Personal Impact
Personal Impact: Living with Chronic End-Stage Renal Disease NUR427 October 3, 2011 Personal Impact: Living with Chronic End-Stage Renal Disease The Chronic disease I chose is chronic end-stage renal disease. End-stage renal disease is when there is a permanent loss of total renal function. End-stage renal disease, is also known as chronic kidney disease (CKD), with five stages. The fifth stage is the most severe stage, this is when the patient needs to begin dialysis, or be transplanted to survive.
The Center for Disease Prevention and Control ranks End stage renal disease the ninth leading cause of death in the United States (“Center For Disease Control And Prevention”, 2010). New cases of ESRD in African Americans is 3. 7 times greater than the rate of Caucasians (Wells, 2011). Conditions that can be contributing factors in loss of renal function are: Diabetes, Hypertension, Glomerulonephritis, Cystic Kidney, and a list of others.
Signs and symptoms of kidney failure are: decreased amount of urine, edema, shortness of breath, nausea and vomiting, poor appetite, metallic taste in the mouth, hiccups, weight loss or weight gain with fluid, fatigue, confusion or mental slowness, leg cramps and itching. These symptoms can present together or by themselves. Anyone can develop kidney failure due to a number of reasons. The people more at risk for developing kidney disease are older people, African-Americans, those who have a family history of CKD especially polycystic disease, Latinos and American Indians especially with type 2 diabetes.
As of 2008 there were more than 550,000 patients receiving renal replacement therapy, coined RRT. The types of renal replacement include, hemodialysis, peritoneal dialysis, home hemodialysis, and transplantation. The cost of ESRD programs in 2008 was approximately 39. 46 billion dollars annually, and has grown every year since. Patient Interview Debra Jones is a 53 year old, African-American female, who has been on dialysis for six months. She is currently dialyzing at a free-standing dialysis unit 5 miles from her mother’s home.
Prior to being diagnosis with end-stage renal disease, Ms. Jones was a practicing LPN for 25 years. Six months ago Ms. Jones noticed some changes in here body, and since she was an LPN she stated she was more aware of these changes. Her symptoms were weight loss, with generalized edema, fatigue, and increased blood pressure. Since she was currently employed she had access to a primary care physician, she schedule a visit. During her first visit the physician ran some blood test, completed a history and physical and scheduled an ultrasound of her kidney.
She was then schedule for a follow-up appointment to discuss the results of her test within a month. Review of test results, revealed she had lab values that indicated that she needed to see a nephrologists. Her physician increase her anti hypertensive medication, and referred her to a specialist. Ms Jones’ appointment was scheduled within the same month. Within two weeks, Ms Jones was told she needed to start hemodialysis. She was scheduled to have a subclavian catheter placed so she could begin her treatment.
First day of dialysis Ms Jones’ was given a tour of the facility and then spent time with a Social Worker, Dietician and a nurse. She was instructed on her dialysis schedule, given a list of foods she could and could not eat, fluid restrictions, and emergency preparedness information that included what to do if she could not get to the facility for dialysis and how to take herself off of the dialysis machine in the event of fire or any other natural disaster. She was also given a host of papers to read and sign.
Ms Jones, stated she felt very overwhelmed by all of the information she was given on the first day. She felt ashamed because she had been in nursing so long and was not aware of all the details surrounding kidney dialysis, so she asked very few questions initially. During her first treatment she had nausea and vomiting, because she had too much fluid removed during the treatment. Post treatment she felt horribly drained and fatigued. Social Impact Ms Jones has been divorced for 15 years and is not actively dating.
When she was initially told she had kidney failure, and had a subclavian catheter placed she was embarrassed to let anyone see her with something sticking out of her neck, especially a man. She felt unattractive, and thought everyone would know she was ill. So initially going to dialysis was the extent of her time spent outside of her home. Her family and colleagues were very supportive and visited her a lot which helped her not be depressed. Six months into the chronic condition she is more comfortable with her condition and is preparing to share this with her male friend.
She is still not comfortable going to the mall, or the grocery store with the catheter in her neck but she has returned to church on Sunday. Financial Impact. Ms Jones was employed as a licensed particle nurse prior to her diagnosis of chronic kidney disease. Her fatigue, and surgery to insert a fistula, has left her unable to maintain her employment, she had a number of sick days taken prior to her diagnosis, and some family medical leave, and after six months she had exhausted her leave and subsequently her job terminated her.
She had not been on her current job long enough to qualify for short-term disability. On one of her treatment days, she was approached by the social worker who encouraged her to apply for Medicare. Medicare eligibility with end-stage renal disease has its benefits, you can enroll in Medicare part A at any age if your kidneys fail, and you require dialysis or a kidney transplant. Ms. Jones has completed the appropriate forms for Medicare with the assistance of the social worker at the dialysis facility.
Two months into her current condition Ms Jones was totally without an income. She has since then rented out her home, and is currently living with her 82 year old mother. Personal Effects. Personally Ms Jones says she is adapting better as time goes on. Some issues that continue to bother her more than others are, not being able to shower and not get her catheter wet, so she has to bath in a tub which she is not a fan of. She also likes to swim and take water aerobics which she was also told she could not do until her fistula is healed completely.
She struggles with the fluid restriction, stating she does the best she can, and the diet. Being a fan of soul food, which has a lot of fried options is another big struggle for her. During one of her sessions with the dietician at the facility she was encouraged to drink ensure, and a supplement called nepro. That makes her feel old, because her mother also drinks ensure, so she seldom drinks it because of the stigma. Educational Experience. Searching the internet is how Ms. Jones has been obtaining information.
She did have an initial session with the nurse, social worker, and dietician. They are all available whenever she goes to treatment but she is not really comfortable enough to ask too many questions that she feels are personal. Educational booklets were given to her at the dialysis facility the first day, and she attended a class to explain different types of dialysis. She is interested in peritoneal dialysis, since this can be done at home but is concerned about body image. Theories and Motivators.
Wells (2011) states that knowledge deficit is a leading cause of non-adherence to treatment regimen, and for chronic renal failure, this is inclusive of diet, fluid restriction, medication compliance, and for Ms. Jones three day a week hemodialysis treatments with a run time of four hours. During the interview Ms. Jones is currently exhibiting behaviors that indicate she is not fully educated on her chronic condition. Ms Jones would benefit from one on one education with a member of her health care team, explaining the importance of adhering to her regimen.
It is also important that her educator be culturally sensitive, and provide information that is relevant to Ms. Jones’ culture. Educational programs need to be geared toward her cultural beliefs, values, morals, customs, tradition and communication patterns. Motivationally, with her body image issues, a mentor who is close to her age and has positive outcomes would be beneficial. Assessing her coping process and her family support is imperative. She also needs positive re-enforcement and continued support. Conclusion. Ms.
Jones was a pleasant educated patient who with continued education, motivation and support, can have a great quality of life if she adheres to her medical regimen. References Center for Disease Control and Prevention. (2010) kidney disease. Retrieved from http://www. cdc. gov/ Larsen, P. D. , & Lubkin, I. M. (2009). Chronic Illness: Impact and intervention (7th ed. ). Sudbury, MA: Jones and Bartlett. Wells, J. R. (2011, March-April). Hemodialysis Knowledge and Medical Adherence in African Americans Diagnosis with End Stage Renal Disease: Results of an Education Intervention. Nephrology Nursing Journal, 38(2), 155-161.
