Case Study: Renal Case Scenario
Please answer the five (5) below questions using information from the provided case study. Your answers need to reflect critical, clinical decision making and be supported by information from the case study. You are required to provide at least three (3) relevant, current references and all in text referencing and your reference list should reflect approved APA reference style as per the ACU academic skills guide
Sharon Anderson is a 42 year old female with a history of Type-1 diabetes diagnosed in childhood. Sharon is independent and lives with her husband David along with her two children Samantha and Riley in a government funded housing apartment. She works part-time, two, six hour shifts per week at a local supermarket. Sharon began haemodialysis eight years ago following the onset of renal failure. She had a right arm Arterio-Venous fistula (AV fistula) created for this purpose. Sharon's recent employment meant she is no longer able to meet the haemodialysis regime requirements of attending her local hospital three days per week for treatment and was not considered a good candidate for home haemodialysis. A tenckhoff catheter was inserted twelve weeks ago and Sharon commenced on APD (automated peritoneal dialysis), also known as CCPD and IPD, at home. You are the community nurse who has been assigned to visit Sharon following her recent hospital admission for peritonitis. Sharon was discharged yesterday from hospital. In addition to an assessment of the home you are to provide any necessary education required and administer intra-peritoneal antibiotics. During her recent admission Sharon alerted her medical team to worsening eye-sight. Additionally, she has told her treating team that she often finds it difficult to manage everything with her dialysis as her husband does not want to be involved in her dialysis and is not interested in learning.
You note from her recent hospital admission the following assessment data: Weight: 58 kilograms Height: 170cm T: 37.1 P: 90bpm R: 26 bpm Sp02: 98% R/A BP: 155/88mmHg- Lying and 135/82mmHg- Standing Lung fields are clear to auscultation.
Past medical history:
- Chronic renal failure
- Hypertension
- Diabetes mellitus Type-1
- Hyperlipidemia
- Fracture- Right Tibia & Fibula six months ago
Surgical history
- Formation Right Radial A-V fistula 2007
- Tonsillectomy as a child
- Current Medications
- Calcium carbonate 1500mg mane
- Ramipril 10mg mane
- Omeprazole 20mg mane
- Captopril 12.5 mg TDS Ca
- citriol 0.025mcg BD
- Actrapid pen 100units/ml as per sliding scale
- Erythropoietin 60 units per week
Blood results on Discharge Serum creatinine is elevated at 290 µmol/L GFR reduced at 6mL/min/1.73 m² Macroalbuminuria-urinary ACR 52 mg/mmol Haemoglobin 82g/L Potassium 5.9mmol/L Urea 18mmol/L Calcium 2.15mmol/L Phosphate 1.90mmol/L HbA1c 53 mmol/mol or 7.1% Elevated PTH 184pmol/l
1. Identify two (2) priorities of care for Sharon. Provide a rationale for each including the information from the case study you used to form these priorities of care. You may use the headings from the clinical reasoning cycle or use table to assist you. (300 words).
2. Based on your identified care priorities, identify and discuss three (3) community nursing interventions needed to ensure Sharon reaches her optimal level of health in the community. (200 words).
3. Indicate three (3) psychosocial issues that may arise or may be impacting on Sharon's health and identify three (3) nursing interventions you may put in place to address these issues (200 words).
4. Describe the link between kidney failure and diabetes (100 words).
5. Identify the primary purpose of three (3) of Sharon's medications and relate their role in her kidney disease and diabetes mellitus treatment (200 words).
1000 words
5 references.