Chronic kidney failure is the group is one of the leading public health problems in the U.S and the main source of poor quality of life to the affected people in the country. Chronic kidney diseases are usually the last stages of progressive loss of kidney functions. The loss is typically slow and gradual with no symptoms until the kidney stage where the kidney almost stops functioning. The end stage renal diseases are the last stage of CKD in which the kidneys are completely unable to get rid of wastes from the body. Dialysis and kidney transplant is necessary at this stage to restore the functioning of the kidney.
The CKD condition considered health problem by the Healthy People 2020 commonly responsible for disabilities and premature deaths. The treatment is also expensive, accounting for a quarter of the Medicare budget. It, therefore, exerts high economic costs to the public and private sectors. Furthermore, the risk of progress and early death has been recently connected substance abuse particularly alcohol, hard drugs, and smoking (News Medical Life Science, 2018).
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Morbidity and comorbidity of the disease
Most patients with chronic kidney are likely to develop one or more comorbidities, or illnesses existing along the main disease. Diabetes and hypertension or high blood pressure are the main comorbidities that lead to CKD in the U.S. Most people with kidney disease also have diabetes and/or hypertension. It challenging for patients with CKD and comorbidities to understand and follow the recommended care and treatment. ( Centers for Disease Control and Prevention, 2010). This is attributed to multiple care and therapies and how to schedule doctor’s appointments and associated dialysis. It is advisable to seek the opinion of the doctor about important areas that are important to the health and focus energy towards that area.
There are also other frequent comorbidities that can lead to chronic kidney disease. These include cardiovascular disease, congestive heart failure, lung disorders, peripheral vascular disorder, malnutrition, and neurological problems. The infrequent comorbidities that lead to CKD include HIV and Aids and Hepatitis C. The proportion of CKD patients in the U.S with this condition is significantly low. Even though chronic kidney disease is often viewed in isolation, studies have shown that CKD comorbidities are quite significant in the U.S. The increasing comorbidity is linked to increased medication burden and reduced survival. Therefore, a care plan for the CKD should consider the aspect of comorbidity.
Impact of CKD and patient morbidity on the overall health of the nation
CKD disease is prevalent, treatable, and harmful to the affected persons and the nation. The condition affects close to 26 million American adults and is projected to increase by 13% annually ( Centers for Disease Control and Prevention, 2010) . The dramatic increase in the prevalence will lead to an increase in diabetes, hypertension, and cardiovascular illness. The condition is costly to treat, and this puts significant financial constraints on the public and private sector in the country. The condition accounts for 25% of Medicaid budget which goes to less than 1% of beneficiaries ( Centers for Disease Control and Prevention, 2010) . This budget is unsustainable particularly in times of economic downturn. The condition also leads to loss of productivity due sick off and lay off due to the illnesses. The health sector is under pressure from the rising number of patients with CKD in the country. This will require additional care professionals including kidney specialists and nurses to offer care to patients with chronic kidney failure.
Healthy People 2020 goals and objectives for the illness
The goal of healthy People 2020 is to reduce new cases of the disease and related deaths, disability, economic burdens, and other complications. The following objectives will help in the attainment of the goals of Health People 2020:
Reducing the proportion of American citizens with kidney disease
Increase the proportion of kidney patients who are aware of having impaired renal function. This is because a significant number of patients with CKD do not know when it develops into impaired condition.
Increase patients follow up for renal evaluation in six months after discharge. This applies to patients who incurred acute kidney injury during hospitalization.
To increase the proportion of patients with CKD and diabetes who receive suggested medical evaluation and treatments
Improve cardiovascular care for CKD patients by reducing the ratio of people kidney problem who have blood pressure and increasing the percentage of elderly patients with kidney illness taking statins to manage their cholesterol.
Reducing new cases of end-stage renal disease and deaths among kidney patients. This will entail reducing deaths among patients on dialysis, reducing the proportion of cardiovascular deaths for dialysis patients, and deaths of patients with functioning kidney transplants.
Reducing cases of kidney failures among diabetic patients and improve vascular access for hemodialysis persons.
Increase patient access to dialysis, and kidney transplants in patients with ESRD aged below 70 years and within 3 years of developing ESRD condition.
Meeting these objectives will reduce the burden of kidney disease, improve quality of life and promote longer lives for the affected people, and eliminate disparities among patients with kidney diseases (Healthy People 2020, 2018).
Questionnaire
What is the nursing diagnosis appearing in the patient CKD?
Decreased Cardiac Output.
Fluid and Electrolyte Imbalances.
Imbalanced Nutrition.
Ineffective Breathing Pattern.
Impaired Skin Integrity
For decreased cardiac Output, what are the nursing goals?
How do I in maintain cardiac output, blood pressures, and strong peripheral pulses
How do I assess hypertension caused by renal dysfunction?
What role will the patient play to help in assessing his or her hypertension?
With the goal of maintaining body weight with no excess fluid, what are the possible intervention?
How will the patient and family member help to limit intake of fluids and response to therapy?
Which explanation will I give to patient and family on liquid restrictions t increase their cooperation to this intervention?
What is an appropriate way of teaching patient/family member on how to record and use fluid intake and output? This is essential in determining the balance of fluid input and output
For the goal of maintaining sufficient nutrients through a balanced diet, what are the interventions?
How will the patient monitor his or her consumption of food and liquids?
How will they determine nutritional deficiencies?
How will they respond to nausea and vomiting if they are noticed? These are symptoms accompanying accumulated endogenous toxins.
How will I ensure that the patient consumes a little food but more often? This is because a smaller portion of foods help to increase food intake
How will improve the social aspects that improve food intake such as increased visits by family members during meals?
How will the patient engage in frequent mouth care? This will lower stomatitis, oral discomfort, and bad taste that can affect intake of food.
How will I teach the patient about deep breathing and effective coughing? This cleanses the airwaves to facilitate the flow of oxygen.
How will the patient limit movements?
For the goal of maintaining skin integrity connected to pruritus, what are the interventions?
What criteria is appropriate in keeping the skin intact and techniques that will prevent skin damage?
What are the cultural values that will positively contribute to the attainment of these goals?
References
Centers for Disease Control and Prevention. (2010). National chronic kidney disease fact sheet: general information and national estimates on chronic kidney disease in the United States, 2010. Atlanta, GA: US Department of Health and Human Services, Centers for Disease Control and Prevention .
Health People2020. (2018). Chronic Kidney Disease. Retrieved from https://www.healthypeople.gov/2020/topics-objectives/topic/chronic-kidney-disease
News Medical Life Science. (2018, June 8). Persistent Substance use associated with higher risk of CKD progression and early death. Retrieved from https://www.news-medical.net/news/20180608/Persistent-substance-use-associated-with-higher-risk-of-CKD-progression-and-early-death.aspx
