%, p = 0.01). Contrast-induced nephropathy after PCI (increase ?25% and/or ?0.5 mg/dl of serum creatinine before PCI vs. 48 hours after PCI) was found in 15% of patients without CKD versus 27% of those with CKD, and de novo dialysis was instituted in 0.1% versus 3.1%, respectively. Contrast-induced nephropathy was independently predicted (all p <.0001) by peri-PCI hypotension (odds ratio [OR] 2.62), insulin treatment (OR 1.84), and volume of contrast medium (OR 1.30). The 1-year mortality rate was strikingly higher (all p <.0001) in patients with CKD who did not receive dialysis (16%) and those on dialysis (44%) compared with the group with preserved renal function (5%). Contrast-induced nephropathy was among the independent predictors of a 1-year mortality rate (OR 2.75, p <.001)." (Mehran, 2004) These insights are illustrating how medically based interventions are effective to a certain extent. This can help to address their problems in the short to medium term. However, the challenge is looking at and addressing other factors which can contribute to chronic kidney failure. This is from taking a purely scientific approach to understand what is happening.

Moreover, Navaneethan (2009) found that the individual must make changes in their lifestyle and activities. In order to prevent their condition from becoming worse with him saying, "Obesity is an independent risk factor for development and progression of chronic kidney disease (CKD). We conducted a systematic review to assess the benefits of intentional weight loss in patients with non-dialysis-dependent CKD and glomerular hyperfiltration. Thirteen studies were included. In patients with CKD, body mass index (BMI) decreased significantly (weighted mean difference [WMD] ?3.67 kg/m2; 95% confidence interval [CI] ?6.56 to ?0.78) at the end of the study period with nonsurgical interventions. This was associated with a significant decrease in proteinuria (WMD ?1.31 g/24 h; 95% CI ?2.11 to ?0.51) and systolic BP with no further decrease in GFR during a mean follow-up of 7.4 mo. In morbidly obese individuals (BMI ???L?H?]??Y?[???[?][?

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