NSG2HPB Nursing Health Priorities B


We will discuss the pathophysiology as well as management of Chronic Renal Failure using current literature.

Explain the relationship between Mr Goodpasture’s presentation.

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his signs and symptoms as well as pathology results.

Describe the relationship between Mr Goodpasture’s chronic kidney disease and his medical past.

Define the management of end stage kidney disease.

Compare and contrast both the risks and psychosocial implications of two management options.

Answer to Question: NSG2HPB Nursing Health Priorities B

Presentation of Mr. Goodpasture, and the Pathophysiology of His Kidney Disease

My Goodpasture explains that end-stage kidney disease (ESRD), is a progressive deterioration in renal function. It’s characterized by the body’s inability maintain a healthy metabolic and fluid/electrolyte balance.

Its presentation can be seen across many interrelated systems including neurologic, cardiovascular, pulmonary and integumentary.

End-stage kidney disease patients often have neurologic problems such as Mr. Goodpasture’s state agitation.

Common neurological complications that can occur in end-stage kidney disease include cognitive dysfunction (encephalopathy), stroke, peripheral and autonomic neural pathies, and cognitive dysfunction (Arnold. Issar. Krishnan., 2016).

CNS injury in ESRD could be due to multiple factors.

The pathophysiologic mechanisms of CNS injury in ESRD are multifactorial, i.e. they include both neurodegenerative (vascular) and vascular factors.

Additional neurologic signs and symptoms that are common include irritability, disorientation (seizures, weakness, fatigue), inability to concentrate and behaviour changes such as asterixis, seizures, burning soles of the feet, and inability for one to concentrate (Smeltzer Bare, Hinkle and Cheever, 2010).

Mr. Goodpasture’s respiratory exam revealed scattered crackles across the bases. This is another common sign of end-stage disease.

ESRD may also present with pulmonary symptoms like shortness or crackles, Kussmaul style respirations, thick, tenacious sputum (Smeltzer Bare and Hinkle, 2010).

The close relationship between lung function and kidney function is the reason for pulmonary problems.

A reduction in the systemic effects caused by renal acid-base disturbances is possible through changes in respiratory function (Cury Brunetto and Aydos 2010).

Patients also present with problems in the cardiovascular system.

Smeltzer Bare-Hinkle and Cheever (2010) say that common symptoms of cardiovascular disease include hypertension and hyperlipidemia.

The patient is suffering from both oedema, hypertension, and both.

The most common cause for death in patients with ESRD on dialysis is cardiovascular disease. This is partly due to the fact that there are many risk factors.

Gastrointestinal manifestations can include constipation and diarrhoea (Smeltzer Bare and Hinkle, 2010).

The accumulation of products from protein metabolism in blood results in a decline in renal function.

The rate of decline of kidney function is related to urinary protein excretion.

Patients with ESRD often have high creatinine or urea levels (Khalidah & Suhad, 2015).

Paige & Nagami (2009) report that patients with ESRD often have elevated serum phosphorous or potassium levels. This is evident in My Goodpasture.

On hematology, Mr. Goodpasture shows below normal haemoglobins, red cells count, haematocrits, white cells count, and neutrophils levels.

This is in agreement of Suresh and Mallikarjuna, Sharan and Hari Krishna, as well as Shravya (2012). They concluded that patients suffering from chronic renal disease have abnormal haematological parameters.

Along with other associated factors, such as haematuria or increased haemolysis and haemoglobin levels, the main reason for the decrease in haemoglobin content, red blood cell count and platelet count, as well as haematocrit and total leucocyte counts, is the impaired production of Erythropoietin.

His Medical History and Mr. Goodpasture’s Kidney Disease

The underlying disorder of protein excretion by the kidneys, and hypertension are the main factors in the decline in kidney function and progression of CKD.

He also has hypertension, which is a well-known risk factor for chronic renal disease and ESRD.

Hypertension, which is second only to diabetes, is believed to be the leading cause of kidney damage (Tomiyama und Yamashina, 2014.).

Yamashina & Tomiyama (2014) have reported that the prevalence and incidence of hypertension and ESRD has increased over the past 20 years.

As shown by the high rate of ESRD in haemodialysis patients, hypertension is both a complication of ESRD.

In a very short time, severe high blood pressure (as indicated by the patient’s vital sign) can damage the kidney function.

Other mild forms, such as high blood pressure, can also cause kidney damage if spread over many years.

If uncontrolled, hypertensive patients are at increased risk of rapidly and easily developing end-stage renal disease.

The risk of developing ESRD is increased when hypertension is accompanied by other risk factors, such as obesity, smoking, and alcohol consumption (as the case shows).

Hypertension, which is uncontrolled high blood pressure, can lead to blood vessel damage throughout the body.

The most susceptible to injury are often the venules and arterioles.

The high pressure damages many vessels in the kidneys.

Systemic hypertension causes the kidneys to become hypertensive due to high capillary pressures.

Hypertension can increase the likelihood of developing cardiovascular problems and worsening kidney disease in people with chronic kidney disease.

End-Stage Kidney Disease

There are two options for Mr. Goodpasture: kidney transplant and haemodialysis.

Patients with ESRD prefer kidney transplantation.

This is because of the significant improvement in quality and survival that patients with ESRD receive compared to dialysis patients (Berns (2016)).

Patients who have received transplants experience an average growth of 8 to 12 year.

It is generally known that kidneys from living donors function better and last for longer periods of time than those from deceased ones.

Younger patients have been shown to be more likely to receive transplantation than older adults.

There are some things that could make a patient ineligible for transplantation.

These factors include severe obesity, chronic illnesses that could result in death within a few months, active or recently diagnosed cancer, current drug abuse or addiction, dementia, or the inability or inability to remember how to take medications (Berns (2016)).

One of the biggest drawbacks of transplantation is the need for medication and regular monitoring to prevent organ rejection.

Haemodialysis, however, involves pumping blood through a dialysis device to remove fluids and waste products.

Haemodialysis is not recommended for patients with unstable cardiac rhythms, hemodynamic instability, hypotension or patient refusal (Crawford & Lerma 2008).

In terms of risks and psychological implications, most transplant recipients report a significant improvement in their quality of living, but a very low level of physical and emotional wellbeing after the procedure (Lopes and colleagues, 2011).

Recipients often report anxiety and depression as the main psychosocial problems.

According to some studies, there is twice the number of well-functioning relationships between recipient and donor after positive outcomes (Pasquale and colleagues, 2014).

Risks associated with transplantation include surgery risk, rejection of donor organs, side effects and adverse reactions to anti-rejection drugs or immunosuppressants (Saha & Allon 2016).

Concerning the psychosocial effect, there are depression, anxiety, fatigue and sleep problems. There is also uncertainty about the future.

ReferencesArnold, R., Issar, T., Krishnan, A. V., & Pussell, B. A. (2016).

Neurological complications in chronic renal disease. JRSM Cardiovasc Dis.Berns, J. (2016).

Patient education: Dialysis or transplantation — which one is right?

(Beyond-the-Basics). Retrieved from UpToDate: https://www.uptodate.com/contents/dialysis-or-kidney-transplantation-which-is-right-for-me-beyond-the-basicsCrawford, P., & Lerma, E. (2008).

End Stage Renal Disease Treatment Options

Prim Care Clin Office Pract.Cury, J., Brunetto, A., & Aydos, R. (2010).

Negative effects chronic kidney disease on. Rev Bras Fisiote, 91-8.Khalidah, M., & Suhad, H. (2015).

The Biochemical Differences in Patients with Chronic Renal Disease.

International Journal of Pharma Medicine and Biological Sciences. pp. 75-79.Lastra, G., Syed, S., Kurukulasuriya, L. R., Manrique, C., & Sowers, J. R. (2014).

Type 2 diabetes and hypertension: An update. Endocrinol Metab Clin North Am, 103-122.Lopes, A., Frade, I., Teixeira, L., Oliveira, C., Almeida, M., Dias, L., & Henriques, A. (2011).

Depression and anxiety after living kidney donation: evaluation of recipients and donors. Transplant Proc, 131-6.McQuillan, R., & Jassal, S. (2010).

Neuropsychiatric complications associated with chronic kidney disease. Nat Rev Nephrol, 184-193.Paige, N., & Nagami, G. (2009).

The Top 10 Things All Primary Care Physicians Wish Nephrologists Knew.

Mayo Clin Proc. 180-182.Pasquale, C. D., Veroux, M., Indelicato, L., Sinagra, N., Giaquinta, A., Fornaro, M., . . . Pistorio, M. L. (2014).

Psychopathological aspects related to kidney transplantation. Efficacy and collaboration of multidisciplinary teams.

World J Transplant. 267-275.Rumeyza, K. (2013).

An update of risk factors for chronic renal disease.

Kidney Int Suppl (2011).Saha, M., & Allon, M. (2016).

Diagnosis of hemophilia emergencies, treatment and prevention.

Clin J Am Soc Nephrol 1-13.Smeltzer, S. O., Bare, B., Hinkle, J., & Cheever, K. (2010).

Brunner & Suddarth, Textbook of Medical-surgical nursing. Philadelphia: Lippincott Williams & Wilkins.Suresh, M., Mallikarjuna, r. N., Sharan, B. S., Hari Krishna, B., & Shravya, k. (2012).

Hematological Disorders in Chronic Renal Failure.

International Journal of Scientific and Research Publications.Sweety, S., A. J., Rahman, M., Salim, M., & Mahmood, M. (2014).

Cardiovascular complications in end stage renal disease patients who are on maintenance haemodialysis.

Mymensingh Medicine J, 329-334.Tomiyama, H., & Yamashina, A. (2014).

Beta-Blockers as a Management of Hypertension/Chronic Kidney Disease. Int J Hypertens, 919256.Wang, L.-J., & Chen, C.-K. (2012).

Hemodialysis: The Psychological Effects

M. Polenakovic’s Renal Failure – The Facts (pp. 217-236). Shanghai: InTech.

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