Introduction
Nursing in context evaluates the application of nursing principles given a healthcare situation. It seeks to evaluate the responses a nurse would employ in addressing the situation comprehensively as the lead healthcare consultant who brings together a multidisciplinary team of healthcare professionals to provide the best service to the patient in question.
Rationale
I selected scenario 3 detailing the medical history of a renal patient disorder. I selected this scenario based on several reasons. The medical condition presented in the scenario is affecting more people globally regardless of their age due to changing lifestyles. At least 1 in 2000 people in the UK is at risk of developing End Stage Renal Disease (ESRD) (Rightdiagnosis.com, 2012). Renal disorders have also been prevalent among children. A study by the University of Ulster, (2003) revealed that in 2002, Cystic kidney disease occurred in 6.8 per 10,000 births in the UK. Against these statistics patients suffering from renal disorders have a 94% of surviving if healthcare professionals adhere to appropriate medical procedures and practices in responding to varying renal disorder cases (Chertow et al, 2004). Application of appropriate nursing and principles and practices can adequately reverse the patient’s condition while educating family and community members on the preventative, measures they can put in place to keep renal disorders at bay (Woodward, Webb & Prowse, 2005).
Physiology
The main function of kidneys is to remove waste products such as urea, excess salts and urea from the body in form of urine (Carr, Prien & Babayan, 1990). This function is dependent on the ability of the nephrons to filter or remove the waste products from the blood a role that is aided by hormones and osmotic pressures on the body (Cavendish, 2008). To many people this process takes place normally. This physiological process can however, be altered by deposition of chemical substances such as calcium or excess sodium, which manifest inside the kidneys in form of “kidney stones”. These “stones” cause pain inside the kidneys, that becomes unbearable when pressed. Moreover, the body can suffer hormonal imbalance thereby incapacitating the functioning of kidney, which results in kidney failure.
Mr. J has experienced several physiological changes since he experienced pain while at work. He complains of unbearable intermittent pain, feels nauseated and sweats profusely. Mr. J also noticed changes in his urine colour and output. While at work the following day, Mr. J felt pain radiate on the left of his abdomen. Going by the changes, he had observed in his urine, the sweating and the position at which he felt the pain it was logical to conclude that Mr. J was suffering from a renal disorder. A CT scan showed calcium oxalate crystals in the left kidney calyx, which confirmed a diagnosis of renal calculi. The patient needs to undergo surgery to remove the calcium crystals or “kidney stones” the condition being referred to as renal calculi. Since Mr. J registers excruciating pain as reflected on the pain scale of 10, needs to be on patient controlled analgesics or painkillers to lessen his pain and enable him perform simple tasks such as feeding and washing.
Renal disorders are curable especially when they diagnosed in their early stages of development (McCormack, 2009). Experts put the recovery rate of renal conditions in such cases at 94% (. Recovery is largely pinned on the patients accepting to change their lifestyles especially in terms of dieting. Going by the symptoms Mr. J exhibits, his condition presents a fast progressing renal disorder or late diagnosis. At 34, he is generally young and adherence to a daily activity routine should see him regain full recovery. First, he needs to alter his diet by eating foods prepared with less sodium and salt. He should take less than 1,500 mgs of sodium daily. He can ensure this by rinsing canned foods prior to eating as well as using herbs in place of salt. He also needs to eat the right kind of proteins such as white meat instead of red one as well as fruits and non-fatty foods to ensure fat does not build up in his heart and kidneys. He should also keep off smoking and drinking alcohol. Other than these substances affecting the hormonal balance of the body, they also overwork the organs such as the kidneys, the lungs and the liver when being removed as waste products.
Effects of renal Disorders on Activities of Daily Life (ADLs)
The condition from which Mr. J is suffering from should not interfere with his participation in Activities of Daily Life (ADLs) such as personal hygiene and grooming, self feeding, dressing and undressing. The pain he feels may limit his movement around the house and at such times he should take analgesics to lessen the pain. He should also be able to manage bladder and bowel movements and generally perform all the basic ADLs with little assistance. Mr. J also needs to adhere to light exercises to increase metabolic activity, blood circulation, the removal of waste products and the avoid accumulation of fat in vital body organs such as the heart.
There are several parties involved in the care of renal disorders patients. These include a pharmacist, doctor, dietician, district nurse among others. First, there are doctors who work as a team led by urologists whose role is to accurately diagnose, perform the necessary medical procedures such as surgery and prescribe medication and general treatment of the renal disorder from which Mr. J is suffering. The pharmacists issue and advise the patient on medication. According to the Nursing Standard (2012), the district nurse documents and analyses case-by-case healthcare procedures followed in responding to certain medical conditions in order to develop a working medical strategy to respond to future cases. The nurse is acts as the link to all the professionals and the family members in ensuring that the patient recuperates in the best manner possible (Department of Health, NHS, 2012). She checks and administers medication, monitors changes in body weight, blood pressure, respiration, body temperature and pulse rate. With the assistance of health care assistants, the nurse analyses the fluids from the patient for salts and hormonal balance to ensure the condition does not recur. She then reports her findings to the relevant professional for appropriate action such as change of medication to be effected (Finch et al, 2008).
A dietician is a critical professional in the recovery of renal disorders. He identifies and recommends nutritional requirements of patients. They also recommend and monitor the patient’s daily intake of food. A dietician can also teach family members on the prescribed diet for the patient who can monitor the patient closely. The patient may be more comfortable being attended to by people familiar to him. In this case Mr. J has a close brother who he can rely on to execute instructions from the dietician. Whether a patient recuperates in a hospital setting or under home-based care, immediate family members play a critical role in aiding their loved ones get better (Lathlean, 2007). Manley (2004), family members ought to most importantly offer love, emotional support and encouragement to the patient. Mr. J is lucky to have a close brother and parents by his side who can assist him to execute some chores and also offer him moral support and encouragement by cheering him up.
Discussion
The renal disorder has had a drastic impact on the life of Mr. J. He feels unbearable intermittent pain on the left side of his abdomen as well as a host of other extreme symptoms of a renal disorder such as sweating, nauseating and changes in his urine. These conditions have compelled him to discontinue working. A renal disorder like the one from which Mr. J is suffering has the potential to progress into full-blown Critical Renal Failure CRF in which he could be fully reliant on dialysis machines.
Conclusion
Nursing response to renal disorder to Mr. J highlights a fight against a medical condition that can be adequately and effectively addressed. The patient exhibited all the basic symptoms of a renal disorder, which was conformed as renal calculi or kidney stones. The condition can be cured through removal of the calcium crystals. The nurse acts as the link between a multidisciplinary team of healthcare professional comprising of doctors, pharmacists, dieticians among others, the patient and the family members. To lessen the pain the patient needs to use analgesics while full recovery calls for a change of lifestyle including consumption of less salt and keeping of cigarettes and alcohol.
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