Case Study Analysis: George's CKD and Nursing Care in Australia

This case study assignment analyzes the case of George, a 51-year-old indigenous Australian man with stage 4 chronic kidney disease (CKD), secondary diabetes nephropathy, stroke history, high blood pressure, and other health complications. The assignment explores the application of Levitt-Jones’ Clinical Reasoning Cycle to determine care priorities. It emphasizes the importance of patient-centered care, collecting vital information, and conducting secondary assessments to manage the patient's complex conditions, including diabetes and hypertension. The analysis highlights the significance of addressing anxiety and depression, promoting lifestyle adjustments, and understanding the correlation between the primary and secondary conditions. The case study underscores the need for healthcare practitioners to prioritize the care of vulnerable populations and apply evidence-based practices in managing CKD and related health issues.

Running head: CASE STUDY ASSSIGNMENT 1
Case Study Assignment
Student’s Name
Institutional Affiliation

CASE STUDY ASSIGNMENT 2
Case Study Assignment
Introduction
The case study in this case encompasses an indigenous Australian man; George (aged 51
years). The man has stage 4 chronic kidney disease and secondary stages of diabetes
nephropathy (macro albuminuria). George had stroke two years ago and has high blood pressure.
Furthermore, he has gained some weight including the amount of cholesterol. Among the
prescribed medications include vitamin D, sodium bicarbonate, metformin, atorvastatin,
furosemide, lercanidipine and perindopril. However, he wonders if these medications are
necessary. Most of the health complications named in this scenario are literally linked to old age.
The most fundamental problem in managing the condition circumnavigates the elderly denial to
taking appropriate medication. Furthermore, management of high blood pressure, diabetes and
chronic kidney disease is linked to changes in lifestyle. Therefore, this paper is set to analyze the
case study, provide all the care priorities and explore the two major priorities based on Levitt-
Jones’ Clinical Reasoning Cycle.
Body
Following Levitt-Jones’ Clinical Reasoning Cycle, there are eight stages of the clinical
reasoning cycle. These stages include consideration of the patient, collection of information,
processing the information, identification of the problems, action, evaluation of outcome and
reflecting on the process respectively (Gee, Dalton, & Levitt-Jones, 2015). In considering the patient
as suggested in the initial stages of the clinical reasoning cycle, George is experiencing Chronic
Kidney Disease (CKD) as the primary complication in the case provided. Therefore, the first care

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priorities should be based on the management of CKD. With respect to this condition, the care
priorities are discussed below:
 The first management approach is to collect vital information from the patient regarding
his condition (CKD). In this case, it is important to promote effective communication
with the patient and understand his needs regarding the condition. In the case provided,
George is concerned with whether to continue or stop the medications prescribed to him.
Thus, it is imperative to assess her condition against the prescribed medications and
advise him accordingly with respect to his medication program.
 After primary assessment of the condition, it is vital to conduct a secondary assessment.
At this point, it is important to assess the kidney functions with respect to the patient at
hand. Checking the kidney functions has a significant role in determining the relevance of
prescribed medications. Furthermore, contacting various kidney tests will evaluate the
condition to assess the changes imposed by the medication program.
 Assessing the cause of the condition of the patient (Webster et al., 2017). At this point,
assessing the cause of the condition has a significant role in identifying the relevance of
the medications provided to the patient. CKD can be caused by plenty of factors
including inheritance and poor lifestyle. Therefore, medications provided to an individual
should target at curbing the causal factor of the condition. For instance an individual is
likely to suffer from CKD if one of their family members died due to the condition. In the
case provided, this seems a higher likelihood for Georges Condition since most members
of his extended family have kidney failure. Therefore, it is important to conduct a genetic
analysis on the patient so as to clarify is the condition is genetically based. This will help
in determining an effective medication to the condition. On the other hand, CKD may

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arise due to poor daily lifestyle. For instance, obesity, alcohol intake and smoking
increase the chances of developing CKD. In such a case, someone may be required to
adjust lifestyle programs to healthy living style. For example, abstinence from smoking
and alcohol consumption may serve a significant role in preventing the occurrence of
adverse conditions of the disease. Also, medications that shun an individual from using
drugs may be prescribed. Furthermore, isometric exercises may reduce the impact of
obesity hence minimizing severity of CKD. George express signs of weight increase
which has an ultimately negative implication to the wellbeing of his condition. Therefore,
lifestyle adjustments can be promoted.
 Assessing the correlation between the primary condition and the secondary condition
realized through diagnosis. Some diseases are related in the sense that failure to treat the
secondary problem deteriorates the primary condition (Liyanage et al., 2015). For instance,
George presents other secondary conditions such as diabetes, and high blood pressure.
With respect to scholarly literature, scientific research has revealed a great correlation
between these diseases and CKD. Diabetes and high blood pressure increase the chances
of developing CKD (Collins et al. 2015). Therefore, it is fundamental to initiate programs
that manage all the conditions in a raw. However, failure to manage the secondary
conditions presents huge hindrance to the wellbeing of the patient. Therefore, it is
important to anticipate secondary complications since some of the medications provided
may be irrelevant to the primary medication but very important in handling the secondary
problems faced by the patient.
 Furthermore, it is significant to manage anxiety and depression among patients with
CKD. Anxiety and depression are fundamental problems with patients with CKD. George

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is a typical example of such patients who are deeply disturbed by anxiety and depression.
George not only has a lot of family duties but also lacks the ability to take care of the
family. This gives him anxiety and depression. Furthermore, he is more concerned about
whether to stop of continue with medications since they seem to be many for him. Drug
and substance abuse are fundamental symptoms of depression and anxiety. Smoking has
been fully expressed in George’s lifestyle. Therefore, it is important to address stress and
depression by either providing pieces of evidence-based advice to the patient of financial
support. Freedom from depression and anxiety has a positive implication to the recovery
of the patient. Also, the fact that George is concerned with whether to stop or continue
with medication proves that he is demoralized with the treatment program. Patient
demotivation in the treatment program has proven to have adverse implication on
outcome. Therefore, promoting relief from stress, depression and anxiety plays a
significant role in promoting wellbeing among the patients.
Two Priorities
 Collecting vital information from the patient regarding the condition. With respect to
Levitt-Jones’ Clinical Reasoning Cycle, considering the patient in the first step.
Therefore, the information provided by the patient serves a significant role in healthcare.
Considering the case provided, George is concerned with the aspect of whether to
proceed or stop the medication program. In most cases, elderly patients fail to comply
with medication programs. The reasons behind their resistance to medication are personal
based hence imperative to listen to their individual personalities. Patient-based healthcare
services have also proven to promote satisfaction among the patients thus promoting
good outcomes. Furthermore, patient-centeredness serves a significant role in promoting

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compliance by the patient. Therefore, the primary information collected from the patient
helps identify the tests and preferences of the patient thus promoting patient-centered
care.
 Secondary assessment of the patient. In the case provided, the patient has diversity of
complications which need to be tackled in a raw. However, the confirmation of these
secondary complications requires intensive secondary assessment. For instance, normal
blood pressure readings should range between 120-140 (systolic value) over 80-90
(diastolic value) (Böhm et al., 2018). However, George deviates from the recommended
normal readings. His systolic reading (153) is much above the optimal value (140). On
the other hand, his diastolic value (93) is much above the optimal recommended value
(90). These are implications of high blood pressure which has a great correlation with
CKD. Also, laboratory test on George’s albumin revealed the presence of chronic stages
of diabetes. The normal albumin of an adult should be below 30 mg/mmol (Foster et al.,
2014). However, George’s HbA1c was 78mmol/mol (93%) thus revealing an imbalance
in the blood sugar level. Furthermore, the normal serum creatine should range between
60-100 (Glassock, Warnock, & Delanaye, 2017). However, for George, creatine recorded
was 237 micromom/L which revealed the presence of diabetes. The two complications
(diabetes and high blood pressure) have a positive correlation with the severity of CKD
(Wanner et al., 2018). Therefore, collecting secondary information through lab tests is
significant in the management of the patient’s condition.
Conclusion
Chronic Kidney disease is a vital condition that calls for attention among the elderly
people. Most importantly, it is significant to priorities the most disadvantaged and vulnerable

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societies like the indigenous Australians. The condition is caused by plenty factors including
poor lifestyle and disease infection. Therefore, practitioners have a fundamental role in utilizing
Levitt-Jones’ Clinical Reasoning Cycle to determine the top priorities in the management of the
condition.

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References
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B. (2018). Empagliflozin and clinical outcomes in patients with type 2 diabetes mellitus,

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