Chronic Renal Failure: A Case Study on Melanie Johnson's Condition

This report presents a comprehensive case study of Melanie Johnson, a 55-year-old woman diagnosed with chronic renal failure. It begins with an overview of renal anatomy and physiology, followed by the pathophysiology of the condition, including risk factors and potential complications such as heart disease, anemia, and bone fractures. The report details the differences between acute and chronic renal failure and explores renal replacement therapy options, including dialysis and kidney transplantation. It also examines medications, side effects, and nursing considerations, such as diuretics and iron supplements. Furthermore, it explains the significance of Melanie's GFR and HB levels. The report concludes with a discussion of the teach-back method for patient education, particularly concerning fluid intake. References to relevant medical literature are included.

Nursing

Table of Contents
INTRODUCTION...........................................................................................................................1
Part 1................................................................................................................................................1
1.1 Renal Anatomy and physiology.............................................................................................1
1.2 Pathophysiology of Chronic Renal failure.............................................................................1
Differences Between Acute and Chronic Renal failure...............................................................2
Renal replacement Therapy.........................................................................................................3
Part 2................................................................................................................................................3
2.1 Medicines for chronic renal Failure, side Effects of Medication and Nursing Consideration
......................................................................................................................................................3
2.2 What does Melanie GFR and HB indicate.............................................................................4
Part 3................................................................................................................................................4
3.1 Teach- Back Method.............................................................................................................4
3.2 Teach Back Method for Fluid Intake.....................................................................................4
CONCLUSION................................................................................................................................5
REFERENCES................................................................................................................................6

INTRODUCTION
Taking care of person in sever disease is most important part of health care and nursing
services. This report is explaining the case of Melanie Johnson who is an 55 year old women
suffering from chronic renal Failure. This report is providing information of renal Anatomy and
physiology and major risk factors, possible complication and respective treatment options for
case of Melanie Johnson. Major differences between acute and chronic renal failure provided in
report. Renal replacement therapy is explained in case of lady. Medication required for given
case is also explained in report. Different ways are suggested to manage chronic renal failure of
Melanie Johnson.
Part 1
1.1 Renal Anatomy and physiology
Renal system in body is also known as the urinary system consist organs like kidneys,
bladder, ureters and urethra. There are 1 millions nephrons in the kidneys and each nephrons is
consists of glomerulus and tubule Meersch, Schmidt & Zarbock, (2016). Nephrons acts as blood
free cells, large protein, producing and ultra filtrate composed of other smaller elements. The
ultra filtrate enters the tubule that is specialised in various segments to produce final urine by
removing substances from reabsorption or adding substances in tubular fluid to maintain balance
in terms of water, minerals, electrolytes and hydrogen ion concentration. It is also work of
nephrons to eliminate toxic substances produces by body. This hormonal function is known for
influencing blood pressure, calcium metabolism and red blood cess production. The renal
anatomy and physiology also can be explained as the process that separate toxic and useless
substances from blood and reabsorption of molecules, ions and water that is required for body.
Major three function of Kidneys comes in Renal Anatomy are known as filtration, reabsorption
and secretion. In filtration process blood enters the afferent and flows into glomerulus where
blood component which are filterable such as water, nitrogen moves inside the glomerulus and
other non filterable component such as cells, serum albumins exits from efferent arteriole.
1.2 Pathophysiology of Chronic Renal failure
Chronic Renal failure is known as end stage of Renal disease. It is a progressive,
irreversible deterioration in the renal function in which ability of body to maintain metabolic and
electrolytes faces major failure that resulting as retention of urea and other nitrogen wastes in
blood. In case of Melanei Johnson, she is facing chronic Renal failure there are different risk in
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these condition. Major risks are heart disease, age is common risk of chronic renal failure,
bladder abstraction is also a risk, diabetes and sickle cell disease is major problem in Chronic
Renal failure McCullough & Roberts, (2016). There are different complication are possible in
case Melanie Johnson could be swelling in arms, lungs and legs. Sudden rise in the potassium in
the blood that can cause further heart disease, there is major risk of bone fracture due to weak
bones. Sever renal Failure can lead to failure of central nervous system that reduce the
concentration ability of person. Immune system become weaker and it can make Melanie
Johnson sick with different disease. Major blood loss can lead Melanie Johnson to Anemia.
These are possible complications in case of her. There are many diseases of renal function but
some of them are not curable. There is no cure of chronic Renal Failure.
The treatment related to chronic Renal failure is mainly consists of measures that can
help her to manage and reduce the symptoms, complications and make the progression slower in
the disease. If the kidneys are majorly damages then maybe she will need end stage treatment for
Melanie Johnson. The end stage treatment for chronic Renal failure is dialysis where external
process is used to reduce perform process of filtration, reabsorption and secretion. This will be
difficult for Melanie Johnson to perform regular dialysis because she lives in remote are with
five children with her husband. Other treatment for chronic heart disease is kidney transplant.
Kidney is ultimate treatment for this disease and inn this process infected kidney is replaces with
healthy kidney of donor Coulthard, (2016). After Kidney transplant no dialysis needed further
but patient need to take medication rest of life to keep body from rejecting new kidney
otherwise it can further lead to organ failure.
Differences Between Acute and Chronic Renal failure
There are many difference between acute and Chronic renal failure. Some of the
differences are-
Acute chronic
History of Disease Short history maybe in days or
weeks.
Long history of disease (in
months or years)
Haemoglobin Concentration Normal Low
Renal size Normal Reduced
Renal Osteodystrophy Absent Present
Peripheral neuropathy Absent Present
Serum Creatinine Acute reversible increase Chronic irrversible
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Concentration
Renal replacement Therapy
The Renal replacement therapy that replaces the normal blood filtering function of
kidneys when they are not working well. This treatment can be consider for acute kidney failure
and Chronic kidney failure. Renal replacement surgery includes the dialysis, hemofiltration and
hemodiafiltration. This process is used for the filtration of blood with or without machines. The
renal replacement process is also includes the kidney transplant in the ultimate conditions. This
treatment is not the cure of chronic renal failure but it is just a process to increase the life ogf
person. After this replacement process person need to take medicines rest of life Ozyazgan,
Akgoz & Cigremis, (2017). In case of Melanie Johansen Renal replacement surgery is the best
possible action. Because in her age this process can be used and it is also suitable for her because
in after this she does not need regular dialysis.
Part 2
2.1 Medicines for chronic renal Failure, side Effects of Medication and Nursing Consideration
For case of Melanie Johnson Diuretics and iron supplements are need to be given because
she need to balance the water level in her body to keep body hydrated Chen, Zhou & Wang,
(2015). Due to this disease person lose haemoglobin and to full fill the requirement of body
person need to take iron suppliment tablets.
Different side effects of diuretics are-
1. Too little potassium in blood.
2. Dizziness
3. Thirst
4. Muscle cramps.
Side effects of iron supplements are-
1. Dark Stools
2. stomach pain
3. nausea
4. Vomiting
Medical Consideration for Drug
Diuretics
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1. Consult regular to Doctor.
2. Take the medicine as per the prescription of Doctor.
3. Avoid use in major conditions and issues.
4. Take combination of medicines as per the suggestion of doctor.
Iron supplements
1. do not eat high fiber food along with iron tablets.
2. Do not take medicines with milk or other antacids.
3. Wait at least for 2 hours between taking the medications.
4. Meet doctor in any unusual symptoms.
2.2 What does Melanie GFR and HB indicate
GFR is the first step in making unrine and it is the process through which kidney use to
filter extra fluid and waste products out of a blood into urine so that it will be eliminate from the
body. Normally, the range of GFR should be 90 to 120 ml/min/1.73 mm. But in the case of
Melanie it was found to be 10 ml/min/1.73 mm. Thus, it clearly indicate that she have low GFR
and it shows that she is suffering from kidney disease or dehydration.
While on the other side, Haemoglobin is the protein in red blood which carry oxygen and
the normal range of Hb in female is 12 to 151 g/l and in the case of Melanie it was found that 95
g/l which is quite low. Therefore, it indicate that she have abnormal red blood cells and the body
did not get enough oxygen.
Part 3
3.1 Teach- Back Method
It is the method which Is used by the healthcare providers in order to confirm whether the
patients understand what the General Practitioner wants to explain. It is also called as show- me
method and it is a communication method that is used in order to improve the health literacy of a
patient. Moreover, it is the significant gap which determine how much the patient needs
information and how effective a provider also communicate to the patient. This is also done to
make the patient more comfortable during his/ her treatment.
3.2 Teach Back Method for Fluid Intake
As Melanie is in need of the good amount of the fluid in her body we will teach and will
communicate the benefit of the practices which need to be performed by the Melanie. As we will
take the help of the presentation to explain the benefit of consuming large amount of the
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beverages to the Melanie as the beverages is the one and the only way through which the need of
the fluid can be efficiently managed by the Melanie. We will also try to communicate the
different variety of the Fluids which can be consumed by the Melanie so that the consuming fluid
becomes a fun for the Melanie Chen, Wang & Lang, (2016). Melanie can add the things like
chopped fruits in the water and also can have a low calories juice consumption to increase the
fluid in the body. We will also communicate the different way through which the consumption of
the fluid can be increased by the Melanie by the way of consumption of high water content fruits
such as Tomato and Orange. We can also communicate the way through which Melanie can keep
the record of the amount of the fluid is consumed by the Melanie so that it keep motivating the
Melanie to try harder. In the end we will ask all the recommendation back from the Melanie as
the teach-back method also lay emphasis on understanding what amount of the understanding
has been done by the patience.
CONCLUSION
This repost is concluding importance of nursing services that are required by a person
who is facing Chronic Renal Failure. Brief information of Renal failure and physiology has been
provided in report. Risk, possible complication and treatment options has been suggested for
Melanie Johnson who is facing chronic Renal Failure. Differences between acute and chronic
Renal failure has been concluded along with medication that is required for disease. For Melanie
Johnson Renal replacement therapy is also explained. Different measures has been studied from
the diagnosis of patient. Teach back methods has been understood to provide information to
patient about their fluid diet.
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REFERENCES
Books and Journals
Meersch, M., Schmidt, C., & Zarbock, A. (2016). Patient with chronic renal failure undergoing
surgery. Current opinion in anaesthesiology. 29(3). 413-420.
McCullough, P. A., & Roberts, W. C. (2016). Influence of chronic renal failure on cardiac
structure.
Coulthard, M. G. (2016). The management of neonatal acute and chronic renal failure: a
review. Early human development.102. 25-29.
Ozyazgan, B., Akgoz, M., & Cigremis, Y. (2017). Caveolin-1 gene expression in rats model of
chronic renal failure. Medicine. 6(3). 401-5.
Chen, J., Zhou, Q. Y., & Wang, J. D. (2015). Comparison between subtotal parathyroidectomy
and total parathyroidectomy with autotransplantation for secondary
hyperparathyroidism in patients with chronic renal failure: a meta-analysis. Hormone
and Metabolic Research. 47(09). 643-651.
Chen, S. F., Wang, I. J., & Lang, H. C. (2016). Risk of major depression in patients with chronic
renal failure on different treatment modalities: A matched‐cohort and population‐based
study in T aiwan. Hemodialysis International. 20(1). 98-105.
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