Chronic Kidney Disease

[penasco man]

First of all I want to thank any of you who respond to this posting as it will help me with an assignment I have in relation to the nursing program I am in. I'm a second semester nursing student and am in the process of gathering information and personal experiences in relation to a topic that I have found interesting. I was reviewing a couple American Journal of Nursing articles (September 2005 vol. 105 number 9 and October 2005 vol. 105 number 10) and found discussions on managing Chronic Kidney Disease (CKD) with emphasis on pharmacology and self-management.

The September 2005 issue (pgs.60-72) talks about the pharmacokinetics, pharmacodynamics, and pharmacotherapy in patients with this disease. I found it quite interesting how, in patients with CKD there are vast alterations in the metabolism of numerous drugs and hormones which in turn alter other bodily functions to the point where new conditions arise and have to be addressed. An example of this was illustrated in the article with "acetaminophen (Tylenol and others)" (AJN, Sept 05, vol. 105, number 9, pg 62). Hepatotoxicity is a valid issue when treating patients with CKD when administering Tylenol to these patients, since Tylenol is such a widely used drug.

The October 2005 issue (pgs. 40-49) discusses issues around CKD and the patient's compliance or adherence to a therapy regimen. The article goes into how nurses can approach a patient and how we can change a patient's mode of thought about his or her diagnosis and how this can positively influence the progression of the disease. One interesting point which was made in the article is the way we as health care providers should see how a person diagnosed with this disease perceives or understands their new diagnosis. In the early stage of a chronic disease, patients tend to "make sense in concrete terms of the abstract concept of the diagnosis, usually by examining symptoms." (AJN, OCT 05, vol.105, number 10, pg 43). This is to say that the patient relates their disease with the symptoms they are having. The article illustrates this in patients with hypertension and the symptoms they are experiencing. The patient falsely identifies his or her disease in relation to external cues rather than physiological reasons. Further into the article it gives the nurse some useful tools to help the patient identify and attain a better understanding of their disease process and ways in which to help them maintain adherence to a given drug regimen.

If any of you have any comments on this please respond. Once again I have no experience, but I do have an interest in the renal system and am looking into specializing in this area once out of nursing school. I'm wondering if any of you have any specific ways of going about helping your patients with adherence and getting them to make sense of their chronic illness. If any of you have any experiences other than CKD please respond. Once again thanks for you time.

Victor

Laughter is the best medicine and it doesn't take a prescription to use it.

[TypicalFish]

Victor-

There are two things that I find r/t the topic of your article; usually, and very generally there are two kinds of patients; the ones that are naturally compliant and those that will likley never be compliant with care. You could add a third, "kind of compliant"-but generally there are those two. Most patients that I deal with have a strong sense of the present, and a lack of belief in their mortality (it is a known fact to them that all people eventually pass, but not them, and certainly not now or soon). For some people, it takes a major event for them to really want to comply; and that's the thing for many people-as long as they feel "fine" or can "get around" they do not believe that they are "really" sick. They treat their disease based on severity of symptoms, or even on decreases in quality of life, but there is a qualifier to even that-the sicker that some of them get, the looser they define "getting around" or for the elderly it is either so gradual as to not be noticeable as a vast change, or they and their families feel that it is simply "getting old"; which leads me to my sort of point; you can educate a patient about their disease process, but until they are ready, you'll be able to teach them nothing. And often, as in the case of acetaminophen, pts can make things worse by treating themselves with OTC or even self-change of Rx med schedules. They don't always connect feeling poorly or having a headache or being dehydrated with CRF, or trouble breathing with CHF ("oh, I just get a little winded now and then")-they can isolate the symptoms and disassociate them from disease process.

Also, just as we often need to continue to review and learn as nurses, or go over something several times before we learn it; a patient will not absorb, comprehend and integrate everything in one, or even two sessions, so it is a continuing battle to create a baseline of understanding to build on. Plus, sometimes you are asking a patient to change a lifetime of habit-and then throw in culture, faith, family, educational abilities, and finances (If your patient can't afford their meds-what steps do you take to help them before you even teach?)

I'm not sure if I have helped very much-just kind of my ramblings on the topic. Yes, very often pts do think of their diseases as separate symptoms and not as a physiological whole-but for many different reasons.

[penasco man]

Typicalfish,

Thank you for your response. Sorry that I havn't responded sooner but I've been very busy and am now just catching up with everything. I totally agree with you on that point. I think until a patient is ready to learn and take charge of their own health a lot of our teaching and caring falls on deaf ears. I think this is in part to our human nature and how we don't want to be sick. The patient tries to rationalize and push off how sick they really are, saying that they will get better it just a matter of time. I think as nurses we just have to be honest with our patients and give them as much information as we can to help them understand their disease process.

Victor