Assignment Instructions:
- Review the case study scenario below and the client’s family history and medical profile information from unit 1.
- Next, write a 6-8-page paper analysis of the client (including title and reference page) according to the assignment specifications, outline, and grading rubric.
Case Study 1 Scenario:
Client, Sarah Collins, has chronic kidney disease. She receives dialysis twice a week. Today when Mrs. Collins arrives at the dialysis clinic, the nurse assesses Mrs. Collins and notes her blood pressure is 145/90 mm Hg and she has gained three pounds since her last visit. Mrs. Collins tells the nurse she was trying earlier to walk to her mailbox at the end of the driveway and couldn’t because she was out of breath. Mrs. Collins’ husband and 16-year-old grandson are at the clinic with her.
Case Study Analysis Assignment Outline:
The case study analysis paper should include the following sections with responses and rationales for all the prompts.
Introduction (3-5 paragraphs)
Provide an overview of the pathophysiology of the disease exhibited by the client. Include:
- What additional assessment findings would you look for?
- What lab abnormalities would you expect to see?
- What diagnostics would you anticipate the healthcare team ordering?
- Provide a rationale for your answers.
Implications for Self-Care (2 paragraphs)
- Consider Maslow’s hierarchy of needs and describe where the client falls in that hierarchy and how this will impact care and healing.
- How does this disease process impact the client’s and/or their care provider’s ability to care for themselves?
Patient Education Strategy (2-3 paragraphs)
- Identify 3-5 appropriate nursing interventions and teaching points for your client based on the pathophysiology and assessment findings.
- Describe the educational strategies that should be incorporated when building a plan of care for your client.
- Support with rationale.
Interdisciplinary Collaboration (2-3 paragraphs)
- Identify 2-4 interdisciplinary team members who need to be included in the care of the client. Include rationale.
- Consider the care the client will need while inpatient and upon discharge.
- Consider nutrition, community services, and financial implications.
Conclusion
- Summarize the key concepts of this disease process and client case study scenario.
References
- A minimum of three references should be used in this paper.
- References should be no more than five years old. Exceptions include seminal works, such as original publications by nurse theorists.
- One reference must be your textbook,
- One reference must be from a peer-reviewed journal,
- One reference must be from an authoritative website such as the CDC, NIH or Healthy People 2030.
Title: Case Study Analysis: Chronic Kidney Disease in Sarah Collins
Introduction:
Chronic Kidney Disease (CKD) is a progressive, irreversible condition characterized by the gradual loss of kidney function over time. It can result in various complications due to the accumulation of waste products and electrolyte imbalances in the body. In this case, we will analyze the scenario of Sarah Collins, a CKD patient receiving dialysis twice a week. Her blood pressure is elevated at 145/90 mm Hg, and she has experienced a three-pound weight gain since her last visit. Additionally, Mrs. Collins reports experiencing breathlessness while attempting to walk to her mailbox. To provide comprehensive care for Mrs. Collins, it is essential to consider the pathophysiology of CKD, additional assessment findings, expected lab abnormalities, diagnostic tests, and the rationale behind these considerations.
Pathophysiology of CKD: Chronic Kidney Disease involves the gradual and irreversible loss of nephron function, which leads to impaired filtration, electrolyte imbalance, and the retention of waste products in the body. The pathophysiology of CKD can be summarized as follows:
- Decreased Glomerular Filtration Rate (GFR): As CKD progresses, the GFR decreases, resulting in the impaired removal of waste products and excess fluid from the bloodstream.
- Electrolyte Imbalance: The impaired kidney function leads to abnormalities in electrolyte levels, such as hyperkalemia and hyperphosphatemia.
- Hypertension: CKD often causes hypertension due to increased fluid volume and activation of the renin-angiotensin-aldosterone system.
- Anemia: Decreased erythropoietin production by the kidneys can result in anemia.
Additional Assessment Findings: In addition to the presented information, further assessment findings to look for in CKD patients include:
- Presence of edema (peripheral and pulmonary).
- Signs of anemia, such as pallor and fatigue.
- Changes in urine output, including oliguria or anuria.
- Presence of uremic symptoms, such as nausea, vomiting, and pruritus.
- Fluid overload manifestations, including crackles in the lungs and elevated jugular venous pressure.
Lab Abnormalities: Expected lab abnormalities in CKD patients may include:
- Elevated serum creatinine and blood urea nitrogen (BUN) levels.
- Elevated potassium levels (hyperkalemia).
- Low hemoglobin and hematocrit levels (anemia).
- Elevated phosphorus levels (hyperphosphatemia).
- Metabolic acidosis (decreased bicarbonate levels).
Diagnostic Tests: The healthcare team may order the following diagnostic tests for Mrs. Collins:
- Serum creatinine and BUN to assess kidney function.
- Electrolyte panel to evaluate potassium and phosphorus levels.
- Complete blood count (CBC) to assess hemoglobin and hematocrit levels.
- Arterial blood gases (ABGs) to assess acid-base balance.
- Renal ultrasound or CT scan to assess kidney structure.
- Echocardiogram to evaluate cardiac function due to fluid overload.
- Renal biopsy if necessary to determine the cause and severity of CKD.
Rationale: These assessments and diagnostics are essential to monitor the progression of CKD, identify complications, and guide treatment decisions.
Implications for Self-Care:
Considering Maslow’s Hierarchy of Needs, Mrs. Collins falls primarily in the physiological needs category, given her chronic illness and the need for dialysis. However, her breathlessness and weight gain indicate potential issues with oxygenation and fluid balance, which are also physiological needs. This impacts her ability to perform basic self-care activities.
The disease process significantly affects Mrs. Collins’ and her caregivers’ ability to care for themselves. Her dependence on dialysis for waste removal and fluid balance means she needs frequent medical interventions. This creates a reliance on healthcare professionals and an increased burden on her caregivers.
Patient Education Strategy:
- Fluid and Sodium Restriction: Educate Mrs. Collins on the importance of restricting fluid intake and adhering to a low-sodium diet. Provide tips for monitoring daily fluid intake.
- Medication Adherence: Ensure Mrs. Collins understands the purpose of her medications (e.g., antihypertensives, erythropoietin) and the importance of compliance.
- Signs of Complications: Teach Mrs. Collins to recognize and report signs of fluid overload (e.g., shortness of breath, weight gain) and electrolyte imbalances (e.g., muscle weakness, irregular heartbeats).
- Lifestyle Modifications: Discuss the importance of regular exercise within her physical limitations and stress the need to quit smoking if she is a smoker.
- Home Monitoring: Instruct her on monitoring her blood pressure at home and maintaining a record.
Rationale: These educational strategies address Mrs. Collins’ immediate needs and empower her to actively participate in her care, promoting better outcomes.
Interdisciplinary Collaboration:
- Nephrologist: Essential for managing CKD and dialysis, adjusting medications, and determining the frequency and adequacy of dialysis.
- Dietitian: Required to develop a personalized diet plan, emphasizing sodium and fluid restrictions, and addressing nutritional deficiencies.
- Social Worker: Assists in addressing financial implications, psychosocial support, and access to community resources such as support groups.
- Cardiologist: Given the elevated blood pressure and breathlessness, cardiology consultation may be needed to assess and manage cardiac complications.
Conclusion:
Chronic Kidney Disease is a complex condition that requires a multidisciplinary approach to care. Understanding the pathophysiology, conducting thorough assessments, and educating the patient are essential components of managing CKD effectively. Collaboration among healthcare team members is crucial to address the diverse needs of patients like Mrs. Collins and optimize their quality of life.
References:
- Your Textbook (Author, Year).
- Authoritative Website (CDC, NIH, or Healthy People 2030).
- Peer-Reviewed Journal Article (Author, Year).