NR 305 Week 6 Course Project Milestone 2

Kidney Disease

NR 305 Week 6 Course Project Milestone 2

Chronic hypertension is one of the leading causes of kidney disease.  Hypertension is a preventable disease that can be controlled with life style changes and adherence with medication.  Uncontrolled hypertension can lead to other serious health issues that cause major damage to the system that cannot be reversed.  One of these diseases are the kidneys.  Although my client JD has no family history of kidney disease, he is still at risk due to his uncontrolled hypertension.  The goal and the purpose for this paper is to develop a plan to control his diabetes to decrease his chances for developing kidney disease.  We are going to identify modifiable behaviors (diet and exercise) and ways for him to follow his medication regimen and monitor his blood pressure in between doctor visits.

NR 305 Week 6 Course Project Milestone 2

Preventable Disease Overview

When kidneys are damaged, waste products and fluid buildup in the blood which can cause edema, shortness of breath, and other health issues. High blood pressure damages on blood vessels that go into the kidneys.  A person can be asymptomatic as with hypertension. When it is diagnosed it is usually to late and the person is in end stage renal failure and will need dialysis or a kidney transplant. ESRD can cause unintentional weight loss, general malaise, nausea, vomiting, frequent hiccups, increased skin pigmentation, and significantly decreased urine output. People who are at a greater risk for Kidney disease are those with Diabetes Mellitus I and II, hypertension, cardiovascular disease, and family history of kidney disease.  “Blacks with HTN are more likely to develop ESRD than Whites with HTN, (Schub, T. B. 2018).”  JD is a black male with uncontrolled hypertension and high cholesterol with puts him at a greater risk.

Kidney disease is diagnosed through the following blood, urine, and diagnostic testing (Schub, T. B.2018):

  • Physical Findings of Particular Interest -A renal artery bruit might be heard in patients with renal artery stenosis
  • Laboratory Tests That May Be Ordered 
  • UA might show high levels of creatinine, proteinuria, and/or albuminuria, indicating renal dysfunction
  • Elevated BUN indicates renal dysfunction
  • GFR < 89 mL/min/1.73 m2 indicates reduced kidney function
  • Ultrasonography and selective renal arteriography can show renal blood flow abnormalities, indicating renal artery stenosis
  • Echocardiograph can show left ventricular hypertrophy in patients with cardiovascular involvement

NR 305 Week 6 Course Project Milestone 2

Evidence Based Intervention

One potential method for improving self-management is through the use of interactive digital interventions, which offer the possibility of empowering patients to self-manage their long-term conditions, and by providing patients with better access to personalized information and support for active involvement in treatment, as well as producing significant savings in treatment costs (McLean, G, 2015).”  Having JD use an interactive device like his cell phone that reminders can be sent to him to take his medication and/or check his blood pressure can be a great way for him to keep him in his medication regimen. He can also get reminders that its time to pick up his medications. I would have him access a patient portal where he can see his progress.  I would have the blood pressure monitor set up to sync his information to his account.  This would be a great enforcement to either keep up the good work or show him that improvement is needed.

  Using these technologies would also give me a look at how he is maintaining his blood pressure in between office visits.  I can also call him in for a visit if there is any issues.  In the beginning it will be an adjustment period where he will learn how to modify his diet and incorporate more exercise.  As he continues to log his activities he will be able to have these new changes incorporated into his daily schedule and it would be come easier for him to choose better food and schedule times for exercise daily.

NR 305 Week 6 Course Project Milestone 2

Implementation: Teaching Plan

I would tell JD to monitor his blood pressure 2x’s a day using a monitor that is synced to a portal that he can log into daily to log his meals, when he took his medication, and how much he exercised.

Evaluation

To check on JD’s progress, I would go over his blood pressure readings and activity logs.  I want to see if he has attempted to keep his exercise regimen up, what is his eating habits, has he been taking his medications daily, and making sure he is not smoking or drinking excessively.  If there was trouble with any of these points I would sit down and discuss with him why he was having trouble with it.  I would then suggest a nutritionist if its his diet, joining a gym for exercise, or find him a local support group for smoking or drinking.

NR 305 Week 6 Course Project Milestone 2

Summary

Hypertension can be controlled, and further health issues may be adverted if one is willing to make life style changes and stick with them.  Kidney disease due to hypertension for this patient is possible if he does not find a way to stick to his medication regimen and try to exercise on a regular basis.  JD is not computer savvy, but he is capable of checking his text messages and logging into a portal and keeping track of his health.  I think this could be a great way to help him take control of his health while still under the guidance of his provider.

NR 305 Week 6 Course Project Milestone 2

References

Jarvis, C. (2016). Physical examination & health assessment (7 th ed.). Philadelphia, PA: 

Saunders. 

McLean, G., Murray, E., Band, R., Saunderson, K., Hanlon, P., Little, P., … Mair, F. S. (2015). 

Digital Interventions to Promote Self-Management in Adults with Hypertension: Protocol for Systematic Review and Meta-Analysis. Journal of Medical Internet Research, 17(11), 1. https://doi-org.chamberlainuniversity.idm.oclc.org/10.2196/resprot.4648.

Schub, T. B. (2018). Hypertension and Kidney Disease. CINAHL Nursing Guide. Retrieved from 

https://chamberlainuniversity.idm.oclc.org/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=nup&AN=T703239&site=eds-live&scope=site..

https://www.niddk.nih.gov/health-information/communication-programs/nkdep/identify-manage-patients/manage-ckd.

Leave a Reply