This is a case study about Glenda who has Chronic Renal Failure. This assignment needs to be structured according to the conventions of academic writing, and include an introduction, an integrated conclusion and subheadings as required. You must write in essay style: do not use dot point format. The required length for this response is 2500 words.

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The causes and effects of Chronic Renal Failure in Australia

Introduction

The term ‘renal’ failure is better known as the failure of the ‘kidney’. In this respect it may be said that Chronic Renal Failure is a process by which the kidney slowly tends to lose its normal functioning. It may develop from the complications of other medical conditions which can be extremely harmful. There is a difference between the Acute Renal Failure and the Chronic Renal Failure. The Acute Renal Failure occurs very fast and all of a sudden (Bao et al. 2014). The Chronic Renal Failure takes a period of time to manifest itself. It may take as long as a few months or even years for the kidneys to stop functioning slowly and finally leading to a serious medical condition which is known as the End Stage Renal Disease. The symptoms develop slowly. It has been found out through research that on an average, 1 out of 10 Australians of 18 years age or over have symptoms of Chronic Kidney Disease. This can be in the form of decreasing kidney functions or the existence of albumin in the urine. It is even interesting to know that less than 10 percent of those affected by CRF are aware that they really have this health condition. To be more precise, more than 1.5 million Australians do not know that they have symptoms of CRF or CKD (MacGinleyet al. 2013).

1. Critical Analysis of Glenda’s diagnostic results

1.1 The subjective symptoms and their causes

The symptoms which Glenda had developed over the years are the manifestations of a serious kidney disorder in progress. The symptoms are listed along with their probable causes:

Loss of appetite- She often complained about lack of appetite which is known as Anorexia in medical terms. The continuous decline in the Glomerular Filtration Rate (GFR) in case of the chronic kidney disease patients is related to the decrease in the amount of food taken. In case of Glenda, who is still not under dialysis and the other CRF patients, the reason of loss of appetite can be attributed to the collection of unidentified anorexigenic compounds. There could be other reasons like inflammation of the cytokines. Some of the other reasons could be imbalance of the amino acids which leads to an increase in the flow of tryptophan through the barrier of the brain and blood. This leads to the creation of hyperserotoninergic form that decreases the willingness to take food (Pieniazek et al. 2015).

Tendency to vomit- Glenda had also complained about vomiting. This can happen when there is an excess formation of waste products in the blood which is better known as Uremia in medical terms (Schroten et al. 2015).

Feeling of confusion- Glenda has also reported about feeling dizzy and confused at times. She is having problem in concentration. This might be caused due to anemia. CRF leads to loss of hemoglobin and patience suffers from anemia. This happens as the brain does not receive the required amount of oxygen that is necessary for the brain to function normally. This causes problems like loss of memory, difficulty in concentration and dizziness (Rashid et al. 2015).

Itching on face- Another symptom of CRF is itchiness on the face. This is known as Pruritus in medical terms. Kidneys are used by our body to flush out toxins which are harmful for our bodies. When the kidneys fail to successfully remove the majority of the toxins from our blood, these waste products build up and cause severe itching on our faces and other parts of the body (Park et al. 2015).

Fatigue-Glendahas been feeling very tired of late. When the kidneys are in good condition, they secrete a hormone known as Erythropoietin (EPO). This instructs our bodies to manufacture oxygen-carrying red blood cells. When the kidneys are slowly on the verge of getting damaged, they fail to create more EPO. This results in lesser number of RBCs to bring oxygen to our muscles. As a result of this, the brain becomes fatigued very easily. This results in anemia (Ono et al. 2014).

1.2 The objective symptoms and their causes

Temperature-The normal human body temperature is around 37 degree Celsius. Glenda’s body temperature is around 36.5 degree Celsius. So, there is nothing to be worried about the body temperature which is quite normal.

Rate of pulse-The standard pulse rate of an adult at rest ranges from 60-100 beats per minute. Glenda’s pulse rate is somewhere around 89 beats per minute. So, it quite normal and there is no need for any worry.

Rate of respiration-The normal respiration rate of an adult at rest is 12-20 breaths per minute. So, Glenda is having absolutely normal respiration rate of 20 respirations per minute.

Blood pressure-The normal blood pressure for an adult above the age of 20 years should be around 120/80 mm Hg. However, Glenda is having a blood pressure of 156/97 mm Hg. This is very high than the normal. Glenda is having a medical condition which is known as Renal Hypertension. It is caused when the arteries that control blood flow to the kidneys become narrower. It may happen that either one or both the kidneys are having narrowed arteries. This is known as Renal Artery Stenosis. Since the kidneys are now receiving less blood flow, they think that the lesser flow is in fact dehydration. They release hormones which direct the brain to retain water and sodium. As a result of this the additional fluids get deposited inside the blood vessels and this shoots up the blood pressure (Okenzereet al. 2015).

Saturation level of oxygen-The normal oxygen saturation level in adult is between 95 and 100 percent. In Glenda’s case it is 96 percent. This indicates it is very much at the desired level.

Level of blood glucose-The normal level of glucose in blood for an adult is around 4mmol/L. In normal operation, the body restores this level of glucose to 4.4-6.1mmol/L. In Glenda’s case it is 6mmol/L. This is as it should be. So there is nothing to worry about in this respect.

Analysis of urine-The positive presence of protein in the urine analysis indicates some existing medical conditions for Glenda. The most likely cause is a disease of the glomerulus of the kidneys. Now an extensive urine test is to be done in the form of Urine Dipstick test to determine the amount of protein concentration. If the concentration is more than what should be, then serum and urine protein electrophoresis test should be conducted. It will help to find out if other protein substances are also being released other than albumin (Bullocket al.2013).

1.3 The laboratory test results and analysis

Rate of creatinine clearance- the normal creatinine clearance is around 100ml/minute. In case of Glenda, it is as low as 8.2ml/minute. This indicates kidney problem.

Level of serum creatinine-The normal serum creatinine level in adult human beings is 150/umol/L. But in case of Glenda, it is very high as 1132/umol/L. This is clear indication of progressive kidney disorder. The creatinine level rises as the filtration of the substance by the kidneys decrease to a great extent. For this purpose, it is extremely important to conduct standard blood tests regularly which will help to keep the creatinine level in check.

Level of Urea-The standard level of urea in blood is around 3.5 to 6.5mmol/L. Glenda’s test results show the level to be extremely high around 45mmol/L. it clearly indicates that the kidneys are not able to filter the waste products properly.

Level of Sodium-The acceptable level of sodium in blood is 135 to 145mmol/L. In Glenda’s case it is 128mmol/L. So, the sodium content of the body is normal and within the limits.

Level of Potassium-The standard level of potassium in blood is 3.5 to 5mmol/L. Glend’as reading shows 6mmol/L. This shows that it is little bit on the higher side. It is an indication that there might be kidney problem.

Level of Haematocrit-The standard level for women is 40%. In Glenda’s case it is as low as 20 %. This clearly shows the lesser volume of red blood cells in the blood. Kidney disorder leads to decrease in the volume of RBC in blood.

Level of Bicarbonates-The normal level of bicarbonate in blood should be around 22 to 28 mmol/L. In case of Glenda it is 11.5, which is very low than the desired level. The metabolic acidosis also plays a major part in the CRF as it causes less production of bicarbonates in the blood.

Gap of the Anion-The standard level of the serum anion gap is 8 to 16mEq/L. Glenda’s level shows 20mEq/L. So it is on the higher side. This is an indication of kidney disorder.

Level of Calcium-The level of plasma calcium in normal condition is 2.2 to 2.6mmol/L. In case of Glenda, it is 1.98mmol/L. So the calcium level is on the lower side, indication g that there might be some damage to the kidneys.

Level of Phosphate-The desired level of phosphate in blood is 3 to 4.5mg/dl. Glenda’s reading shows 5.4, which is on the higher side. This indicates that there might be some kidney order.

Level of PH-The normal range of blood PH is 7.35 to 7.45. In case of Glenda, it is 6.1. So the amount is a bit lower. This may be an indication that the kidneys are not functioning normally.

All these results clearly point out to the fact that Glenda is having some serious issues with her kidneys and she needs immediate medical intervention before she falls into a stage where the kidney disorder cannot be repaired at all (Iacoviello, 2015). Glenda should follow the advice of her doctor and probably the doctor will recommend a dialysis process to begin along with some other blood tests (Hassan, 2004).These blood tests should be conducted at regular intervals, so that changes may be monitored. The doctor will prescribe some medicines to take care of the ailing kidneys of Glenda. If treated on time, Glenda will surely recuperate from this ailment (Giustarini, 2004).

2. The factors which contributed to Glenda’s chronic kidney disease

The reason for Glenda’s Chronic Kidney Disease is the rising cases of smoking and alcohol consumption in Australia.Glenda is an indigenous citizen of Australia. It is seen that the people who are indigenous to the country are more likely to become victims of drinking, smoking and several biological and medical factors, such as high blood pressure and obesity. Hence, chronic kidney diseases are on the rise (Giovanetti, 2014).

2.1 The stages of chronic kidney failure

The stages of CRF are computed on the basis of GFR or Glomerular Filtration Rate which is either measured or according to estimation. There are basically five stages of CFR. In stage 1, the function of the kidney remains normal. In stage 2, it begins to decrease slowly. The stages can be well understood with the help of the following table.

*The GFR values have been normalized to average surface area of 1.73 sq.m.

Table 1: It depicts the several stages of chronic kidney failure

(Source:http://www.renal.org, 2015)

From the test results it may be observed that Glenda is currently going through the fourth stage of CRF. Her kidneys are showing symptoms of severe impairment and this will lead to the end stage of CRF if not treated immediately in the proper manner. Glenda is advised to remain in the hospital so that a few more tests are conducted in order to ascertain her chances of getting transferred to end stage kidney failure. The doctors and nurses will have to keep monitoring her throughout the day and look for any new symptom which might be developing (Burgeoisat al. 2012).

2.2 The modifiable and non-modifiable factors of chronic kidney failure

Table 2: It shows the several modifiable and non-modifiable factors

(Source:www.kidney.org.au, 2015)

3. History of chronic renal failure in Australia

Of late, there has been an increase in the CRF cases in Australia. The earlier stages of the disease show very little symptoms, that is why it takes time to detect the CRF and the exact number of persons who are affected by the disease in Australia (George et al. 2014). From the various dependable sources and publications it is known that there are many factors which are responsible for the increase in the CRF in Australia. Some of the key points of the publications are enumerated as follows:

• Chronic kidney failure is emerging as one of the biggest health problems in Australia
• Each year, more and more Australians are undergoing dialysis or kidney transplantation as a result of this end of stage kidney failure.
• Diabetes is on the rise each year. This is the major cause of end of stage kidney failure in Australia.
• The cases are on the rise in case of the indigenous people of Australia.

To summarize, it may be said that chronic kidney diseases led to 10% mortalities in 2006 and more than 1.1 million people were hospitalized from 2006 to 2007. The numbers of people receiving dialysis or transplantation of the kidneys have risen by 26% from 2000 to 2007. The cases of diabetes are on the rise (Carmello et al. 2015). There was a two-third increase in the end-stage kidney failure due to diabetes from 2000 to 2007. It has also been seen that the indigenous Australians were 6 times more prone to develop chronic renal failure compared to the other Australians. The rate of casualties from the disease was reported to be as high as 7 times to 11 times in the case of the indigenous people of Australia (Dogan et al. 2014).

4. The treatment process for end stage renal failure for Glenda

Glenda has already been under Haemodialysis. This process includes the use of an instrument which acts like a real kidney and helps to flush out toxins from the blood. Another method could be Peritoneal Dialysis. Since Glenda does not want to stay at the hospital for dialysis any more, she can be transferred to home for the process of Peritoneal Dialysis. This process allows cleaning of the blood within the body. This can be done at home. This will help her to continue her treatment without remaining untreated (Massy et al. 2014). The other option for treatment could be transplantation of the kidneys. But at this stage, it is not advisable for Glenda. It is a much prudent decision to see how the Peritoneal Dialysis impacts Glenda. If it is not showing improvements within a few months, then the other options like Haemodialysis need to be considered. In that case, Glenda will have to be kept very close to the hospital for treatment. In that case, it will be wise for her not to leave the hospital and stay at Wurrumiyanga. If she is shifted to her home town in Wurankuwu, she will not be able to receive proper treatment and medication as Wurankuwu is a rural area with the mere population of 50 residents. It does not have the infrastructure to treat critical disease like CRF (Robertset al. 2012).

5. Difference between implied consent and compliance in case of Glenda

Prior to the process of nursing, the nurse should be careful, about depending on the concept of consent which is implied. It is very important to take written or verbal consent of the patient during the course of treatment. If the patient does not communicate any consent in detail to the doctor or the attending nurse for the course of treatment, then in absence of consensus, the nurse or doctor will have to carry on the treatment (Chen et al. 2014).This is implied consent is known as compliance. It is always advisable for all the nurses to carry on the concept of implied consent and not compliance. In the case of Glenda we can see the over usage of compliance rather than implied consent. The nurse never knew that Glenda did not want to continue with the process of dialysis and wanted to go back to her home. It should have been asked to Glenda before starting the various treatment procedures (AktaAY et al. 2015).

6.Conclusions

To end this article, it might be observed that, Chronic Renal Failure and End-stage Renal Failure are on the rise in Australia. It is especially more potent in the indigenous Australian people. Every year there has been a rise of diseases like diabetes and high blood pressure in these people. These are causing the problem of kidney failure. We can see the situation with Glenda’s story. We have also come across the different treatment procedures and nursing techniques to keep the disease under control. Here one can also observe the concepts of implied consent and compliance (Cayir et al. 2015).

7. Reference list

AktaAY, S., SaAYdAk, H., AktaAY, H., GAlcan, E., TetikoAYlu, M., & CoAYgun, S. et al. (2015). Tear function in patients with chronic renal failure undergoing hemodialysis. Ren Fail, 37(2), 245-248.

Cayir, A., & Kosan, C. (2015). Growth Hormone Therapy in Children with Chronic Renal Failure. The Eurasian Journal Of Medicine, 47(1), 62-65.

Chen, J., & Wang, J. (2014). Radioguided parathyroidectomy in patients with secondary hyperparathyroidism due to chronic renal failure. Nuclear Medicine Communications, 35(4), 391-397.

Chillon, J., Brazier, F., Bouquet, P., & Massy, Z. (2014). Neurological Disorders in a Murine Model of Chronic Renal Failure. Toxins, 6(1), 180-193.

Coskun Yavuz, Y., Ganidagli, S., Yilmaz, T., Altunoren, O., Deniz, M., & Dogan, E. (2014). Orofacial digital syndrome type 1: an underlying cause of chronic renal failure. Ren Fail, 36(6), 946-947.

de Albuquerque Seixas, E., Carmello, B., Kojima, C., Contti, M., Modeli de Andrade, L., & Maiello, J. et al. (2015). Frequency and clinical predictors of coronary artery disease in chronic renal failure renal transplant candidates. Ren Fail, 1-4.

George, S., Mohamed, A., & Maamoun, A. (2014). Chronic renal failure, hyperkalemia, and colonic ulcers. Indian J Nephrol, 24(3), 193.

Giovanetti, F. (2014). Hepatitis B immunization in patients with chronic renal failure. GTND, 26(4), 326-328.

Hassan, E. (2014). Effect of chronic renal failure on voice: an acoustic and aerodynamic analysis. Egypt J Otolaryngol, 30(1), 343.

Iacoviello, M. (2015). Evaluation of chronic kidney disease in chronic heart failure: From biomarkers to arterial renal resistances. World Journal Of Clinical Cases, 3(1), 10.

Okenzere, N., & Okeke, C. (2015). Cardiovascular Disease in Women with Chronic Renal Failure. J. Medicine, 16(1).

Park, J., & Middlekauff, H. (2015). Abnormal neurocirculatory control during exercise in humans with chronic renal failure. Autonomic Neuroscience, 188, 74-81.

Pieniazek, A., & Gwozdzinski, K. (2015). Changes in the Conformational State of Hemoglobin in Hemodialysed Patients with Chronic Renal Failure. Oxidative Medicine And Cellular Longevity, 2015, 1-9.

Rashid Khan, M., Ahsan, H., Siddiqui, S., & Siddiqui, W. (2015). Tocotrienols have a nephroprotective action against lipid-induced chronic renal dysfunction in rats. Ren Fail, 37(1), 136-143.

Schroten, N., Damman, K., Hemmelder, M., Voors, A., Navis, G., & Gaillard, C. et al. (2015). Effect of additive renin inhibition with aliskiren on renal blood flow in patients with Chronic Heart Failure and Renal Dysfunction (Additive Renin Inhibition with Aliskiren on renal blood flow and Neurohormonal Activation in patients with Chronic Heart Failure and Renal Dysfunction). American Heart Journal.

Roberts, D. Adapted by Wylie, A. (2012). Nursing assessment: Musculoskeletal system in D. Brown and H. Edwards (Eds.), Lewis’s medical-surgical nursing:Assessment and management of clinical problems(4^thed.). (pp.1767-1759). Elsevier, Australia.

Burgeois, S. & Van der Riet, P. (2012). Caring. In A. Berman, S. Snyder, T. Levett-Jones … (Eds.), Kozier and Erb’s Fundamentals of Nursing (2nd edition). Australia: Pearson (p. 515).

Bullock, S. and Hales, M. (2013). Principles of pathophysiology. Frenchs Forest, Australia: Pearson Australia.

World Health Organisation (WHO). (2010). Evidence-based public health initiatives.

MacGinley, R., Walker, R and Irving, M. (2013). Use of iron in chronic kidney disease patients.