Patient Educational Plan Essay Paper

August 18, 2012

The patient suffers from the chronic renal failure. In fact, the chronic renal failure (CRF) is a very serious disease which may represent a serious threat to the life of a patient. In fact, for a considerable period of time, this disease was considered to be incurable, but the development of the modern science and the progress of the medicine opened larger opportunities for healthcare professionals to treat CRF effectively. Nevertheless, it is still very important to diagnose the development of the disease at the early stages since the early diagnosis allows treating the CRF more effectively than diagnosing at the late stages of the disease.

The patient is a male at the age of 38. The chronic renal failure was diagnosed at the early stage of the disease development and the patient has already started to undergo the treatment, including medication that minimizes the development of negative effects of the disease and slows down its progress. The patient belongs to the middle class with the higher education. The patient has developed a successful professional career but his current health problems prevent him consistently from the maintenance of his traditional life style, while his career opportunities have reduced substantially because of his health problems (Giri, 2004). At the same time, the patient noticed early problems related to the chronic renal failure six years ago and, on detailed examination, he was diagnosed with the progressing chronic renal failure.

At that time, the patient was unprepared to the disease because he did not know what the essence of the disease is, what its major causes and effects are but he definitely suffered from the ongoing deterioration of his health, which was slowed down by health care professionals when the treatment had got started. In such a context, the patient definitely needs to get educated to learn more about the disease. The educational plan would focus on provision of the patient with detailed information on the causes of the disease, its development and possible treatment.

First of all, it is necessary to start with the causes of the chronic renal failure because the patient should know the causes to minimize the risk of the ongoing exposure to risk factors which can cause the deterioration of his health. The major causes of the chronic renal failure are presented in the following table:

Cause Examples
Prerenal
ECF volume depletion Excessive diuresis, hemorrhage, GI losses, loss of intravascular fluid into the extravascular space (due to ascites, peritonitis, pancreatitis, or burns), loss of skin and mucus membranes, renal salt- and water-wasting states
Low cardiac output Cardiomyopathy, MI, cardiac tamponade, pulmonary embolism, pulmonary hypertension, positive-pressure mechanical ventilation
Low systemic vascular resistance Septic shock, liver failure, antihypertensive drugs
Increased renal vascular resistance NSAIDs, cyclosporine

, tacrolimus

, hypercalcemia, anaphylaxis, anesthetics, renal artery obstruction, renal vein thrombosis, sepsis, hepatorenal syndrome

Decreased efferent arteriolar tone (leading to decreased GFR from reduced glomerular transcapillary pressure, especially in patients with bilateral renal artery stenosis) ACE inhibitors or angiotensin II receptor blockers
Renal
Acute tubular injury Ischemia (prolonged or severe prerenal state): Surgery, hemorrhage, arterial or venous obstruction, NSAIDs,cyclosporine

, tacrolimus

, amphotericin B

Toxins: Aminoglycosides, amphotericin B

, foscarnet

, ethylene glycol, hemoglobin (as in hemoglobinuria), myoglobin (as in myoglobinuria), ifosfamide

, heavy metals,methotrexate

, radiopaque contrast agents, streptozotocin

Acute glomerulonephritis ANCA-associated: Crescentic glomerulonephritis, polyarteritis nodosa, Wegener’s granulomatosis

Anti-GBM glomerulonephritis: Goodpasture’s syndrome

Immune-complex: Lupus glomerulonephritis, postinfectious glomerulonephritis, cryoglobulinemic glomerulonephritis

Acute tubulointerstitial nephritis Drug reaction (eg, β-lactams, NSAIDs, sulfonamides,ciprofloxacin

, thiazide diuretics, furosemide

,cimetidine

, phenytoin

, allopurinol

), pyelonephritis, papillary necrosis

Acute vascular nephropathy Vasculitis, malignant hypertension, thrombotic microangiopathies, scleroderma, atheroembolism
Infiltrative diseases Lymphoma, sarcoidosis, leukemia
Postrenal  
Tubular precipitation Uric acid (tumor lysis), sulfonamides, triamterene

,acyclovir

, indinavir

, methotrexate

, Ca oxalate (ethylene glycol ingestion), myeloma protein, myoglobin*

Ureteral obstruction Intrinsic: Calculi, clots, sloughed renal tissue, fungus ball, edema, malignancy, congenital defects

Extrinsic: Malignancy, retroperitoneal fibrosis, ureteral trauma during surgery or high impact injury

Bladder obstruction Mechanical: Benign prostatic hyperplasia, prostate cancer, bladder cancer, urethral strictures, phimosis, paraphimosis, urethral valves, obstructed indwelling urinary catheter

Neurogenic: Anticholinergic drugs, upper or lower motor neuron lesion

ANCA = antineutrophil cytoplasmic antibody; GBM = glomerular basement membrane.
*Myoglobin also has toxic effects on the kidneys.

 

Source: Acute Renal Failure (2009).

Furthermore, the patient should learn the essence of the disease. In fact, this disease is accompanied by a progressive loss of renal function over a period of months or years through five stages. Basically, each stage is a progression through an abnormally low and deteriorating glomerular filtration rate, which is usually determined indirectly by the creatinine level in the blood serum. In order to diagnose the disease, it is necessary to identify basic symptoms which accompany the development of the disease. In fact, the CRF is accompanied by the increase of the blood pressure due to fluid overload and production of vasoactive hormones. Furthermore, urea accumulates, leading to azotemia and ultimately uremia, when urea is excreted by seating and crystallizes on skin. Potassium accumulates in the blood and erythropoietin synthesis is decreased. Also the disease is accompanied by fluid volume overload and hyperphosphatemia, which is provoked by the reduction of phosphate excretion. Finally, metabolic acidosis may progress due to decreased excretion of bicarbonate by kidney (Giri, 2004).

The diagnosing of the CRF is often based on previous renal problems of patients, because, as a rule, the disease progresses on the basis of other renal problems. At the same time, it is important to distinguish the CRF from the Acute Renal Failure (ARF) because ARF can be reversible. Abdominal ultrasound is commonly performed in order to diagnose the disease and with its help the size of kidneys is measured. Another effective tool of diagnosing the disease is the measurement of the level of creatinine since a gradual rise in serum creatinine indicates to the progress of the CRF, especially, if this rise is opposed to a sudden increase in the serum creatinine. Additional tests may include nuclear medicine MAG3 to confirm blood flows and establish the different function between the two kidneys. DMSA scan are also used in kidney imaging (Giri, 2004).

In fact, there are five stages of the CRF (Giri, 2004):

Stage 1: Slightly diminished function; Kidney damage with normal or increased GFR (>90 mL/min/1.73 m2). Kidney damage is defined as pathologic abnormalities or markers of damage, including abnormalities in blood or urine test or imaging studies.

Stage 2: Mild reduction in GFR (60-89 mL/min/1.73 m2) with kidney damage. Kidney damage is defined as pathologic abnormalities or markers of damage, including abnormalities in blood or urine test or imaging studies.

Stage 3: Moderate reduction in GFR (30-59 mL/min/1.73 m2)

Stage 4: Severe reduction in GFR (15-29 mL/min/1.73 m2)

Stage 5: Established kidney failure (GFR <15 mL/min/1.73 m2, or permanent renal replacement therapy (RRT).

The causes of the disease may be vascular, glomerular, tubuloininterstitial, or obstructive.

The treatment targets at the slowing down of the progression of the CRF to the stage 5. Basically, the treatment includes the control of the blood pressure, the replacement of erythropoietin and vitamin D3, and at the stage 5, the renal replacement therapy is used.

Obviously, the treatment of the patient and the development of the disease will raise a number of challenges the patient will need to overcome. Therefore, health care professionals should prepare the patient to these challenges. In this respect, it is worth mentioning the fact that one of the major challenges the patient should be aware of is the necessity to change his traditional life style (Muther, 2009). In fact, fact the development of the CRF forces the patient to change his life style to avoid the deterioration of his health. For instance, the patient needs to change his diet and focus on the consumption of the food that acceptable in case of the development of the CRF (Lameire, 2009). In addition, he should be very careful in regard to physical activities to minimize exhaustion of the body that increases the risk of the deterioration of his health and accelerated development of the CRF. Furthermore, the patient will face the problem of the maintenance his professional performance because his health problems can distract him from his professional job and he may face the problem of being unable to perform all his professional duties as well as he used to. Consequently, the patient is likely to have problems with his further promotion and career development. At this point, the psychological assistance may be very helpful because the deterioration of career prospect can cause depression and other psychological problems, which, in their turn, can provoke the deterioration of the physical health of the patient.

Nevertheless, the patient should learn as much as possible about the CRF, its causes, essence, development and treatment. The patient should be confident in health care professionals and aware of potential risks, which he has to minimize through the change of his life style. The recommendations give above may be helpful and the treatment of the patient with the CRF can be successful. In this respect, the understanding of the essence of the disease by the patient may be crucial because if the patient is aware of his health problem, its  causes and effects as well as possible and effective treatment, he will be able to cooperate with health care professionals effectively and tackle his health problem successfully.

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