CASE STUDY ON CHRONIC KIDNEY DISEASE

CASE STUDY ON CHRONIC KIDNEY DISEASE

Table of Contents

Introduction                                                                                                                                      2

SECTION I: Description of Case                                                                                               2

SECTION II: Description and justification of Intervention                                                       3

  1. Defining the role of a health professional 3
  2. Identification and description of intervention 3
  3. Identification of the ICF components that the intervention may target 4
  4. Identification of risks associated with intervention 4
  5. Strategies that must be implemented to minimize the risks 4

SECTION III: Identification of another health professional in the team and evaluation of her role5          

  1. Identification and description of the role of the other health professional working as a part of interprofessional team 5
  2. Identification of the ICF components that the role may target 6

SECTION IV: Specification of Professionalism Characteristics                                                    6

  1. Three characteristics of professionalism 6
  2. Alignment of the characteristics with the intervention method carried out 7

Conclusion                                                                                                                                       8

References                                                                                                                                        9

 

Introduction

Chronic renal failure or chronic kidney disease (CKD) is a gradual and progressive decline of kidney function. It is usually observed in individuals who are pre-exposed to clinical conditions of type II diabetes mellitus, hypertension, and various cardiovascular diseases. The current international guidelines characterize CKD with a Glomerular Filtrate Rate (GFR) of less than 60mL/min per 1.73m3 or other significant determinants of kidney damage existing for at least 3 months (Webster et al, 2017). This piece is a holistic analysis of a case study of a person suffering from CKD and intends to provide a brief insight into her clinical conditions, the impacts the disease has on his activity participation and general limitations, interventions suggested by professional health experts, and the assessment of the professional characteristics exhibited by the health experts.

SECTION I: Description of the Case

Stephanie Smith is a 65-year-old Australian female dialysis patient, a resident of Sydney, and suffering from chronic kidney disease (CKD). She has been recently discharged after being admitted to the Sydney State Hospital for one week after complaining of shortness of breath, nausea, fatigue, lower extremity edema right up to her knees, vomiting, and decreased urine output. The patient is known to have a past medical history of type II diabetes mellitus and hypertension for more than 20 years. In addition to this, it has been further reported that ever since she has been on dialysis, there has been a gradual decline in her mobility performance which has been exacerbated in the last 8 months. When asked if she faces problems in carrying out her daily tasks, she responds in the affirmative and states that there has been a gradual worsening in carrying out the most basic of her daily activities and that often she finds it even more difficult to get out of her bed. This has greatly impacted her social participation for she stays wheelchair bound for most of the time and requires a 24-hour professional medical practitioner to help her with her daily activities.

SECTION II: Description and justification of the Intervention

A. Defining the role of a health professional

As a practicing nurse in direct charge of helping the client with improving her functioning, the role is well defined. The case study states that the patient finds it difficult to perform both ADLs (Activities of Daily Living) and IADLs (Instrumental Activities of Daily Living) which is indicative of the pronounced role of the nurse in catering to her direct and indirect needs.

B. Identification and description of the intervention

It has been evidenced that 12 weeks of supervised exercise resulted in favorable improvements not only on fatigue-related outcomes but also in immobility issues (Wilkinson et al., 2019). The exercise schedules can entail walking tests of 2 or 6 or 12 min duration, intermittent shuttle walking, gait speed training, chair stands, and even stair climb tests. In addition to this, resistance training further helped to reduce the symptoms about loss of muscle power and strength in the CKD patient (Wilkinson et al., 2019).

C. Identification of the ICF components that the intervention may target

It has been realized that the ICF core sets for the acute hospital and post-acute rehabilitation facilities show great relevance for rehabilitation nursing (Mueller et al., 2008). In the context of the client with CKD, the prevalence of the disease has widely shown to affect her mobility, thereby subjecting her to musculoskeletal impairments and conditions such as sarcopenia. The ICF core sets laid down by the World Health Organization aim to provide a list of essential categories that are relevant in different healthcare contexts (ICF Research Branch, 2020). The intervention provided here is in alignment with improving muscle strength and endurance and also entails activities and participation categories in cases of disabilities triggered by musculoskeletal impairments which therefore finds compliance with the ICF core set for patients with musculoskeletal conditions in post-acute care.

D. Identification of risks associated with the intervention

In carrying out the intervention procedures, certain risks may be identified. It has been realized that during the conduction of walking tests or intermittent shuttle walks or the procedure of stair climb tests, the patient might lose her balance and hurt herself physically owing to the fragility and weakness of her muscles.

E. Strategies that must be implemented to minimize the risks

To avert the potential risks that are associated with the intervention method, certain strategies must be implemented:

  1. Constant monitoring: Ensuring that the patient is not alone during the walking or gait speed or stair climb tests therefore the professional practitioner must be alert and keep a constant check on the patient.
  2. Dietary supplements: Encouraging the intake of certain dietary supplements such as foods rich in vitamin D that help in building bone strength (Moorthi & Avin, 2017).

Insufficient amounts of vitamin D can lead to balance problems.

  1. Keeping assistive devices handy: During the execution of the intervention procedures, keeping assistive devices such as wheelchairs or walkers can come in handy so that the patient can use its support in case she feels dizzy.

SECTION III: Identification of another health professional in the team and

evaluation of her role

A. Identification and description of the role of the other health professional working as a part of interprofessional team

In achieving an effective intervention procedure to better client health, it has been realized that the role of a physiotherapist is almost imperative. Chronic kidney disease is known to be associated with protein wasting and multiple derangements due to uremia, which facilitates sarcopenia (Moorthi & Avin, 2017). Sarcopenia accentuates immobility in CKD patients and this regard undergoing proper exercise schedules in the form of high-intensity resistance training under the supervision of a trained physiotherapist is expected to positively contribute to muscle gains (Beckwée et al., 2019). Therefore, the presence of a physiotherapist, in addition to having a skilled nurse would facilitate swifter results for the patient concerned.

B. Identification of the ICF components that the role may target

ICF core sets, laid down by the World Health Organization help in outlining the functioning of clinical practice by providing a list of essential categories that are significant in the case of special health conditions and healthcare contexts (ICF Research Branch, 2020). The case study of Stephanie Smith highlights acute immobility issues characterized by the inability to perform

ADLs (Activities of Daily Living) such as bathing, toileting, and dressing and IADLs (Instrumental

Activities of Daily Living) such as taking medications, cooking meals, and traveling (Painter & Marcus, 2013). This is entirely owing to the existence of her clinical condition of CKD which over some time has been reported to have worsened. Therefore, the intervention provided complies with the ICF core set for patients with musculoskeletal conditions in post-acute care.

SECTION IV: Specification of Professionalism Characteristics

A. Three characteristics of professionalism

The act of professionalism is extremely central to the idea of nursing because it mandates quality patient care and simultaneously upholds the values of empathy, care responsibility, advocacy, and honoring the respect and dignity of the patient.  It has been evidenced that the profession of nursing is characterized by three distinct attributes, namely cognitive, attitudinal, and psychomotor (Ghadirian, Salsali & Cheraghi, 2014).

  1. Cognitive aspect:

All nursing practitioners must possess the cognitive framework to understand professionalism (Mueller et al., 2008). It primarily entails understanding the underlying principles of professional conduct and realizing why it is necessary to incorporate it into the daily execution of activities to effortlessly make decisions.

  1. Attitudinal aspect:

Understanding the values of nursing as a profession and upholding its ideals are a key determinants in defining professionalism in this profession. The ability to understand one’s feelings, the willingness to help those in need, exhibiting humanistic values of care and empathy, tolerance and flexibility in communication, and the proactive attitude to take responsibility to define the attitudinal aspect of professionalism (Mueller et al., 2008).

  1. Psychomotor aspect:

Professional nursing demands clinical work. It has been evidenced that nurses who foster psychomotor competencies value professionalism (Mueller et al., 2008). Over some time, there has been an expansion in the dimension of a nurse’s role in caregiving and often entails getting involved in therapeutic activities based on their professional qualification.

B. Alignment of the characteristics with the intervention method carried out

It has been realized that in the assessment of the intervention method, the nursing professionals were able to carry out their activities in compliance with the three major attributes of nursing professionalism. Not only did the professionals were shown to foster a mindset that upheld the humanistic values of care, empathy, and tolerance but also exhibited great communication skills while discussing important matters pertaining to the patient that facilitated easier and swifter intervention procedures. It must further be stated in this regard that in the understanding and rectification of the mobility impairment in compliance with the ICF norms, the cognitive and psychomotor aspects of professionalism were adhered to by the professionals in addition to maintaining a caring attitude (Mueller et al., 2008).

Conclusion

This case report therefore comprehensively addresses the problem of chronic kidney disease observed in an Australian patient and in doing so offers a holistic understanding of the role and justification of the chosen intervention method to combat the disease. It also highlights the physiological, mobility, and disability impairments caused as a result of this disease and in compliance with the ICF suggests ways in which it can be tackled. It also helps in the realization of professionalism characteristics that are central in the execution of duties and states how the activities of the medical experts were in alignment with that.

 

Case Study on Chronic Kidney Disease

References

Beckwée, D., Delaere, A., Aelbrecht, S., Baert, V., Beaudart, C., Bruyère, O., … & Bautmans, I. (2019). Exercise interventions for the prevention and treatment of sarcopenia. A systematic umbrella review. The journal of nutrition, health & aging, 23(6), 494-502. https://doi.org/10.1007/s12603-019-1196-8

Ghadirian, F., Salsali, M., & Cheraghi, M. A. (2014). Nursing professionalism: An evolutionary concept analysis. Iranian journal of nursing and midwifery research, 19(1), 1–10.

https://doi.org/10.1111/2047-3095.12082

ICF Research Branch. (2020). ICF RESEARCH BRANCH – Musculoskeletal_Conditions. Retrieved 23 October 2020, from https://www.icf-research-branch.org/icf-coresets/category/7-musculoskeletalconditions

Moorthi, R. N., & Avin, K. G. (2017). Clinical relevance of sarcopenia in chronic kidney disease. Current opinion in nephrology and hypertension, 26(3), 219.

https://doi.org/10.1097/mnh.0000000000000318

Mueller, M., Boldt, C., Grill, E., Strobl, R., & Stucki, G. (2008). Identification of ICF categories relevant for nursing in the situation of acute and early post-acute rehabilitation. BMC nursing, 7, 3. https://doi.org/10.1186/1472-6955-7-3

Painter, P., & Marcus, R. L. (2013). Assessing physical function and physical activity in patients with CKD. Clinical Journal of the American Society of Nephrology, 8(5), 861-872. DOI:

DOI: https://doi.org/10.2215/CJN.06590712

Webster, A. C., Nagler, E. V., Morton, R. L., & Masson, P. (2017). Chronic kidney disease. The lancet, 389(10075), 1238-1252. https://doi.org/10.1016/s0140-6736(16)32064-5

Case Study on Chronic Kidney Disease

Wilkinson, T. J., Watson, E. L., Gould, D. W., Xenophontos, S., Clarke, A. L., Vogt, B. P., … & Smith, A. C. (2019). Twelve weeks of supervised exercise improves self-reported symptom burden and fatigue in chronic kidney disease: a secondary analysis of the

‘ExTra CKD’trial. Clinical kidney journal, 12(1), 113-121. DOI:

https://doi.org/10.1093/ckj/sfy071

CASE STUDY ON CHRONIC KIDNEY DISEASE. GET MORE TOPICS ON CHRONIC KIDNEY DISEASE.   READ ON THE PREVALENCE OF KIDNEY FAILURE IN NIGERIA

 

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