Quality of Life and the Patient With Renal Failure Research Proposal

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Quality of Life and the Patient With Renal Failure

Quality of life

The patient in this case study is known as Mrs. E.S. She was admitted to the Renal Medicine Unit on the September 25, 2009, after a diagnosis of renal failure. The patient was born on the 31st of July 1922. Her weight at the time of admission was 77.270kg. Her height is 162.6cm. Her prior medical history includes breast cancer thirty years ago, which resulted in a hysterectomy of the left breast. Other relevant medical aspects include stents to the heart (2005), hypertension, gout, and arthritis of hands and legs, a cataract removed in both eyes and TIA. Currently, she is undergoing hemodialysis three times a week. Allergies include Penicillin and CT dye, but she has no food allergies.

In terms of family background, relatives and caregiving, her husband is the major caregiver and they both live in the same house. She also has a daughter, son and four grandchildren and they live outside her own city (Mississauga). They visit once a month but still keep in touch by calling twice daily.

Mrs E.S. is aware of and understands her diagnosis. In terms of independence and dependency factors she is dependent and finds self-care problematic.

1. Introduction

Simplistically stated, renal failure is essentially a serious medical condition affecting the kidneys which do not function adequately. This failure can be "…a progressive disease or a temporary one depending on the cause and available treatment options" (What is Renal Failure?) One has to distinguish between acute and chronic renal failure. Acute renal failure is described as the "… sudden loss of the ability of the kidneys to remove waste and concentrate urine without losing electrolytes" (Acute kidney failure). Chronic renal failure is a condition that typically develops over a number of years as a result of the progressive damage to the internal structure of the Kidneys. Symptoms of renal failure in this case often are hidden and are not obvious until kidney function is less than one-tenth of normal (Acute kidney failure).

Unlike acute failure, chronic renal failure becomes progressively worse over time and can range from mild kidney dysfunctionality to severe kidney failure -- which is the case in the patient under discussion. This condition may also lead to end-stage renal disease or ESRD.

As is the case with Mrs. E.S., renal failure is often diagnosed in its chronic phase in older patients. The literature points out that this fact is has only recently been established through research (Beeson et al., 2009, p 245). Importantly from a nursing and healthcare perspective, this disease also has a number of comorbid implications. These include, among others, the following, "Increased cardiovascular risk, secondary complications such as renal anemia and bone disease and a small but significant risk of progression to established renal failure ( ERF)" (Beeson et al., 2009, p. 245). As will be discussed, these aspects also refer and relate to the important issue of quality of life. This also refers to psychological as well as socio-psychological aspects that play a significant role in the management and treatment of these patients.

Related to the above is the research finding that; "Chronic kidney disease or CKD is becoming increasingly common. The United States Renal Data System has reliably estimated that the number of patients on maintenance dialysis in the United States will double over the next few year"(Locatelli and Pozzoni, 2006, p. 2118). This applies particularly to the elderly: "The increased incidence of CKD among the elderly translates into a similarly increased prevalence" (Locatelli and Pozzoni, 2006, p. 2118). The Third National Health and Nutrition Examination Survey (NHANES III) of a nationally representative sample of adults in the United States between 1988 and 1994 found that, "7.6% of the individuals aged 60 -- 69 years, and 25.9% of those aged at least 75 years, had a glomerular filtration rate (GFR) of 15 -- 60 ml per minute per 1.73 m2, as against only 1.8% of those aged 40 -- 59 years and 0.2% of those aged less than 40 years (Locatelli and Pozzoni, 2006, p. 2118/9).

With regard to general treatment, dialysis patients require a "constraining" regime of protocols and care; which includes regular hospital for treatment and ongoing monitoring (Tyrrell et al., 2005, p. 374). It also a significant to note that since the inception of treatment for this condition by means of dialysis there have been an increasing number of older people who have undergone this intervention; for example, "… in 1991, 18,000 patients received dialysis and only 5.5% of them were more than 80 years old; three years later, about 20,000 patients underwent dialysis procedures and 10% of these were more than 80 years old…" ( Tyrrell et al., 2005, p. 375).

As a result this has become a relatively common treatment for older patients and the outcome in terms of recovery has also improved ( Tyrrell et al., 2005, p. 375). However, the focus of this paper will be on the quality of life associated with various interventions and the way that the patient and family are affected and cope with this condition.

2. Background

The patient in this study has a long history of ailments and illness. The overall health and psychological as well as existential perceptions and outlook of the patient have to be taken into account. Her situation in terms of quality of life is compounded by the dialysis treatment, and this in turn has a number of important effects and consequences. These have to be considered in the light of management and coping strategies as well as in treatment protocols. Central to this analysis is the impact on the family and immediate caregivers.

2.1. The impact on family

A very insightful study into the affect on the family and the spouse of the patient undergoing dialysis is by Ziegert et al. (2006). "When a patient is stricken by a chronic disease, his/her everyday life changes as do the lives of his/her spouse and other family members who are emotionally and socially close to the patient " (Ziegert et al., 2006, p.223). This article goes on to outline the type of demands made on family members. The authors note that, " Despite the fact that haemodialysis demands that next of kin support and assist the patient during the treatment period, little attention has been focused on their own health in this situation" (Ziegert et al.,2006, p.223).

The point being made is that the spouse or the immediate caregiver has to endure a great deal of uncertainty within their own lives as a result of the demands of the dialysis treatment. This can lead to various negative outcomes, for example, "the uncertainty in relation to the patient's health leads to resignation in everyday life. It is also well-known that next of kin of patients on haemodialysis can suffer from fatigue and depressed mood as well as guilt and hopelessness (Ziegert et al.,2006, p.223).

Not only does this article suggest that dialysis places a great deal of stress on the spouse but it also adds to the responsibility that he or she might feel as they have to maintain a supportive role.

This aspect will be explored in more detail as it relates particularly to the question of quality of life. This refers as well to the overall quality of life that is a combination of the patient, her family and living environment. As noted, the patient in question in this study is supported almost entirely by her husband. Both are elderly and the fact that she has to rely on her husband has created areas of anxiety in her life, which has compounded and exacerbated the difficulties of treatment. As Ziegert points out, "…the care for and worry about the patient can lead to the relationship between the spouses becoming complicated and fraught with responsibility, a situation that can become strenuous for both of them (Ziegert et al. 2006, p. 227).

This is an important point and one that will be pursued in terms of theories of existential and holistic care that should guide nursing protocol. Furthermore, this perspective or trajectory of thought has in turn necessitated a more cautious and psychologically sensitive approach in terms of management and treatment protocols. As will be elaborated on, an area that is lacking in much of the literature or which could be better understood and implemented is the spiritual or religious dimension of treatment as it pertains to improving quality of life.

3. Overview of the relevant literature

Some aspects of the nursing literature pertinent to this case have been referred to above. However, there are a number of other aspects in terms of the issues and challenges that face the patient and family experiencing a complex health challenge. This also relates to the topic of quality of life. Tyrrell et al. (2005) discuss the definition and assessment of the quality of life. This refers to a combination of medical, sociological and psychological factors that contribute to the… [END OF PREVIEW]

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