Ckd Any One?

I think I posted this in the wrong place yester day, so here it is again.

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.

It's a ongoing process. You just have to keep telling them what will work. Unfortunately, the choices patient's make in the long desending slope to ESRD are not immediately noticable. And the reprecussions are not instaneous.

People tend to live in the present and not in the future. The savings rate for retirement is a good analogy here.

Dear NephroBSN,

Thank you for your response. I've been very busy and am now getting caught up. I totally agree with you in that patient teaching is an ongoing process. I feel that we as humans we don't want to be sick and try to push that into the back of our minds always hoping it will get better. Honesty and giving the most information we have for them is in my opinion the way to go. We can teach and talk all we want, but it will not hit home with the patient until they are ready to take charge of their own health care. Thanks again.

Victor