Question

Case Study: 22 year old with ESRD DB is a 22 yo male who developed ESRD Secondary to glomerulonephritis as an IGA nephropathy. His comorbitidies include anemia secondary to chronic disease and HTN. He also suffers from chronic UTI's and does not feel well on some days. He states he is chronically tired but must work full time. He is an undocumented worker whose primary language is Spanish. He speaks and understands some English but processes information slowly and reads only Spanish. He works as a cook in a diner and supports and lives with his elderly father. He has very few friends and no girlfriend currently. He has an AV fistula in his left lower arm which is patent and has a positive thrill and bruit. He is scheduled to receive dialysis 3 times a week for 4.5 hrs but sometimes misses appoints and often leaves early (after 1.5 hrs of treatment). He is afraid to miss work or be late for work. He usually eats 1-2 meals a day at the diner and often forgets to take his Renvela with his meal at work. He has been given a free supply of Renvela and advised to take this with every meal but compliance is poor. As an alternative he is advised to carry Tums with him and take this if he does not have his Renvela with him. His current Vs are BP 170/100, P 104, R 18, T100 orally. EKG: Sinus Tachy CXR: Clear Current Labs: Serum albumin 3.4, Creatinine14.8, Hgb 5.2, Ca 6.8, PO4 10.9, K.5.8, WBC 12.2 Orders are as follows: 1. Diet 85 GM Protein 2 GM NA 2 Gm Kand 1140 mg Phosphorus 2. Fluid restriction 1000ml/24 hrs 3. Procardia XL 90 daily 4. Lisinopril 20 mg daily 5. Coreg 25mg every 12 hrs 6. Renagel 800mg TID 7. Phoslo 1 packet TID 8. Kayexalate 15 gms TID 9. Clonidine 1 mg BID 10. Labetalol 200mg BID

Answer 1

H.The most important teaching for this client is about medication regimen and its benefits to tackle his symptoms because of chronic kidney disease Medication adherence will be the priority here.This has to be followed with complete dialysis thrice a week without skipping or decreasing the time for quality of life.

I.Holistic care will be very helpful to the client to find a peace of mind out of the stressful job, responsibility to take care of his elderly father, lack of proper intake of food. This can provide him a sense of relaxation and time to think of self health and its quality. He can be given good psychological support, moral support .Wellness coaching, dietary modification,meditation can be provided to heal the patient psychologically which can improve his physiological needs.