Case Study: Chronic Kidney Disease of a 51 Years Old Man

In the following section, discussion will be carried out with respect to the applicability of the Levitt-Jones’ Clinical Reasoning Cycle in identification of the two care priorities within the realm of the given clinical scenario. The nursing vocation makes use of the Clinical Reasoning Cycle for considering the situation of the patient, further collecting and processing information, followed by identification of the problems. Based on the identified issues, goals are established, and actions are taken accordingly. As part of the next step in this cycle, outcomes are evaluated followed by reflecting on the process that in turn leads to new learning (Hunter & Arthur, 2016). According to the narration in the given case study, George is a 51 years old Aboriginal and Torres Strait Islander man who has been diagnosed with several issues on arrival to the general practitioner for his annual health check-up. He suffers from stage 4 chronic kidney disease (CKD) alongside macro albuminuria secondary to diabetes nephropathy in addition to deteriorating kidney function, high blood pressure, excessive weight gain and raised level of cholesterol. He lives with his wife and three children in his own home and both husband-wife receives the Centrelink payments. He was ex-smoker and had history of stroke. Family history reveals that many of George’s extended family members undergo dialysis procedure. Moreover, he has been prescribed several medications, about which he is unsure as to whether he needs to continue taking the medications and is not aware about why they were given, even the names of the tablets. Deteriorating kidney function combined with elevated blood pressure and albuminuria prompted him to be referred to the nurse practitioner. Under such circumstances, it is imperative and most prudent on the part of the nursing professionals to streamline actions that in turn will aid in addressing the situation at hand in an effective manner.

The information presented in the case study shows that the individual is suffering from chronic kidney disease and likewise he has been subjected to various medications that are prescribed to be taken at appropriate doses and appropriate timings by the concerned physician. However, upon arrival for the annual health check-up, George has been referred to the nurse practitioner to deal with his deteriorating kidney function and elevated blood pressure. Therefore, as per the available data, George’s care regime should comprise of undertaking actions that will help in ameliorating his condition in an emergency basis and help to sustain long-term health thereby facilitating quick recovery. As per the given case scenario, effort is to be directed to tackle with the debilitating renal function condition together with elevated blood pressure conjointly first. Next, initiatives are to be taken so that the patient on recovery must adhere to the prescribed medications to avoid repercussions and bore the benefits for compliance to medications. Therefore, amidst all the care options those are practicable under such situation owing to excessive weight gain (10 kg in last two years), elevated blood pressure (153/93 mmHg) , macroalbuminuria (30 mg/mmol), faulty serum creatinine (237 micromol/L) , Glomerular filtration rate (GFR) and HbA1c (9.3%) function as evident from the assessment report of the patient, the issue pertaining to deteriorating kidney function coupled with elevated blood pressure need to be addressed on priority basis. Moreover, the issue of complying to the prescribed medications will also be addressed on a priority basis as the patient has been described of not having conform to his set of medicines and lack awareness regarding the utility of having them. As the practicing nurse, two of these care options are to be prioritized to ensure optimal recovery of the patient and long-term sustenance.

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First, it has been suggested in the case study that George is facing a crisis due to his deteriorating kidney function in addition to the elevated blood pressure. Moreover, the names of the medications that has been prescribed to George has also been given. Amongst them, furosemide is one such drug that George is supposed to take. Furosemide has been identified as a medicine that find its use in treating fluid build-up under multiple conditions of liver scarring, heart failure or kidney disease. In fact, this particular medicine is also used in treating high blood pressure through administration of either intravenous injection or oral route. Research based evidence has already brought to the forefront the feasibility of using this medicine in case of renal condition where acute kidney injury has set in and furosemide stress test has been identified as a potential option to predict its progression (Rewa et al., 2019). Critically ill patients with acute kidney injury are also subjected to low dose furosemide medication to deal with their worsening situation (Bagshaw et al., 2017). Moreover, in order to treat specific subsets of this chronic kidney injury, furosemide medication has been relied upon as well due to its action as a diuretic. In such cases, furosemide attend onto sodium retention, volume expansion besides hypertension characteristic of the chronic kidney disease that has been vividly mentioned in prospective literatures (Greenberg, 2019). Apart from all these potential actions of furosemide, it has also been reported to be a safe drug in treating hypertension for the diabetic patients that do not cause increase in blood glucose level (Osmanovic et al., 2017). Thus, in keeping with the available evidence, it will be rational to administer the furosemide medication for dealing with the dual complications owing to deteriorating kidney function and elevated blood pressure. Post administration of the chosen medicine, the patient will be monitored adequately to see for the signs of improvement as might be expected through reduction in blood pressure and normalized Glomerular filtration rate (GFR), indicative of normalizing renal function. Finally, it may be said that charging the patient with furosemide medicine will harbor benefits that may be evaluated well through proper monitoring of various parameters.

According to the case study, George is prescribed medications like that of perindopril and lercanidipine, furosemide, atorvastatin, metformin, sodium bicarbonate and vitamin D. All these medications have been prescribed to him for dealing with the multitude of clinical problems he has been suffering from. However, George does not remember the name of the medications and is unaware of the fact why they have been prescribed to him. Moreover, he is also under delirium regarding the frequency of the medications and is doubtful about the efficacy of them. Considering, the present situation of the patient it is imperative on his part to regularly comply with the prescribed medications to tackle with his clinical condition and his present attitude and behaviour is quite antagonistic to that. It has been cited in appropriate literatures that the impact of compliance with acute kidney injury can lead to decrease in fatality in addition to reduction in progression of the condition (Kolhe et al., 2015). Moreover, other research has also highlighted the benefits of patient compliance and medication adherence thereby necessitating the urgency to monitor these two factors while evaluating patient outcomes (Loprinzi et al., 2018). Further, a study directed to identify the barriers to medication in case of patients with hypertension revealed certain pivotal themes. Themes comprised of environmental challenges of life, forgetfulness to take medicines, incompatibility of patients and inefficient recommendations of the family. Thus, these themes must be intervened properly to remove the barriers (Najimi et al., 2018). Moreover, it has been recommended in suitable study that it in order to prevent occurrence of further complications in case of hypertensive subjects, it is indispensable to tackle the problem of low drug compliance thereby lowering incidences of morbidity and mortality (Johnson et al., 2019). In the given case study, George will be given directions to adhere to his medication regime so that missing of doses would not endanger his health. He will be constantly encouraged to ensure compliance to medications on his return home. For further safety, his wife who also happens to be his caregiver at home will be taught about the importance of adhering to a medications chart to keep complications at bay. Every week, a follow up will be done to ensure that George is maintaining his medication regime properly.

The nursing profession, unlike other professions, requires rigorous training and sound judgment on the part of the attending nurses to provide cure to a particular problem. In order to attain optimal outcomes through nursing pursuit, it is desirable for the nursing professionals to take proper course of actions that will enable them to provide suitable remedy for tackling the patient’s issues. Prioritizing the care options is of utmost importance for the nurses to address the patient condition in a manner that will facilitate quick recovery. Further, for the sake of allowing the best possible remedy for the patient, the nurses must resort to the clinical reasoning cycle that in turn will help in making judgments about the patient care options and likewise pave the way for a definite treatment modality that will be beneficial for the patient. Critical analysis and reflection are two crucial virtues that nurses must possess in order to excel in their profession. In this connection, the clinical reasoning cycle appears as a vital tool to make judgments and prioritize nursing cares. For the given case study, administration of the medicine that is required immediately to start off the treatment regime and offer remedy in the imminent situation alongside ensuring compliance to medications on the part of the patient are two of the prominent nursing care needs that the nurse must promptly channelize in course of her duty.