Case Study: Analysis of Mary's Chronic Renal Disease and Diabetes Care

This case study examines the complex medical case of Mary, a 45-year-old woman suffering from chronic renal disease and type 2 diabetes. The assignment delves into Mary's medical history, including her lifestyle factors and emotional state, and details the pathophysiology underlying her conditions, particularly focusing on the progression of chronic kidney disease and its implications. It outlines the medications prescribed, such as ACE inhibitors and Beta-blockers, and discusses relevant medical diagnostics and treatments, including dialysis and dietary recommendations. The study also emphasizes the nursing care provided, including monitoring and evaluation processes, and identifies areas for improvement in nursing interventions. The analysis considers the impact of these interventions on Mary's overall health, addressing her physical and emotional well-being within the context of her chronic illnesses. The case study highlights the importance of comprehensive care, including medication management, dietary adjustments, and emotional support, in managing chronic conditions and improving patient outcomes.

COMPLEX CASE STUDY
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TABLE OF CONTENTS
Case study........................................................................................................................................3
Relevant medical history and present status................................................................................3
Describe the pathophysiology underlying the primary reason for the current hospital admission
.....................................................................................................................................................4
List the medication that has been prescribed for the diseases.....................................................5
Discuss relevant and current medical diagnostics/ treatment and its implications on health
aspects of Mary............................................................................................................................6
Log of daily activities to the nursing care.......................................................................................7
Monitoring and evaluation process for the implementation of nursing intervention................12
Identify effectiveness of nursing care provided to Mary and Areas of improvement...............13
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CASE STUDY
Relevant medical history and present status
Mary is a 45 years old women who is suffering from Chronic renal disease from last 8
months and instead of getting appropriate treatment her health condition is not getting improved.
She works in a supermarket for more than 10 hours a day and she does not live with her husband
as they both were separated 2 years ago. Two days back, she had a chronic attack and looking
towards the medical condition, her daughter decided to admit her in the hospital. The medical
condition of Mary is getting affected and as a result, doctors conducted a test wherein it is found
out that Mary has type 2 diabetes as well.
Further, it is also analysed that due to prolonged obstruction of the urinary tract, Mary
has the chances to develop kidney stones and some cancers as well (Krum and et. al., 2014).
While treating the patient, nurses have her calclum carbonate (Caltrate 600 tums) which
normalized her phosphate concentrations and this is also used as a supplement in the patient.
However, it is also observed that Mary soemtioems drinks too much which targets the blood
pressure and brings chronic pain in the kidney. Due to her busy schedule, she is not taking proper
diet which is further hampering her health condition. It is also identified that she is not active in
physical exercises; hence she is losing the stamina as well.
While carrying out a discussion session, it is ascertained that Mary feels alone sometimes
and due to such isolation, she drinks too much (Roth and et. al., 2015). Moreover, Mary is also
having other health complications which restricts her to involve in different activities and
practices. Her daughter also complained that she keeps herself busy in her work most often and
she do not talk or meet with her friends. Hence, due to lack of moral support, she feels emotional
sometimes. According to the current status, she is not discharged as the medical practitioners
have recommended rest for few days in hospital only.
Thus, according to the details of the case, the present research report is being made to
give suitable care and treatment to Mary in all respects. Moreover, in this context researcher has
also stated pathophysiology and medical processes conducted for Mary along with clear
justification. At the same time, focus has also been laid on nursing care that is being provided to
Mary when she is hospitalised (Barnett and et. al., 2014). In addition to this, based on the
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outcomes, areas of improvements are also ascertained so that nurses can improve the practices of
nursing intervention. In the process of nursing, monitoring and controlling holds more
importance because that gives clear idea about the nursing procedure; hence accordingly in the
present case also researcher has mentioned monitoring and controlling requirements of nurses.
Describe the pathophysiology underlying the primary reason for the current hospital admission
Chronic renal failure or chronic kidney disease slowly hampers the functioning of kidney
and it also brings other complications in the medical condition. Chronic renal failure is just
opposite to acute renal failure in which kidney gets damaged gradually over a period of time.
Typically, the progression is slow; hence the symptoms usually do not appear immediately until
it brings major damage to kidney (Andrassy, 2013). It is apparent that chronic renal failure is a
worldwide health problem and the cases are increasing at higher rate because people do not
identify the symptoms on initial basis. Medical history states that chronic kidney disease is more
prevalent in elderly population; however it can be treated if proper care and treatment is being
given to the patient.
Stating about the pathophysiology, it can be said that CKD (chronic kidney disease) has
direct association with risk of cardiovascular disease; thus it brings more complications in the
health aspects (Ortiz and et. al., 2014). The patient suffering from chronic renal failure has many
signs of metabolic acidosis in stage 5 which includes protein- energy malnutrition, muscle
weakness and loss of lean body mass. At the same time, anemia is also associated with chronic
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kidney disease which leads to fatigue, reduced exercise capacity and impaired cognitive and
immune function. Similarly, it also brings nee onset of heart failure which is highly risky for a
person. It is also ascertained that type 2 diabetes and high blood pressure are the major causes of
chronic renal failure which also brings inflammation disease in the kidney.
At the same time, according to past records, it is also ascertained that Mary has such
health complications because of diabetes or high blood pressure which is also damaging her
small blood vessels in the body. Mary is also getting increased urination especially during nights,
blood in urine and urine that is tea coloured. It is also been observed that due to overtime, she
fainted as well in the office which has raised her blood pressure level as well (Hall and et. al.,
2014). Therefore, the kidney failure gets worse and the toxins also continued to grow in the body
which also brings mental confusion in the body. There are several purposes for which Mary got
admitted in the hospital such as diabetes, high blood pressure and chronic renal failure.
According to the case scenario, it is also ascertained that Mary’s condition is not
improving because she is emotionally disturbed as well and nobody is there to give her mental
and moral support. Furthermore, in this respect it can also be said that due to chronic attack,
Mary is unable to adjust herself in the home and as a result, she has to get admitted. According to
the diagnosis, it is identified that her medical problems is increasing at a faster rate which needs
to be improved so that other body parts may not get affected (Moorhead, Johnson, Maas and
Swanson, 2014). Several changes are also suggested to Mary so that she can take appropriate diet
as per the health conditions. She is offered to have a low protein diet so as to slow down the
build-up of waste in the body and at the same time it also aids in limiting the nausea and
vomiting that can accompany chronic renal failure. Considering the same aspect, a dietician has
been appointed for her so that she can have appropriate protein diet.
List the medication that has been prescribed for the diseases
Apparently, medicines are required to be given to every patient so that the health
condition can be improved and at the same time, it can also bring more changes in the eating
patterns. In this case, special consideration is required to be given to Mary as she is having
several health problems. Since, she was hospitalised for many days; therefore it is essential for
the nurse to consider the importance of proper medication (Dougherty and Lister, 2015). Chronic
nurse has recommended dialysis for Mary which aids in removing excess fluids and waste using
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a membrane instead of a kidney. This is essential since kidney does not perform the function
properly due to renal failure. This is happening with Mary because of her sedentary lifestyle in
which she smokes and drinks. Though dialysis is not a cure; but it could assist Mary to follow
strict diet that is being prescribed by the doctors.
Earlier, doctors also recommended kidney transplant so that the issue of chronic renal
failure problem can be managed. This is ultimately suggested for the purpose of resolving kidney
related problems. However, at the same time for someone who have serious health problems may
also have increased risk of complications from surgery and antirejection medications. Since,
Mary has type 2 diabetes; therefore considering the same doctors have suggested medicines like
ramipril, perindopril, candesartan and losartan (Ferreira and et. al., 2013). These medicines are
useful for the purpose of improving the health conditions of Mary and at the same time they are
also given because of increased pressure on the kidneys. Such medications are being given to
Mary so that to reduce the level of blood pressure and also to slow the progression of kidney
dysfunction through reducing proteins in the urine. At the same time, it also reduce pressure in
the urine and kidneys which causes further damage to the body.
Currently, Mary is taking ACE inhibitors and Beta-blockers which helps in treating high
blood pressure. In the same manner, nurse has also carried out vasodilators so that blood pressure
level can remain balanced. However, the most prominent medicine that was given to Mary is
Erythropoietin so as to keep bones strong and healthy. Apart from this, the medicine is also
useful in increasing the levels of iron in the body which changes the blood transfusions.
Considering the medication process, Mary is also suggested to take steps to avoid the
onset of kidney failure and at the same time it also aids in recognising some of the initial warning
signs. While the chances of cure does not exist; however still it aids in minimizing the level of
complications and symptoms. This is the reason doctors have also recommended proper dietary
to Mary which is also essential to follow on continuous basis (Jha and et. al., 2013). However,
doctors have suggested Mary not to smoke because continuous smoking can speed up damage to
the small blood vessels in the body. Chronic nurses are also engaged in monitoring blood
pressure regularly so that to limit the health conditions (Chawla, Eggers, Star and Kimmel,
2014). The chances of hypertension could also appear; henceforth in this context, Mary is sternly
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suggested to follow the process of treatment. However, looking towards the present health
condition, medical practitioners have reduced the dosage of medicines.
Earlier, Mary was provided several medications such as Erythropoietin therapy since she
had the issues related to anemia and at the same time, doctors have also recommended her to take
medicines for electrolyte imbalances. Since, she had chronic disease along with type 2 diabetes;
hence suggested treatment was diuretics for the purpose of treating fluid build-up that causes
Chronic renal disease.
Discuss relevant and current medical diagnostics/ treatment and its implications on health aspects
of Mary
Considering the health aspects of Mary, doctors have given several medicines which are
necessary to take especially on continuous basis. All the medicines are given after considering
the co-morbidity of diseases. As, in the case it is identified that the hyper filtration and
hypertrophy o residual nephrons are affected; hence they are being hypothesized to represent a
major cause of progressive renal dysfunction (Ferreira and et. al., 201). This has also increased
the glomerular capillary pressure which may damage the capillaries and which may also lead to
secondary focal and segmental glomeruloscerosis. This hypothesis is supported by several
lesions that are identical to those observed in humans with chronic kidney diseases.
However, instead of getting several medications, Mary’s health is not improving and she
is continuously having chronic problems. This not only leads to other health problems; but also it
aids Mary to suffer additional problems along with renal failure. According to the diagnosis, it is
determined that Mary needs to focus more on medication process so that her overall health
dimensions can be improved (Hering, Esler and Schlaich, 2013). Moving on to her health values,
it is clear that she does not have anyone in her family who can take care of her; thus she is
entirely responsible for her health. Proper medication process is being followed for Mary so that
chances of developing other health problems can be minimized. At the same time, it can also be
said that such medicines are highly useful for Mary as this can aid in managing the blood vessels.
Chronic nurses have also identified that the given medicines are useful for Mary as
because of that she could manage her health aspects in the best possible manner. Moreover, this
will also aid her to get rid of the process of dialysis. Several therapies are also recommended to
Mary so as to improve her health conditions. Moreover, in this facet it can be said that Mary
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needs to ensure that proper diet as well as medicines are being taken on continuous basis
(Chawla, Eggers, Star and Kimmel, 2014). This is also essential for the purpose of determining
further health implications that may come in Mary’s situation. Though nurses are following
suitable care provision for Mary; however then also it is vital for Mary to evaluate her own
health dimensions on regular basis. Proper evaluation will also assist the nurses to make
necessary changes in the medicines for betterment of Mary’s conditions. In this respect it can be
said that there are several aspects that needs to be considered at the time of analysing Mary’s
heath conditions.
LOG OF DAILY ACTIVITIES TO THE NURSING CARE
In the above mentioned section, the actual health condition of Mary is being discussed;
hence according to that, nurses need to adopt suitable care provision. This will not only aid in
managing health complications; but also it will promote health standards in the society.
Therefore, looking towards the health conditions, it can be said that chronic nurses working in
health care department needs to focus on various nursing intervention and approaches. Chronic
renal failure is the end result of a gradual loss of kidney function (Coresh and et. al., 2014).
Thus, here in the present case, it is essential for chronic nurses to set desired goal for Mary for
the purpose of preventing further complications and delivering supportive care. In this respect,
client education is also necessary and it holds more importance because it gives long term
benefits to the patient. The below mentioned things are essential to include in the care provision
as that will assist Mary to improve her health aspects in prominent manner.
Nursing intervention Benefits Duration
Risk for decreased cardiac
output
This helps in ascertaining
the risk for inadequate
blood pumped by the heart
for the purpose of meeting
metabolic demands of the
body (Muzaale and et. al.,
2014). Along with this, it
will also aid the nurses to
ascertain the risk factors
For 6 months
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that includes fluid
imbalances which further
affects circulating volume,
myocardial load and
systematic vascular
resistance.
Risk for ineffective protection Chronic nurses are also
required to ascertain
abnormal blood profile
which decreases RBC
production and survival and
at the same time it also
increases capillary fragility
(Andrassy, 2013). In terms
of outcomes, nurses need to
analyse if the symptoms of
bleeding still exists. At the
same time, the subsequent
intervention is also useful in
order to maintain
improvements in laboratory
values.
For the period of 10 months
Disturbed though process This is a state in which
individual experiences are
disrupted in cognitive
operations and activities and
this may happen due to
psychological changes.
Thus, carrying out such
intervention for Mary’s
health condition will assist
For a period of around 5
months
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the chronic nurse to regain
and maintain optimal level
of mentation (Stevens and
Levin, 2013). At the same
time, it will also assist the
nurses to identify ways to
compensate for memory
deficits.
Acute pain In this nursing intervention,
chronic nurses are required
to establish a rapport so as
to get cooperation from the
patient. At the same time,
nurses must also perform a
comprehensive assessment
of pain as this will aid in
comparing changes from
previous reports to
underlying conditions.
Therefore, in this context it
can be said that nurses must
also observe nonverbal cues
which includes no body
walk, toes and holding
power (Abed and et. al.,
2014). Along with this, it is
also essential for the nurses
to acknowledge the pain
experience through
conveying acceptance of
Mary.
This shall be done within
the period of 2 months
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Impaired renal tissue perfusion It decreases the amount of
oxygen that results in the
failure to develop the tissues
at the capillary level.
Therefore, for optimal cell
functioning, the kidney
excrete potentially harmful
nitrogenous product urea
and uric acid; therefore
nurses are required to focus
on the same thing for
managing the functioning of
kidney (Krum and et.
al.,2014). Similarly, nurses
should also emphasize on
measuring the urine output
on regular basis as that also
results in assessing renal
perfusion and function.
Impaired urinary elimination It result to loss of kidney
and at the same time it also
decreases the rate of GFR
and as a result the kidney
cannot excrete nitrogenous
product and fluid that
causes impaired in urinary
elimination. Thus, in this
respect it can be said that
nurses need to ensure that
there is an impaired urinary
elimination where in patient
For 5 months
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will verbalize understanding
of condition (Roth and et.
al., 2015). At the same time,
it is also vital for the nurses
to plan for patient
participation which also aids
in measuring to correct and
compensate for defects.
Nurses are required to
encourage and verbalize the
fear concerns so that open
the fear concerns. Nurses
must also ensure that Mary
is giving suitable adherence
to prescribed diet so that to
prevent aggravation of
disease condition.
Imbalanced nutrition In this respect proper diet
chart is being developed for
Mary so that she can have
maximum amount of protein
for her health benefits. In
this case, it is also essential
for the nurses to restrict the
food as prescribed (Barnett
and et. al., 2014). It is also
essential for the nurses to
ensure that the food item
contains sufficient nutrition.
In terms of assessment, it is
vital for the nurses to
For a period of around 10
months
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