its about chronic kidney disease case study.
Written assessment Written Assessment – Clinical Case Study Report Weight: 50% of the total unit mark Length: 2000 words ± 10% Task The objective of the clinical case study report is to gain comprehensive knowledge about kidney disease and its management. In this case study report you will focus on the stages of chronic kidney disease (early detection to end stage kidney diseases) and the assessment and management of each stage. Within the Moodle unit HSNS265 “Case: Glenda; Glenda is from the Tiwi Islands. Your assignment needs to be structured according to the conventions of academic writing following American Psychological Association(APA) - 6th Edition - commonly referred to as APA 6 and include an introduction, an integrated conclusion and subheadings as required. You must write in essay style: do notuse dot point format. Your response needs to be supported by recent evidence based resources. This could include information from your texts or from other peer reviewed sources. In this case study report you will present the clinical case of Glenda and discuss her kidney disease and management at each stage of her chronic kidney disease; this will include: The assessment and management of each of the stages of Glenda’s chronic kidney disease. Consider for each stage of her kidney disease; the pathophysiology, health priorities, interdisciplinary team approaches, health promotion strategies, health concerns and communication strategies that you would apply to Glenda, her family and wider community. Rationale (Based on Unit Learning Outcomes 1 – 5) This activity will allow you to demonstrate your ability to: 1. demonstrate an understanding of the renal system including related anatomy and physiology, pathophysiology, diagnostics, pharmokinetics, pharmodynamics, the quality use of medicines and complementary therapies; 2. demonstrate and apply comprehensive renal assessment and evidence based clinical reasoning skills in theory, clinical and simulated environments; 3. demonstrate the capacity to integrate and relate principles of ethical and legal practice within a team approach to person centred care; 4. learn and apply reflective practice and intra and interprofessional communication strategies that facilitate the delivery of safe and effective quality care across diverse settings; 5. plan and implement person centred primary health care and health promotion strategies related to renal health and wellbeing. This assignment is important because it will enable you develop a greater understanding of the stages of kidney disease, as well as, apply a patient centred care approach to undertaking the assessment and management of each stage. You are also required to apply your critical thinking skills to the case study and show your capacity to identify, interpret, and critically analyse issues raised by the case study. This assignment is the third assessment within the unit. The concepts that you are exploring will assist in building your knowledge in relation a registered nurse's accountability and responsibility for caring for patients with chronic kidney disease. It should contain the following sections: Introduction - Set the scene for chronic kidney disease, Glenda's chronic kidney disease. Provide a Case Description- Provide pertinent information about Glenda - This usually begins with presenting signs and symptoms, medical history, (family history, if relevant), social history, medications, results of physical examination and/or nursing assessment, final diagnosis, treatment, nursing care provided, and outcomes. Discussion - Critique the care, assessment and management for Glenda at each stage of her chronic kidney disease. You may include any care that may not have been effective within the case study and provide any recommendations that would have improved her care. Incorporate the relevant literature within your discussion. You can discuss any unusual aspects of the case and the care that is/would be provided to assist Glenda to manage her condition. Conclusion - A succinct summary of the information provided to draw the case study to a close. Reference list - APA 6 referencing style must be used. References should be as current as possible. As a general rule of thumb, literature published before 2008 will not attract marks. However, older research literature can be used for the review where necessary, if you can justify the importance of the seminal work to be included. Follow the link at the top right of the page for further information and examples. Glenda case begins here Life on Bathurst Island with Glenda (part 1) PAGE 1 Life on Bathurst Island... Glenda comes to the clinic Glenda is a 56 year old Aboriginal woman who presents to her local health clinic at Wurrumiyanga, to see the doctor. Glenda is complaining of an itchy face. The doctor is currently at Milikapiti on Melville Island providing a morning clinic and is available by phone. He will return later that day. On request from the doctor you take blood so that it can be transported to the Darwin pathologist on the morning plane. Results will then be available in the evening. Review Subjective data · Glenda does not feel like eating and has not eaten for a week (anorexia) · Complains that she has been vomiting (nausea) · Feels a little bit confused · Itchy face (pruritus) · Tired Objective data · Temperature – 36.5 · Pulse rate – 89 beats per minute · Respiratory rate – 20 resp per minute · Blood pressure – 156/ 97 mmHg · Oxygen saturation level – 96% at room air · Blood glucose level – 6 · Urine analysis – positive protein trace Laboratory data · Creatinine clearance rate: 8.2 mL/min · Serum creatinine level: 1132/umol/L · Urea level: 45 mmol/L · Sodium 128 · Potassium level: 6 mmol/L · Haematocrit: 0.20 · Bicarb 11.5 · Anion Gap:20 · Ca 1.98 · P04 5.4 · PH – 6.1 Glenda's story continues (part 2) PAGE 1 February 2010: Glenda's journey February, 2010: An unexpected journey for Glenda Part of your role as a Registered Nurse at the remote clinic is to find the necessary medical records to document the clinical care. It is also essential to look at the care that Glenda has been receiving by the community nurses, any past admissions and her medical history as part of your comprehensive health assessment. In particular you look at the nursing report from 2010 in the notes, you then look further in the correspondence to find the discharge summary from Royal Darwin Hospital. You need to interpret the past medical history to assist you with her latest admission. 12/2/2010: 1010hrs Nursing report Glenda Kerinaiau presented to the clinic complaining that her eye lids felt swollen and she felt sick. On physical examination she has generalized swelling, including on the face, feet, ankles and hands. When she walks she complains of stiffness and pain in her knees and elbows. Glenda’s family states she was unwell about two weeks ago with a sore throat. Pain relief given as per medication chart with effect. Observation attended as per obs chart awaiting medical review. (S Jones RN 35416) Observations attended on admission · Temperature – 38.8 · Pulse rate – 98 beat per minute (resting pulse rate) · Respiratory rate – 22 resps per minute · Blood pressure - 180/100mmHg · Oxygen saturation level – 96% at room air · Blood glucose level – 6mmols · Urine analysis: Rust-colored urine, tested positive for blood, protein Nursing history · Smoking – 20 cigarettes per day · Alcohol – binge drinks fortnightly, 4 or more drinks · Diet - eats a traditional diet of seafood, bush tucker, fruit and vegetables. Currently drinks water about 2-3L per day, 3 cups of tea and 500mL of Coca Cola per day, · Physical activity - exercises, walking everywhere usually at minimum pace, weight within healthy weight range. · Immunisation – flu vaccination & pneumococcal vaccination up to date 13/2/2010: 1410hrs Nursing report Glenda prepared for transfer via RFDS (fixed wing) to Royal Darwin Hospital for further investigation. Handover given to bed manager – Nurse Manager at Royal Darwin Hospital. All paper work including nursing transfer, medical letter are with transferring RFDS nurse. Glenda's NOK has been notified of transfer. (S Jones RN 35416) 12/2/2010: 1010hrs Nursing report Glenda Kerinaiau presented to the clinic complaining that her eye lids felt swollen and she felt sick. On physical examination she has generalized swelling, including on the face, feet, ankles and hands. When she walks she complains of stiffness and pain in her knees and elbows. Glenda’s family states she was unwell about two weeks ago with a sore throat. Pain relief given as per medication chart with effect. Observation attended as per obs chart awaiting medical review. (S Jones RN 35416) Glenda's story continues (part 2) PAGE 2 Glenda was diagnosed with Post Streptococcal Glomerulonephritis and treated at Royal Darwin Hospital. She was then transferred back to the Tiwi Islands. The nursing discharge letter was addressed to the clinic nurse and included: Glenda’s follow up includes a monthly health check by the community nurse which includes blood pressure monitoring and urine analysis. Glenda’s follow up includes a monthly health check by the community nurse which includes blood pressure monitoring and urine analysis. The Nurse Manager at Royal Darwin renal ward has asked you the registered nurse to go over to the Tiwi Islands for two days to assist with health staff education to detect and manger chronic kidney disease she provides you with a USB with the two lectures below: One session will be to the community nursing staff, to assist them to manage and educate the community: Understanding how to care for Glenda (part 3) PAGE 1 Putting the patient at the centre of care During this admission Glenda is transferred from the clinic to Royal Darwin hospital for further investigation. She is admitted to the renal ward under the care of Nephrologist Dr Pell. When Glenda arrives in the Darwin emergency department they are prepared for her arrival, they insert a vas cath, order a portable x-ray, ECG and EUC & she is then urgently sent to the hemodialysis unit & is placed on hemodialysis that evening. She is scheduled for surgery in one week to have fistula formation in her Left arm. Who is Glenda? Glenda is from Wurankuwu, a small settlement on Bathurst Island sixty kilometres from Wurrumiyanga. Glenda lives there with her extended family including her two sisters, one of her sons and his four children. Glenda has five children, three girls and two boys. Her eldest daughter died in a car accident on the island when she was only fifteen years of age. Glenda's remaining four children all live in the Northern Territory. Her daughter lives in Darwin with her family, while her three sons live on the Tiwi Islands with their families. Glenda moves around the Tiwi Islands regularly to visit family, and attend meetings, cultural events and special occasions. Glenda is quiet; she speaks both English and Tiwi. Glenda attends haemodialysis three days per week as an outpatient at the Nightcliff renal unit. She lives with her daughter in Darwin who is her main carer and who also transports Glenda to and from the outpatient dialysis clinic. Whilst on dialysis, Glenda covers herself with a blanket to try to keep warm in the air conditioned unit, and usually falls asleep for the five hours of her treatment. One day when she brings Glenda for her dialysis, Glenda's daughter Roseen asks you, 'When can my