NRSG366: Diabetic Nephropathy Case Study and Nursing Report Analysis

This nursing assignment presents a detailed case study of a 74-year-old male, Mr. Anh Duong, who is undergoing peritoneal dialysis and presents with a possible bacterial infection at the catheter site, likely due to diabetic nephropathy. The report delves into the patient's background, including normal vital signs and adherence to medication, and analyzes the pathophysiology of the condition, including the impact of diabetes on kidney function, glomerular changes, and the role of factors like VEGF-A and glomerular hypertension. It also explores the impact of comorbid conditions such as hypertension and impaired vision. The assignment further examines Mr. Duong's medication therapy, including erythropoietin, metformin, calcitriol, and other drugs, detailing their roles in managing his conditions and their impact on his health. References from medical journals and research papers are included to support the analysis.

Running head: NURSING ASSIGNMENT 1
Nursing Task Assignment
Name of Author
Institution
Date of Submission

NURSING ASSIGNMENT 2
Nursing Assignment
Client Information
The client is a 74 year old male Mr. Anh Duong.
Current Issue
Currently Mr Duong is undergoing peritoneal dialysis which is done through self-
management at home. Presently, Mr. Duong presents with reddened area around the catheter site
indicating a possible bacterial infection.
Background
Patient Cues
The physical activity of Mr. Duong is fine, as he participates actively in both religious
and community projects. His vital signs are normal. He also indicates that his vision is much
better which indicates better blood glucose control. Mr. Duong also seems comfortable with the
home peritoneal dialysis intervention and would wish to continue with it. Lastly, he reports no
adverse drug effects and reports of strict compliance to the medication therapy.

NURSING ASSIGNMENT 3
Pathophysiology of Mr. Duong’s Condition
Taking into consideration the medical history of Mr. Duong he must be suffering from
diabetic nephropathy. The reddening of the area around catheter insertion point is an indication
of a bacterial infection. The infection could be a result of either gram positive or gram negative
infection which activates the immune system around the insertion site causing inflammation and
hence the redness observed. Subsequently, there are major changes in histology occur in
individuals suffering from diabetic nephropathy. The histological changes include messangial
expansion, the thickening of the glomerular basement membrane and glomerular sclerosis. These
changes bear similar prognostic significance to the patient. Notably, these changes are associated
with altered vascular permeability and albuminuria associated with endothelial dysfunction.
During the early stages of diabetic kidney disease, there is marked increase in expression of
glomerular vascular growth factor-A (VEGF-A). Increase in VEGF-A is associated with
dysregulation in the expression of other growth factors like angiopoietins. These changes lead to
lengthening and increase in diameter and volume of the glomerular tube and hence increased
vascular permeability (Gallagher & Suckling, 2016).
Consequently, these changes in expressions and histological integrity results into increase
in renal plasma flow as well as elevation of the glomerular filtration rate (GFR). In patients with
diabetes, the there is always a marked glomerular hypertension synergized with the
hyperglycemia related to the pathophysiology of diabetes. The glomerular damage is thus
mediated by factors that include increased glomerular pressure, raised glucose levels in diabetic
patients in Mr. Duong’s system and the disproportionate transmission of pressure from the
system into the glomerular circulation. These processes lead to increased oxidative stress that

NURSING ASSIGNMENT 4
results from activation of different cellular pathways leading to eventual inflammation, increase
in the extracellular matrix deposition, alteration if the angiogenesis, as well as progressive tissue
failure of kidney (Gallagher & Suckling, 2016; Toth-Manikowski & Atta, 2015). Subsequently,
there develops diffuse glomerulosclerosis, tubular interstitium fibrosis and tubular damage.
It should be noted that parallel changes occur to the glomerular filtration barrier. These
changes are influenced by the injury to the glomerular endothelial cells, accompany by loss of
glycocalyx and finally cell apoptosis. Loss of the glycocalyx affects the functioning of the
glomerula vascular and permeability because it is the extracellular aqueous layer covering the
glomerular capillary lumen. Further, alteration of the permeselective features of the glomerula
filtration barrier as well as progression of the disease is causes by loss of podocytes, and
thickening of glomerular basement membrane (Gnudi, 2016). Eventually, the patient presents
with chronic diabetic nephropathy as in the case of Mr. Duong that requires dialysis.
Impact of Comorbid Issues to Patient
Notably, the cormobid issues associated to the case of Mr. Duong include hypertension,
diabetes type II mellitus and impaired vision. It is worth highlighting that type II diabetes affects
the arteries of Mr. Duong increasing his susceptibility to artherosclerosis which may eventually
cause high blood pressure (hypertension). Similarly, Type II diabetes is associated with excess
glucose in blood of Mr. Duong; this high concentration eventually leads to glomerular
hypertension. Synergistically, these exacerbate kidney damage. Impaired vision is an aspect
retinopathy associated with diabetes type II and may affect the quality of life of the patient
(Papanas & Ziegler, 2015). As noted, these co-morbidities contribute to adverse health outcomes
in Mr. Duong.

NURSING ASSIGNMENT 5
Analysis of Patient’s Medication Therapy
Mr. Duong receives 60 units erythropoietin per week. This medication helps in the
management of anemia that characterizes patients with end stage renal failure to restore their
normal red blood cell count. The renal failure means that he cannot synthesize adequate red
blood cells from the kidney. Metformin helps to increase glucose sensitivity, reduce the uptake
of glucose from small intestine, influences increased uptake of glucose peripherally into cells as
well as reduction of weight to help in management of type II diabetes disease in the case of Mr.
Duong (Tumma & Tan, 2015). Calcitriol administration reduces the inflammation associated
with diabetic nephropathy hence slowing progression of the disease (Wang et al., 2019). Further,
the administration of Captoril to Mr. Duong reduces the effects of hypertension as it is
antihypertensive. Ramipril is an angiotensin-converting enzyme inhibitor that helps reduce blood
pressure and any possibility of cardiovascular complication. On the other hand, Omeprazol
which is a proton pump inhibitor (PPI) helps in the management of type II diabetes by achieving
promoting good glycemic control. Lastly, Mr. Duong receives calcium carbonate thrice a day to
regain the affected homeostatic mechanisms controlling serum calcium and normal bone
metabolism because the balance of calcium is affected in nepthropathy.

NURSING ASSIGNMENT 6
References
Gallagher, H., & Suckling, R. J. (2016). Diabetic nephropathy: where are we on the journey from
pathophysiology to treatment?. Diabetes, Obesity and Metabolism, 18(7), 641-647.
Gnudi, L. (2016). Angiopoietins and diabetic nephropathy. Diabetologia, 59(8), 1616-1620.
Papanas, N., & Ziegler, D. (2015). Risk factors and comorbidities in diabetic neuropathy: an
update 2015. The review of diabetic studies: RDS, 12(1-2), 48.
Toth-Manikowski, S., & Atta, M. G. (2015). Diabetic kidney disease: pathophysiology and
therapeutic targets. Journal of diabetes research, 2015.
Tumma, A., & Tan, K. S. (2015). Inadvertent Use of Metformin in a Peritoneal Dialysis Patient:
Case Report and Literature Review. J Nephrol Ther, 5(204), 2161-0959.
Wang, Y., Yang, S., Zhou, Q., Zhang, H., & Yi, B. (2019). Effects of Vitamin D
Supplementation on Renal Function, Inflammation and Glycemic Control in Patients with
Diabetic Nephropathy: a Systematic Review and Meta-Analysis. Kidney and Blood
Pressure Research, 44(1), 72-87.