As Sharon was suffering from renal kidney failure and was undertaking hemodialysis and she also had diabetes mellitus of type 1 since childhood. So following this case study, following questions were answered.
The priority care for Sharon would be for the renal kidney failure for which she was taking hemodialysis thrice a week and the other being the diabetes type 1.
From the clinical reasoning cycle, the case of Sharon would be framed by the nurse for easy understanding. This clinical reasoning is important in the Sharon’s case because it would help the nurse to put her effective reasoning in her case so that she get the positive outcomes on her health. Sharon was 42 years old suffering from diabetes and renal failure, and when she was at the hospital, she even complains of worse eyesight (Koivisto et al., 2016).Her other body signs were normal like body temperature, heart beat but her blood pressure was high. After reading this, the nurse could refer some medications and psychological solutions to Sharon so that she could improve her health better and at the same time could focus on her job. The nurse could also interpret that her kidney problems could not get better because she was not allowed to do hemodialysis as she was asked to look at the supermarket by her husband. It could also be inferred that due to this, Sharon might be suffering from some anxiety or depression as she had ailment but she could not get the treatment for this due to her low economic status. Next, she already had diabetes mellitus type 1 since childhood, and she became adapted to it and this diabetes may have caused damage to the kidney as it is seen that diabetes is the reason for renal failure. After seeing the whole scenario, the nurse's intervention would be towards the treatment for kidney and diabetes care more that how it could be prevented from getting worse and at the same time, she could be given psychological relief to recover faster (Liou et al., 2016).
The three community nursing interventions for maintaining the health of Sharon for renal kidney failure and diabetes are as follows:
In the renal kidney failure, the excess fluid volume is the threat. The intervention to be done is to accurately record the fluids intake and output. Along with this monitoring of heart rate should also be done by the nurses (Peeters et al., 2014).
Rationale: when there is a decrease in the fluid output <400 ml /24 hrs, then it is the indication of acute failure. This monitoring is necessary for the determination of the renal function and replacement of fluids. Tachycardia and hypertension are related to the kidney failure and excess fluid accumulation. Thus, heart monitoring is important for intravascular volume assessment.
Another intervention is the monitoring of heart rate should also be done for the patients of renal kidney failure as well as diabetes because in both the case the cardiac function is important.
Rationale: Tachycardia and hypertension are related to the kidney failure and diabetes. Thus, heart monitoring is important for intravascular volume assessment (Remuzzi et al.,2013).
Diet Planning is another intervention by the community care nurse, where her goal would be to decide the correct amount of calories, to maintain the energy levels and maintaining the insulin treatment.
Rationale: when the patient food choice is given priority in the diet chart then this would make the patient recover fast. Regular and correct insulin dose could help more glucose to move into the body cells.
Psychosocial issues are the most important concern in the overall health of the patient suffering from diabetes and renal failure. Stress is the major reason behind such illness, and it greatly affects the patients. Since Sharon was not allowed to take her hemodialysis by her husband as she has to do the job in a supermarket. The three psychosocial issues which she had to suffer were low socioeconomic status, family disturbances, and marital dissatisfaction. The intervention given to this by the nurse was that she would educate Sharon about the healthy life and how could she manage between her personal and profession life. Secondly, Sharon could convince her husband that she is capable enough to mange both the personal as well as her professional life and lastly due to her low economic status she could work more efficiently by well managing her life (Remuzzi et al.,2013).
The diabetes mellitus damages the small blood vessels in the kidneys. These blood vessels are nothing but are act like filtering unit. When such blood vessels are injured, then the kidneys cannot filter the blood properly, and as a result, more water and salt would be retained than the normal. This retention results in the weight gain and swelling of an ankle. On the other hand, Diabetes also damages the body nerves. When the kidney's nerves are injured, then it causes difficulty in the emptying of the bladder and thus the bladder pressure could reflow and cause damage to the kidneys. Also, when urine remains in the bladder for most of the time, then this would develop an infection in the patient (Forbes & Cooper 2013).
After the discharge from the hospital, Sharon was prescribed some medications mainly for the renal failure and also diabetes mellitus type 1. These medications were given to her by monitoring all the vital signs and symptoms of her. These medications would improve her symptoms so that she could lead a better life in the future.
The three primary medications prescribed to Sharon were Ramipril, Erythropoietin, and Actrapid pen.
Ramipril, among the medications, is one of the ACE inhibitors, which slows down the kidney failure progression along with hypertension. It also reduces the damage done to the kidneys done by diabetes. This medicine has fewer side effects and could be well tolerated by the patient (Nasri & Rafieian-Kopaei, 2014).
The other medication is Erythropoietin, which is given weekly. This is also very beneficial in renal failure. In normal healthy kidneys, this hormone erythropoietin is produced in the blood which maintains the other body functions by triggering the other factors of the body (Coldewey et al., 2013).
The third medication is Actrapid pen which is an insulin injection to be taken to combat diabetes. This is taken intravenously to lower the level of glucose in the body. Sharon was given insulin injection as this works much faster than the pills taken in the oral form. This injection keeps the glucose level of Sharon in control (Heerspink et al., 2014).
Coldewey, S. M., Khan, A. I., Kapoor, A., Collino, M., Rogazzo, M., Brines, M., ... & Yaqoob, M. M. (2013). Erythropoietin attenuates acute kidney dysfunction in murine experimental sepsis by activation of the β-common receptor. Kidney international, 84(3), 482-490.
Forbes, J. M., & Cooper, M. E. (2013). Mechanisms of diabetic complications.
Heerspink, H. J. L., Gao, P., de Zeeuw, D., Clase, C., Dagenais, G. R., Sleight, P., ... & Mann, J. F. (2014). The effect of ramipril and telmisartan on serum potassium and its association with cardiovascular and renal events: results from the ONTARGET trial. European journal of preventive cardiology,21(3), 299-309.
Koivisto, J. M., Multisilta, J., Niemi, H., Katajisto, J., & Eriksson, E. (2016). Learning by playing: A cross-sectional descriptive study of nursing students' experiences of learning clinical reasoning. Nurse Education Today, 45, 22-28.
Liou, S. R., Liu, H. C., Tsai, H. M., Tsai, Y. H., Lin, Y. C., Chang, C. H., & Cheng, C. Y. (2016). The development and psychometric testing of a theory‐based instrument to evaluate nurses’ perception of clinical reasoning competence. Journal of advanced nursing, 72(3), 707-717.
Nasri, H., & Rafieian-Kopaei, M. (2014). Protective effects of herbal antioxidants on diabetic kidney disease. Journal of Research in Medical Sciences, 19(1).
Peeters, M. J., van Zuilen, A. D., van den Brand, J. A., Bots, M. L., van Buren, M., ten Dam, M. A., ... & van de Ven, P. J. (2014). Nurse practitioner care improves renal outcome in patients with CKD. Journal of the American Society of Nephrology, 25(2), 390-398.
Remuzzi, G., Benigni, A., Finkelstein, F. O., Grunfeld, J. P., Joly, D., Katz, I., ... & Antiga, L. (2013). Kidney failure: aims for the next 10 years and barriers to success. The Lancet, 382(9889), 353-362.
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