Case Study Analysis: CKD, Albuminuria, and Medication Management

This case study presents a comprehensive care plan for a 51-year-old male patient diagnosed with stage four chronic kidney disease (CKD) and secondary albuminuria. The assignment utilizes the clinical reasoning cycle to assess the patient's condition, including deviations from normal readings such as high blood pressure, elevated HbA1c levels, and medication mismanagement. The care plan addresses key priorities like blood pressure and nutritional intake management, along with medication review and patient education. Interventions include monitoring vital signs, adjusting medications, and providing dietary recommendations. The study emphasizes the importance of patient and carer education, with the goal of preventing further kidney deterioration and related complications. The evaluation of outcomes focuses on monitoring vital signs, such as blood pressure, sugar levels, and fluid balance. The reflection highlights the importance of patient education and communication, with suggestions for improvement by considering social and cultural factors. The case study concludes that quality care requires incorporating the clinical life cycle to analyze all aspects of developing an efficient care plan and evaluating the outcomes of interventions to minimize clinical negligence and risks.

Case study

TABLE OF CONTENT
INTRODUCTION...........................................................................................................................1
DIAGNOSIS ...................................................................................................................................1
Case study overview and purpose of paper .................................................................................1
Collecting cues to find deviations from normal readings ...........................................................1
Processing information ...............................................................................................................1
Problems identified .....................................................................................................................1
INTERVENTIONS AND TREATMENT APPROACHES ...........................................................2
Goal establishment and actions ...................................................................................................2
Pharmacokinetics of medications and their indication................................................................2
Nursing management for adverse impact of mediations .............................................................2
Treatment and interventions .......................................................................................................3
Patient education .........................................................................................................................3
HEALTH OUTCOMES ..................................................................................................................3
EVALUATING OUTCOMES ....................................................................................................3
REFLECTION ............................................................................................................................4
CONCLUSION ...............................................................................................................................4
REFERENCES ...............................................................................................................................5

INTRODUCTION
Clinical reasoning cycle is defined as the systematic and sequential approach through
which nurses diagnoses health issues and perform clinical interventions. The process also
includes the evaluation of outcomes and interventions applied so that reflective learning can also
be taken into account for improving future practices (Webster & et.al., 2017). The report will
discuss the care plan for the case study of given patient by applying various stages of clinical life
cycle.
DIAGNOSIS
Case study overview and purpose of paper
A 51 year old man named George has been diagnosed with stage four chronic kidney
disease (CKD) and secondary albuminuria. The patient also suffers some abnormalities in
physiological parameters and also consumes medications without knowing their usage or need.
Thus the purpose of this paper is to assess and diagnose the physiological issues experienced by
the patient and to develop a care plan. The paper also aims at applying various stages of clinical
practice in preparing care plan for the patients and to enhance clinical learnings by incorporating
reflective and case analysis practices for learning.
Collecting cues to find deviations from normal readings
George is diagnosed with stage 4 CKD and increasing weight and cholesterol I diabetes
has also contributed in macro albuminuria. He has high blood pressure and haemoglobin levels.
He was a former smoker but has quit the practice. However unhealthy life style has made
diabetes, cholesterol and blood pressure worsen.
Processing information
In patients with CKD obesity and high blood pressure makes them vulnerable to
cardiovascular diseases such as chronic heart failure or stroke (Kovesdy & et.al., 2017). Despite
living with wife and children no care is provided to ensure that which medications are taken by
patient. Thus there is need of specific care to monitor the fluid, nutritions and administration of
medicines.
Problems identified
The first problem or care priority identified for the patient is management of blood
pressure (BP) and nutritional intake. The high BP and unhealthy food puts over burden on
kidneys and thus their deterioration rate is increasing (Verberne & et.al., 2016). The
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management of higher level of HbA1C is also another care priority because it enhances the risk
factor of stroke and heart failure in CKD patients. Due to lack of knowledge and guidance
patient is also consuming some medications without knowing their usage and impact (Isakova &
et.al., 2017). Thus it is also one of the issue to manage medications for patient so that their
adverse impact can be avoided.
INTERVENTIONS AND TREATMENT APPROACHES
Goal establishment and actions
The primary goal for George is to maintain normal level of blood glucose, fluid balance
and blood pressure so that CKD is not progressed into cardiac and other complications. Thus the
first action which must be taken for patients is regular monitoring of body vitals such as blood
pressure, sugar level, heart and lung sounds and rates, GFR. The psychological stress can also
worsen the situation by causing stroke and heart failure. Thus input output of body, fluid flow
must be controlled and regulated (Davison & et.al., 2015). Since patient has abnormal readings
of blood pressure, albuminuria and HbA1C these must also be monitored and treated so that they
can be improved to lie in normal range.
Pharmacokinetics of medications and their indication
The existing drugs such as sodium bicarbonate, metformin are considered to be restricted
for patients of CKD. Thus it is necessary to understand the pharmacokinetics of medicines
consumed. Kidney diseases bring significant changes in pharmacokinetics. As a result of CKD
the drug clearance is decreased and thus the volume of distribution may increase (Kovesdy &
et.al., 2017). Similarly the absorption of drug which is executed by gastrointestinal tract is also
affected by pathophysiological changes in patients with diabetes and CKD. This can be indicated
by delay in emptying gastric variables. The excretion function of drugs is performed by kidney
and thus it is also observed that George may react abnormally against consumption of some
specific drugs (Eckardt & et.al., 2015). The abnormal behaviour can be indicated by the means
of several side effects such as nausea, skin reactions or changes in renal outcomes or blood
pressure.
Nursing management for adverse impact of mediations
Nurses must assure that patient does not consume any medication without approval from
the health care professional. Thus at first nurses must assess all the medications and their dosage
taken by George. The medications which contraindicated with patients of CKD, diabetes and
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blood pressure (Gharbi & et.al., 2016). It must be also be assured by the service providers that
George as well as his family members are acknowledged about dosage, use and possible side
effects of each medication. In cases if nurses observe any adverse reaction then it must be
addressed on immediate basis.
Treatment and interventions
The key treatment for CKD includes haemodialysis, kidney transplant and peritoneal
dialysis. The diet and nutrition has significant impact upon kidney functioning thus patient must
be provided with diet which has low sodium and protein content. Food with low fat and
potassium must be given to patient along with the close monitoring of fluid intake so that
excessive burden on kidneys can be avoided (O’Hare & et.al., 2016). The high blood pressure,
obesity and increased sugar level must be treated by providing appropriate medications and life
style plan.
Patient education
The patient and carer must be educated about treatment process so that they can work in
collaboration with health professionals. George often takes medication without any guidance
and knowledge. It can lead to adverse reactions and overload on kidney. Thus patient must be
educated about mediations he is taking and the nutritional intake or life style changes which must
be incorporate for improving health outcomes. In patient education carers must also be included
so that they can make better decision about which treatment choice they prefer for the patient
(Murtagh & et.al., 2016).
HEALTH OUTCOMES
EVALUATING OUTCOMES
The outcomes of patient can be measured by monitoring the vital signs such as HbA1c
level, sugar level and blood pressure. The fluid readings must also be measured to analyse the
effectiveness of the interventions. The normal readings of these attributes along with the healthy
life style can prove to be crucial for the patient to avoid further deterioration of kidney (Murtagh
& et.al., 2016). Regular physical activities, intake of healthy food and complete abolishment of
smoking activities, controlled intake of fluids and nutrition will enhance the functioning without
any overload on rental system.
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REFLECTION
The case study analysis has been effective for me to understand the role of patient
education and communication in improving health outcomes. I also understood that nursing
goals must be developed as per the care priorities for safety of patient. However I believe that
care plan can be improved by considering social factors. For instance George is member of
aboriginal community which has higher prevalence of chronic disease and exposure to
vulnerable factors. Thus in future practices I will also incorporate cultural and psychological
assessment of patient. This improvement will assist me in improving my understanding
regarding interventions and problem assessment which is vital for patient safety and quality care.
CONCLUSION
It can be concluded from the above discussion that quality and secure care cannot be
provided to patient without incorporating clinical life cycle. The phases helps nurses and health
professionals to analyse all aspects required for developing a efficient care plan. It is also
suggested that when necessary interventions are developed for achieving health goals then their
outcomes must be evaluated critically. It helps health professionals to minimise the possibilities
of clinical negligence and risk factors.
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REFERENCES
Books and Journals
Davison, S. N. & et.al., (2015). Executive summary of the KDIGO Controversies Conference on
Supportive Care in Chronic Kidney Disease: developing a roadmap to improving quality
care. Kidney international. 88(3). 447-459.
Eckardt, K. U. & et.al., (2015). Autosomal dominant tubulointerstitial kidney disease: diagnosis,
classification, and management—a KDIGO consensus report. Kidney
international. 88(4). 676-683.
Gharbi, M. B. & et.al., (2016). Chronic kidney disease, hypertension, diabetes, and obesity in the
adult population of Morocco: how to avoid “over”-and “under”-diagnosis of
CKD. Kidney international. 89(6). 1363-1371.
Goraya, N., & Wesson, D. E. (2015). Dietary interventions to improve outcomes in chronic
kidney disease. Current opinion in nephrology and hypertension. 24(6). 505-510.
Isakova, T. & et.al., (2017). KDOQI US commentary on the 2017 KDIGO clinical practice
guideline update for the diagnosis, evaluation, prevention, and treatment of chronic
kidney disease–mineral and bone disorder (CKD-MBD). American Journal of Kidney
Diseases. 70(6). 737-751.
Kovesdy, C. P. & et.al., (2017). Obesity and kidney disease: hidden consequences of the
epidemic.
Murtagh, F. E. & et.al., (2016). Supportive care: comprehensive conservative care in end-stage
kidney disease. Clinical Journal of the American Society of Nephrology. 11(10). 1909-
1914.
O’Hare, A. M. & et.al., (2016). Provider perspectives on advance care planning for patients with
kidney disease: Whose job is it anyway?. Clinical Journal of the American Society of
Nephrology. 11(5). 855-866.
Verberne, W. R. & et.al., (2016). Comparative survival among older adults with advanced
kidney disease managed conservatively versus with dialysis. Clinical Journal of the
American Society of Nephrology. 11(4). 633-640.
Webster, A. C. & et.al., (2017). Chronic kidney disease. The lancet. 389(10075). 1238-1252.
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