Case Study: Glenda's Chronic Kidney Disease and Nursing Interventions

This case study focuses on Glenda, a 56-year-old Aboriginal woman presenting with symptoms of chronic kidney disease (CKD). The case study analyzes Glenda's condition, including her medical history, presenting symptoms (itchy face, vomiting, anorexia, confusion), and vital signs (elevated blood pressure, abnormal lab results). The assignment delves into the pathophysiology of CKD, exploring the progression through various stages and the associated clinical complications. It emphasizes the importance of nursing interventions, including assessment, monitoring, and patient education. The study also examines the specific challenges of providing care within a remote community context, considering cultural factors and the need for culturally sensitive communication. The case study highlights the significance of early detection, lifestyle modifications, and the management of complications such as electrolyte imbalances and the need for dialysis. The nursing interventions include assessment, monitoring, and patient education. The goal is to help students understand how to apply theoretical concepts to real-life patient scenarios, demonstrating the importance of comprehensive care for individuals with CKD.

Running head: NURSING CASE STUDY
CASE STUDY
Student Name
University Name
Author Note

1
NURSING
Introduction
When kidneys fail to function properly, it is termed as chronic kidney disease. It is a
very progressive and slow disease, which takes place over several years. People think that
this disease is uncommon but it is more extensive than estimatedby often going undiagnosed
in initial stages. When the kidneys stop functioning to their full capacity, there is an immense
build-up of waste and accumulation of fluid in the body but reduces with proper medications.
There is no specific treatment that can be provided to the patients.Glenda is a 56-year-old
aboriginal woman who arrives at her local health clinic to visit a doctor. Glenda complained
of an itchy face and is visibly tired. The registered nurse tabulated the orthostatic parameters
and some laboratory tests were recommended to understand her condition better. This paper
gives a clear understanding of the current health condition of Glenda by focusing on the
pathophysiology and the underlying clinical complications of chronic kidney disease. The
paper also talks about the nursing intervention strategies that should be implemented for the
management of kidney failure and promote the overall health of Glenda and people from her
community.
Description of the Case Study
Glenda Kerinaiau, a 56-year-old female had arrived at her local health clinic in
Wurrumiyanga with complaints of an itchy face, vomiting and feeling anorexic. Laboratory
tests like urea level, creatinine clearance rate and its level, sodium, potassium levels were
suggested to her by the doctor on the phone. Upon analysis of her vital parameters, her
respiratory rate was observed to be around 20 breaths per minute, blood pressure to be around
156/97 mm Hg, pulse rate was 89 beats per minute and the oxygen saturation level to be 96%
at room air. The laboratory tests conducted on Glenda revealed her creatinine clearance rate

2
NURSING
to be 8.2 mL/min, creatinine level was 1132 umol/L, urea level was 45 mmol/L, sodium and
potassium levels to be around 128 and 6 mmol/L.
On 12 August, she arrived at the clinic complaining of swollen eyelids with a
generalized feeling of sickness. She was physically examined which revealed her to be
swelled in the face, ankles, feet and hands. She has had a history of smoking twenty
cigarettes a day with binge drinking every two weeks. Upon questioning by the nurse, she
revealed her diet to include mostly seafood with fruits and vegetables with a 500 mL Coca
Cola every day. The pulse rate measured was 98 beats per minute; blood pressure was
180/100 mm Hg and her oxygen saturation level was 96% at room air. In addition to this,
urine analysis was carried out which came out positive for the presence of protein and blood.
She was admitted to the hospital in the emergency ward.
On the next day, the administration prepared for a transfer to the Royal Darwin
Hospital’s renal ward for ECG and EUC tests. The results of the tests revealed her to be
suffering from Post Streptococcal Glomerulonephritis. It is, for this reason, she is
immediately shifted to the haemodialysis unit for haemodialysis. Later on, she was
transferred back to the Tiwi Islands. During the discharge process, a nursing summary was
provided to Glenda with a monthly check-up of her blood pressure and urine analysis.
Discussion
In the case of Glenda, the doctor had recommended on her first visit for tests that
would measure the creatinine level and its filtration level in the serum. These are very
common tests that are conducted on patients with slight symptoms of kidney disease (Voors
et al., 2016). In addition to the tests, which are already mentioned in the case study, renal
ultrasound and renal scan should be utilized in this case, study to enhance the diagnosis
process of Glenda (Dalal & Sehdev, 2019). Smoking and drinking alleviate the suffering for

3
NURSING
the patient. It is mandatory for the patient to maintain a healthy weight throughout the time of
the diagnosis and treatment (Lane et al., 2015). In the case of Glenda, her weight had always
been around 54 kg.
Stage 1 and Stage 2 Chronic Kidney Disease
There are no visible symptoms that are faced by patients who are suffering from stage
1 Chronic Kidney Disease (CKD) (Nagin, Padman & Burckhardt, 2016). In the initial stages,
the performance of the kidney is below 100% but still functions close to proper(Lewis's
Medical-Surgical Nursing: Assessment and Management of Clinical Problems, 2015).
Diabetes and high blood pressure are the leading causes of kidney diseases (Palmer et al.,
2015). Presence of protein and the blood in the urine of the patient helps in providing
stronger evidence for the patient suffering from this kind of disease. In the second stage, the
blood tests typically reveal to be normal (Principles of Pathophysiology + Fundamentals of
Pharmacology, 2018). The blood pressure at this stage is elevated above the normal stage
with a few abnormalities in the urine sample of the patient (Tong et al., 2015). Good blood
pressure control and some dietary modification are recommended for patients who have
advanced towards the second stage in their chronic kidney disease (Webster et al., 2017). The
problem areas should be discussed with the patient to make them understand where specific
changes in their lifestyle are required to prevent them to proceed further in the advanced
stages (Sue, Sue, Neville & Smith, 2019).
Glenda had been including fruits and vegetables in her diet. It has not been mentioned
to her to avoid fruits and vegetables that may have a high content of sodium and potassium
(Lewis's Medical-Surgical Nursing: Assessment and Management of Clinical Problems,
2015). In this stage, it is typically recommended for the patient to maintain a blood pressure
of around 130/85mm Hg (Banach et al., 2016). Smoking has been a major issue in the case of
Glenda (Principles of Pathophysiology + Fundamentals of Pharmacology, 2018). She has

4
NURSING
been smoking 20 cigarettes a day before the detection of this disease. When she had first
visited the health clinic, the nurse should have asked her about her eating habits and must
have made her understand the disadvantages of smoking for her health (Radford et al., 2018).
As per the case study, it does not look like this was attended.
Stage 3 and Stage 4 of Chronic Kidney Disease
In stage three, the estimated glomerular filtration rate has further deduction and is
around 30-59 mL/min. In stage four, the estimated GFR in this stage is usually around 15-29
mL/min and the creatinine level to be around 800 umol/L (Lewis's Medical-Surgical Nursing:
Assessment and Management of Clinical Problems, 2015). This implies in medical terms that
the kidney has suffered significant damage with more amounts of waste being accumulatedin
the body of the patient. The phosphate levels have seen a significant increase in the serum of
the patient (Principles of Pathophysiology + Fundamentals of Pharmacology, 2018). There
will be a presence of some abnormalities like swelling of ankles or feeling lethargic or losing
the desire to eat. Liquid moves into the extravascular space, because of expanded hydrostatic
weight, causing setting oedema in the lower limit. The patient may have a tendency to excrete
salt in their urine, which elevates the level of blood pressure (Lewis's Medical-Surgical
Nursing: Assessment and Management of Clinical Problems, 2015). There is severe anaemia
observed in the cases of patients suffering from CKD (Principles of Pathophysiology +
Fundamentals of Pharmacology, 2018). The erythropoietin present in the red blood cells
observes a decrease in production because of the failure of the kidney to function properly
(Notaras & Conti, 2018). The oxygen levels in the blood of the patient are decreased,
resulting in weakness and tiredness. Practical aspects like providing education to the patient
about the process of haemodialysis should be initiated with the patient to help the patient is
mentally preparing themselves with the drastic changes that can take place.

5
NURSING
In the case of Glenda, when she had first arrived at her local clinic, she had mentioned
feeling anorexic and complained of stiffness in her knees and elbows because of the
accumulation of urea in the blood of Glenda. The powerlessness of the kidneys to discharge
potassium in the pee prompts perilous arrhythmias (Principles of Pathophysiology +
Fundamentals of Pharmacology, 2018). Careful assessment of the condition of Glenda should
be carried out when she had approached her local clinic (Lewis's Medical-Surgical Nursing:
Assessment and Management of Clinical Problems, 2015). The nurse who was given the
responsibility of conducting the test on Glenda should have informed the doctor about the test
results. It should have been notified to Glenda to prepare for a hospital administration for
haemodialysis as her condition had worsened and there may be a chance of her suffering
from CKD to surface.
Stage 5 Chronic Kidney Disease
At this stage, the kidney stops working and there is an urgent need for dialysis or
kidney transplant. The kidney loses all of its abilities that result in kidney failure and
eventually lead to death (Luckett et al., 2017). The Glomerular Filtration Rate is below 15%
of the normal level and the creatinine level in the serum of the patient is above 800 umol/L
(Lewis's Medical-Surgical Nursing: Assessment and Management of Clinical Problems,
2015). This is the last stage of chronic kidney disease characterised by various symptoms like
loss of appetite, headaches, vomiting or nausea, tiredness, unable to concentrate on anything,
make little or no urine, itching and swelling near the eyes, muscle cramps, skin colour
changes by an increase of skin pigmentation and tingling in hand and feet (Principles of
Pathophysiology + Fundamentals of Pharmacology, 2018). These symptoms have been
observed in the case of Glenda (Pugh‐Clarke, Read & Sim, 2017).Dialysis is used as an
artificial replacement for kidney functioning (Liyanage et al., 2015). It employs the process
of removing waste and extra water from the blood.

6
NURSING
In the case of Glenda, her filtration rate has been measured to be 8.2 mL/min and
creatinine levels to be 1132 umol/L. In this stage, the diabetes level increases above the
normal level which increases the patient’s chances of experiencing itching. This can cause
bleeding and severe swelling of ankles (Principles of Pathophysiology + Fundamentals of
Pharmacology, 2018). Pain and ache in the joints are also very common symptoms faced by
patients in stage five of this disease. In addition to these, it can be understood that with proper
monitoring of her illness would not have escalated to this stage. Careful risk assessment of
her condition should have been monitored to make her feel better. Proper education must
have been provided to her in the initial stages to stop the escalation of this disease to its
advanced stage.
Arrangement of educational conferences should be planned for aboriginals like
Glenda to make them aware of the importance of health. The aboriginals have been observed
to be very careless to look after their health. They should be made aware of the need to take
care of their health and their community (Lewis's Medical-Surgical Nursing: Assessment and
Management of Clinical Problems, 2015). This can help in maintaining health in their
community. The first day when Glenda had arrived at her local health clinic, it should have
been communicated to her in clear language about her condition. It would have been easier to
adopt an action plan to reduce the intensification of her disease. The nurse who was given the
opportunity to take up her case should have been able to communicate to her in her local
language despite Glenda being proficient in English. This helps in decreasing the
communication gap between the nurse and the patient.
Conclusion
In conclusion, it is clear that the condition which Glenda faced could have been
avoided if the nursing professional had informed her about the gravity of her disease. The

7
NURSING
symptoms with which she had presented in her health clinic were the onset of the symptoms
which are typically observed in stage 3 of chronic kidney disease. The blood pressure and the
creatinine levels in the serum of Glenda could have been reduced if proper monitoring would
have been carried out. The nursing professional who had taken up her case in the absence of
the doctor on the first day should have informed her about the condition. She should have
made Glenda understand the results she had obtained from the tests. This would have enabled
her to know the situation that she is into. The pathophysiology of the kidney condition and
the symptoms should have been correlated by the nurse to make it easier for Glenda to
understand as to why these symptoms are prominent in her.
References
Burckhardt, P., Nagin, D. S., & Padman, R. (2016). Multi-trajectory models of chronic
kidney disease progression. In AMIA Annual Symposium Proceedings (Vol. 2016, p.
1737). American Medical Informatics Association.
Dalal, R., & Sehdev, J. S. (2019). Physiology, Renal, Blood Flow and Filtration.
In StatPearls [Internet]. StatPearls Publishing.
Elseviar. (2015). Lewis's Medical-Surgical Nursing: Assessment and Management of Clinical
Problems (4th ed.).

8
NURSING
Liyanage, T., Ninomiya, T., Jha, V., Neal, B., Patrice, H. M., Okpechi, I., ...& Rodgers, A.
(2015). Worldwide access two treatment for end-stage kidney disease: a systematic
review. The Lancet, 385(9981), 1975-1982.doi: 10.1016/s0140-6736(14)61601-9
Luckett, T., Spencer, L., Morton, R. L., Pollock, C. A., Lam, L., Silvester, W., ...& Clayton,
J. M. (2017). Advance care planning in chronic kidney disease: a survey of current
practice in Australia. Nephrology, 22(2), 139-149.doi: 10.1111/nep.12743
Notaras, S., & Conti, J. (2018). A qualitative analysis of eating behaviour change for patients
with diabetes and non‐dialysis dependent chronic kidney disease stages 4–5. Journal
of Renal Care, 44(4), 219-228.doi: 10.1111/jorc.12258
Palmer, S. C., Mavridis, D., Navarese, E., Craig, J. C., Tonelli, M., Salanti, G., ...&Strippoli,
G. F. (2015). Comparative efficacy and safety of blood pressure-lowering agents in
adults with diabetes and kidney disease: a network meta-analysis. The
Lancet, 385(9982), 2047-2056.
Papatheodorou, K., Papanas, N., Banach, M., Papazoglou, D., & Edmonds, M. (2016).
Complications of diabetes in 2016. Journal of diabetes research, 2016.doi:
10.1155/2016/6989453
Pearson. (2018). Principles of Pathophysiology + Fundamentals of Pharmacology. Australia.
Ponikowski, P., Voors, A. A., Anker, S. D., Bueno, H., Cleland, J. G., Coats, A. J., ... &
Jessup, M. (2016). 2016 ESC Guidelines for the diagnosis and treatment of acute and
chronic heart failure: The Task Force for the diagnosis and treatment of acute and
chronic heart failure of the European Society of Cardiology (ESC). Developed with
the special contribution of the Heart Failure Association (HFA) of the ESC. European
journal of heart failure, 18(8), 891-975.

9
NURSING
Pugh‐Clarke, K., Read, S. C., &Sim, J. (2017). Symptom experience in non‐dialysis‐
dependent chronic kidney disease: A qualitative descriptive study. Journal of renal
care, 43(4), 197-208.doi: 10.1111/jorc.12208
Radford, J., Kitsos, A., Stankovich, J., Castelino, R., Khanam, M., Jose, M., ...&Razizaidi, T.
(2018). Epidemiology of chronic kidney disease in Australian general practice:
National Prescribing Service Medicine Wise Medicine Insight
dataset. Nephrology.doi: 10.1111/nep.13537
Raschenberger, J., Kollerits, B., Ritchie, J., Lane, B., Kalra, P. A., Ritz, E., &Kronenberg, F.
(2015). Association of relative telomere length with the progression of chronic kidney
disease in two cohorts: effect modification by smoking and diabetes. Scientific
reports, 5, 11887.doi: 10.1038/srep11887
Sue, D. W., Sue, D., Neville, H. A., & Smith, L. (2019). Counselling the culturally diverse:
Theory and practice. John Wiley & Sons.
Tong, A., Crowe, S., Chando, S., Cass, A., Chadban, S. J., Chapman, J. R., ...& Johnson, D.
W. (2015). Research priorities in CKD: report of a national workshop conducted in
Australia. American Journal of Kidney Diseases, 66(2), 212-222.doi:
10.1053/j.ajkd.2015.02.341
Webster, A. C., Nagler, E. V., Morton, R. L., & Masson, P. (2017). Chronic kidney
disease. The Lancet, 389(10075), 1238-1252.doi: 10.1016/s0140-6736(16)32064-5