Nursing Assignment: Medical Case Analysis & Patient Information Resource
Nursing Assignment Part A: Written Case Analysis Essay
In this essay you will analyse the case study you have chosen giving a brief description of the chronic conditions and the presenting health issues for the person. This will give context to the Patient Information Resource you create in Part B.
Case Study: Than
Than Huang is 52 years old. He owns a very busy business with his wife and has two teenage children. They live in a large regional town west of Toowoomba in Queensland. Than has a history of hypertension which has been difficult to control and chronic glomerulonephritis.
Than has presented to his GP with worsening symptoms of kidney failure. His pathology tests indicate a Glomerular Filtration Rate (GFR) of 38% and high levels of protein and creatinine.
Task Part B – Patient Information Resource
The Patient Information Resource (PIR) can be written in the style of a pamphlet or hand out, or alternately, a blog or website article for the patient and family/ carer in your case study, about the chronic condition being experienced.
Part A: Written Case Analysis Essay
This essay build in this nursing assignment is associated with an in-depth analysis of Than Huang is a 52-year-old man with a busy business with his wife and his two teenage children. He however has a history of hypertension which has become difficult to control over the years along with chronic glomerulonephritis. He presented himself to the general physician who identified that the symptoms of Kidney failure were worsening. His pathology test indicated that his Glomerular Filtration Rate is at 38% and has a high level of protein and creatinine. According to Aseneh et al. (2020), chronic kidney disease is a condition where an abnormality in the structure of the kidney or the function of the kidney has been assessed using the matrix variable including Glomerular Filtration Rate, the threshold of albuminuria and duration of the injury. Therefore this study will provide an in-depth analysis of the chronic disease as well as the presenting conditions so that proper patient information resources of Mr Than Haung can be obtained.
Mr Than Huang has a history of chronic glomerulonephritis which is a chronic kidney disease where the chance of kidney failure is relatively high. His chronic condition has significantly impacted his daily activities and performance alongside the presenting conditions of hypertension he experiences. This can be due to the fact that chronic glomerulonephritis includes focal segmental glomerulosclerosis as well as a proliferation form of glomerulonephritis such as IgA nephrology that is directly associated with the increased chance of hypertension (Ihm, 2015). Therefore, the connection between hypertension and glomerulonephritis is dependent on the volume of the condition however the increase in the blood levels does not relate to the detrimental renal functions. Therefore, hypertension is one of the most common findings within chronic kidney diseases such as chronic glomerulonephritis. Approximately 75% of patients with an acute form of GN experience mild to moderate hypertension (Ihm, 2015). This is due to the fact that there is Sodium retention that leads to an overload of fluid which can be evidently witnessed through the separation of the renin-angiotensin-aldosterone (RAAS) system. According to the Australian Institute of Health and Welfare stated that approximately 11% death within the nation was caused due to chronic kidney disease estimating a total of 16800 (www.aihw.gov.au, 2021), where some of the serious causes of the death due to kidney failure were glomerulonephritis which is an inflammation in the kidney due to inheritance or infection (www.healthdirect.gov.au, 2021).
According to Ihm (2015), there are three main factors that contribute to hypertension in patients that experience chronic GN. The first reason for Hypertension within patients with chronic GN is the retention of sodium, excessive RAAS activities along with increased activities in the systematic nervous system. The pathogenesis of hypertension in chronic GN illustrates these three points as the main indicator as well as a contributor towards the development of hypertension. In the case of Than it can be evaluated that sodium sensitivity can be witnessed due to the fact that in glomerulosclerosis, as well as tubulointerstitial, the damage progresses. Along with this and excessive activity of RAAS can be identified through the inducement of renal ischemia. It has been reported that patients with IgAN have higher blood volume which is directly associated with the correlation between arterial pressure and blood volume whereas no plasma renin activity or GFR. Therefore, hypertension has a potential effect on the prognosis of mild proteinuric IgAN nephropathy through vascular lesions (Ikee et al. 2006). Kobori et al. (2007), suggested that both intrarenal reactive oxygen species and RAAS activation play a critical role in the development of IgAN in the initial stages while providing a foundation for RAAS blockade in IgAN effectively (Kobori et al. 2007). Therefore, it is speculated that patients with chronic glomerulonephritis often become salt sensitive due to the fact that there persists progressive renal damage which consequently reduces the interstitial flow of blood along with this hypoxia is also called which stimulates the intrarenal RAAS which ultimately contributes to the overall development of salt-sensitive hypertension. Therefore, Than experiences moderate to intensive hypertension due to the detrimental consequences of chronic glomerulonephritis with high levels of protein and creatinine.
Glomerulonephritis is considered a group of diseases that directly injures a certain part of the kidney that is required to filter blood. Than, who is diagnosed with chronic glomerulonephritis has the potential of experiencing acute kidney failure due to its ever-increasing persistence in daily life. Here his age and complexity of the condition adds to the degrading condition. Therefore, the relevant diagnosis and ongoing test to evaluate Than’s chronic and presenting condition are briefly mentioned in the subsequent sentences. A Urine test is required to be conducted as it enables in identifying the blood or protein in the urine. Therefore the antigens and antibodies in the blood can be identified through the urine test.
Another test that is required to be conducted is the kidney function test (Lee et al. 2019). In this test both blood and urine samples are taken that helps in the identification of substances released by the kidney such as sodium levels, chloride, potassium, urine as well as identifying the production level of urine by the person. Through the kidney biopsy, a sample of the kidney tissues will be obtained using a small needle to evaluate the consequences of the condition. In case the condition is evidently deteriorating, an imaging test will also be conducted through CT scan, X-Ray and/or ultrasound.
Chronic glomerulonephritis is a situation where the inflammation or the information causes damage to the kidney which ultimately loses its ability to filter substances properly within the body. Therefore the injured kidney can not get rid of wastes and extra fluids within the body which persists within patience and ultimately results in kidney failure (Hu, Zhang & Liu, 2018). As a result, high levels of dangerous fluid and electrolytes, as well as wastes, may build up within the body that may ultimately cause harmful effects within the body. While evaluating the chronic GN it has been identified that the two possible complications associated with this disease include acute kidney failure and chronic kidney disease. Acute kidney failure results in the ultimate loss of the function of the kidney as a filtering part of the nephron that results in rapid development and accumulation of waste products. In such a situation immediate dialysis is required which artificially removes the excess fluid and waste within the blood. On the other hand, chronic kidney disease is the gradual tendency of the kidney’s ability to filter (Li, Wang, Wang & Chen, 2018). In such cases, the kidney enters the end stage of kidney failure where only 10% of the kidney is able to function properly. In such circumstances either, dialysis or kidney transplant is required to sustain the life of the patients.
Toowoomba is one of the developing cities in Queensland Australia from where Than Haung belongs. The living conditions in this regional town is quite effective as multiculturalism can be witnessed within the region. The family of Than Haugn consisting of his wife and two teenage children are constantly worried about his health as both his chronic disease along with the presenting condition is increasing rapidly for staff this has ultimately affected his day-to-day activity. While caring for a patient it is critical to evaluate factors such as cultural aspects, health literacy as well as psycho-social considerations (Lubas et al. 2017). It must be presumed that they live in it down that effectively believe in communal living and the neighbours and Well wishes are at every nook and corners of the town. According to Erikson’s psychosocial developmental theory, Human Development can be divided into different stages where each stage is derived from internal conflicts or crises within the person. When considering Than it can be identified that the age at which he is, is either generativity or stagnation phases. At his age, he is more aware of the changing consequences within his body and significantly understands the ageing process. As chronic glomerulonephritis and hypertension worsen his ability to be interested reduces which ultimately brings monotony and stagnation in life (Vaidya, Aeddula & Doerr, 2021). The disease that he appears in does not have a permanent cure and even if there is a permanent cure through transplant it is a very expensive procedure that does not guarantee patients an extra life.
While evaluating nursing intervention and nursing management for Than, it has been identified that the patient requires astute nursing care in order to avoid complications through reduced renal function and other life-threatening illnesses associated with it. Under the nursing assessment, the procedures undertaken are assessing the fluid status, assessing the nutritional dietary patterns, assessing the status of Nutrition level, and assessing the ultimate cause for renal failure so that correct treatment can be provided assessing patients and families responses to the illness (Vaidya & Aeddula, 2018). The fluid status will enable in identifying the potential cause of the imbalance within the system whereas the nutritional intake assessment will be allowed the nurse to provide a dietary program so that proper nutritional intake can be provided to Than to limit the consequences.
On the contrary, pharmacological therapy can be applied through calcium and phosphorus binders, hypertensive and cardiovascular agents, anti-seizure Agents and erythropoietin. These will subsequently help in treating and managing hyperphosphatemia and hypocalcemia, hypertension, seizure and amenia respectively.
Whereas for home-care, Than must have excess vascular access care report any form of a problem to the family and undergo follow-up examinations and treatments within the hospital care. The patient must be taught how to check vascular accesses through devices for patency.
The above section of the essay identified that Than suffers from chronic kidney disease which has been deteriorating his health drastically. His Glomerular Filtration Rate was reported at 38% which indicates that the kidney was moderately decreasing while a high level of protein and creatinine was also reported. It is also essential to note that such chronic disease along with presenting conditions has detrimental consequences on the health of the individual. At the same time, Than is a middle-aged individual whose probability of being affected by the disease is more likely.
Part B: Patient Information Resources
A resource for patients, families and carers.
What is Chronic Glomerulonephritis (GN)?
Glomerulonephritis is considered a group of diseases that directly injures a certain part of the kidney that is required to filter blood. Therefore the injured kidney can not get rid of wastes and extra fluids within the body which persists within patience and ultimately results in kidney failure.
What causes GN?
Infection or inflammation in the kidney drastically impacting its filtration ability.
What are the signs and symptoms?
The signs and symptoms of acute GN are briefly mentioned in the following points below:
- Excessive blood flow or protein in the urine can be identified using microscopic in the urine test
- High blood pressure/ hypertension
- Increase in the frequency of urination especially at nighttime
- Abdominal pain
- Foamy urine; due to the fact that there is excess protein.
Is there a cure?
At the present moment, there is no permanent cure for Chronic Glomerulonephritis, however, there is a temporary treatment for the condition. This can be identified through pharmacological therapy, dialysis or kidney transplant that will allow the patients with extra years in their life.
How bad can GN get?
Chronic Glomerulonephritis is an acute consequence of kidney disease that may ultimately lead to kidney failure. Therefore the consequences of Chronic Glomerulonephritis is extremely bad if it is not identified at the earliest state where its treatment through pharmacological therapy can curtail the detrimental effect of the disease.
How do you test for GN?
In order to test for Chronic Glomerulonephritis, a urine test, kidney function test, biopsy as well as imaging test can be done to identify the deteriorating consequences of the kidney of the patient.
Is a medication used to treat GN?
Medication is used for treating GN, however, it cannot be cured completely.
What can be done to minimise the impact of GN or slow down its progression?
In order to minimise the impact of GN the following points be followed:
- Eat healthy meals
- The management of blood pressure by implementing a low-salt diet
- Prevention of infection by following good hygiene.
- Consult a GP whenever there is a chance of catching strep throat.
Additional online resource:
Aseneh, J. B., Kemah, B. L. A., Mabouna, S., Njang, M. E., Ekane, D. S. M., & Agbor, V. N. (2020). Chronic kidney disease in Cameroon: a scoping review. BMC nephrology, 21(1), 1-11. DOI: https://doi.org/10.1186/s12882-020-02072-5
Hu, X. C., Zhang, Y., & Liu, M. Q. (2018). Changes of renal function impairment, extracellular matrix regulation, renal fibrosis and inflammation in patients with chronic glomerulonephritis. Journal of Hainan Medical University, 24(21), 41-44. Retrieved from: http://www.hnykdxxb.com/PDF/201821/11.pdf
Ihm, C. G. (2015). Hypertension in chronic glomerulonephritis. Electrolytes & Blood Pressure, 13(2), 41-45. DOI: 10.5049/EBP.2015.13.2.41
Ikee, R., Kobayashi, S., Saigusa, T., Namikoshi, T., Yamada, M., Hemmi, N., ... & Miura, S. (2006). Impact of hypertension and hypertension-related vascular lesions in IgA nephropathy. Hypertension research, 29(1), 15-22. Retrieved from: https://www.nature.com/articles/hr20063.pdf?origin=ppub
Kobori, H., Katsurada, A., Ozawa, Y., Satou, R., Miyata, K., Hase, N., ... & Shoji, T. (2007). Enhanced intrarenal oxidative stress and angiotensinogen in IgA nephropathy patients. Biochemical and biophysical research communications, 358(1), 156-163. DOI: 10.1016/j.bbrc.2007.04.105
Lee, J. Y., Ihm, H. S., Kim, J. S., Hwang, H. S., Jeong, K. H., & Ihm, C. G. (2019). Baseline High Blood Pressure is Associated with Clinico-Pathologic Findings and Later Renal Progression in Chronic Glomerulonephritis. Electrolytes & Blood Pressure, 17(2), 54-61. DOI: https://doi.org/10.5049/EBP.2019.17.2.54
Li, Y., Wang, W., Wang, Y., & Chen, Q. (2018). Fetal risks and maternal renal complications in pregnancy with preexisting chronic glomerulonephritis. Medical science monitor: international medical journal of experimental and clinical research, 24, 1008. DOI: 10.12659/MSM.905494
Lubas, A., Kade, G., Ryczek, R., Banasiak, P., Dyrla, P., Szamotulska, K., ... & Niemczyk, S. (2017). Ultrasonic evaluation of renal cortex arterial area enables differentiation between hypertensive and glomerulonephritis-related chronic kidney disease. International urology and nephrology, 49(9), 1627-1635. DOI 10.1007/s11255-017-1634-7
Vaidya, S. R., & Aeddula, N. R. (2018). Chronic renal failure. Retrieved from: https://europepmc.org/article/NBK/nbk535404
Vaidya, S. R., Aeddula, N. R., & Doerr, C. (2021). Chronic Renal Failure (Nursing). Retrieved from: https://europepmc.org/article/nbk/nbk568778
www.aihw.gov.au, (2021). Retrieved from: https://www.aihw.gov.au/reports/chronic-kidney-disease/chronic-kidney-disease/contents/deaths-from-chronic-kidney-disease
www.healthdirect.gov.au, (2021). Retrieved from: https://www.healthdirect.gov.au/chronic-kidney-disease