Write a respond to each these discussion questions with 125 words or more. Ask a thought provoking question or find an article with more detail to further discuss.
1. Chronic kidney disease can affect various body systems. A nephrologist can help manage the progression of kidney disease. The main goal is to prevent further kidney damage and slow the progression of kidney damage. This can be accomplished by preventing and managing complications. One common complication is hypertension. It’s essential to regularly monitor your blood pressure because adequate control of your blood pressure can slow the progression of chronic kidney disease. Your provider may prescribe you medications such as angiotensin-converting enzymes inhibitors or angiotensin receptor blockers. These drugs can help lower your blood pressure and also help lower protein that is excreted in your urine. You also may be prescribed blood pressure-reducing medication such as a diuretic. It is crucial to adhere to your medication regime (Berns, 2021; Norris, 2019; Rosenberg, 2020).Another common complication of chronic disease is anemia. Kidney disease can reduce the production of erythropoietin which stimulates red blood cell production. A decrease in red blood cells can result in anemia, which may make you feel tired and fatigued. Your provider may prescribe you iron supplements (Berns, 2021). Your diet is vital in preventing common complications of chronic kidney disease. Your diet should consist of lowering your salt, protein, and cholesterol intake. Decreasing your salt intake will help avoid retaining water. Too much salt in your diet can cause you to retain fluids and indirectly elevated blood pressure. Lower protein intake may slow the progression of kidney disease. Hyperlipidemia is common in kidney disease, and therefore, lowering your intake of cholesterol can help decrease the risk of cardiovascular complications. In some cases, chronic kidney disease can cause elevated levels of potassium and phosphate in your blood. Limiting food that is rich in potassium and phosphate can decrease the risk of complications. If possible, a plant-based diet would be ideal (Berns, 2021)
Severe complications of chronic kidney disease can lead to uremia, renal failure, and ultimately end-stage kidney disease. The goal is adequate control to prevent uremia and renal failure. Common signs of uremia are altered acid-base balance, blood pressure, and fluid regulation, to name a few. Symptoms may manifest as nausea, pruritus, fatigue, weakens, decreased appetite, and possibly altered mentation. It’s essential to notice the signs and symptoms and seek medical care when appropriate. Continue insult to the kidneys with repeat acute kidney injury leads to loss of nephron function. Ultimately, severe loss of renal function leads to end-stage renal disease and results in hemodialysis for the rest of your life or you may possibly need a kidney transplant (Meyer & Hostetter, 2014; Norris, 2019). Chronic kidney disease can impact the patient’s daily living. The patient will need to be more cognizant of their diet and fluid intake. Moreover, they will probably have added daily medications. Making sure they take their daily medications is important to prevent complications. They will likely have to incorporate monitoring their blood pressure into their routine. Furthermore, daily exercise is crucial. Lastly, if their kidney disease progresses to end-stage kidney disease, they will need dialysis which will greatly impact their daily living. Therefore, prevention of progression of the disease is vital.
2. Kidney failure, also called end-stage renal disease (ESRD), is currently uncurable but may be managed via dialysis (hemodialysis or peritoneal) or through a kidney transplant. ESRD happens when the kidneys are no longer able to filter blood adequately and toxins that would usually be eliminated are instead trapped in the body. Generally, there are no specific symptoms that may be used to distinguish ESRD from other health issues, but some common physical manifestations may include: swelling of the feet and ankles (aka edema), difficulty sleeping and fatigue, headaches, muscle cramps, itching, feeling less hungry, nausea and vomiting, changes in urine output/frequency, and difficulty catching your breath.Although some patients will qualify and choose to complete a kidney transplant, dialysis will still be required until a suitable match is found and all requirements are met. Hemodialysis may be done in a dialysis center through specialized equipment that filters the blood, or at home through a home-system, or on the go via peritoneal dialysis which utilizes the person’s abdomen to complete the exchange of fluids. Hemodialysis is generally done about 3 times a week, depending on the patient’s needs, takes several hours to complete, and may be done in a clinic or at home with proper training. Peritoneal dialysis can be done throughout the day with about 4 sets of 4-6 hour dwell times that each require 30-60 minutes of draining time or through continuous cycling at night that lasts about 10 hours and does not require day-time dwelling or draining (Norris & Brown, 2019 pg. 1027). If a suitable match for a kidney transplant is found and obtained, the person receiving the kidney will need to take immunosuppressant medications to try to keep their body from rejecting the new kidney. This will be life-long and unfortunately rejection may happen at any time. Immunosuppressant medications also increase a person’s chance of becoming ill from infections and they may be placed on prophylactic antimicrobial medications to keep the chance of infection as low as possible (Norris & Brown, 2019 pg. 1028).
Persons with ESRD will benefit from having a strong professional and personal support system. While living with ESRD is possible, there are many factors to consider. These include a special kidney-friendly diet, safe exercises to participate in, getting lots of rest, and a strict medication regimen that needs to be followed. Joining a support group is helpful and finding a therapist or counselor to help navigate the feelings of stress, anxiety, and depression is strongly recommended. Good communication is especially important when setting up dialysis appointments, car rides may need to be arranged with friends and family in between their own schedules. A last option of ESRD is medical management. This option will not cure kidney failure or prolong the person’s life. This may be done with a Hospice agency at home or in a facility, and allows the person to live out their last days in comfort. When this route is chosen, there are no more need for restrictions, including one’s diet. Some considerations for medical management include completing an Advanced Care Directive and POLST, speaking with a spiritual advisor/counselor, and having a personal team available to be with the person as they transition.
3.
Review the etiology, epidemiology, diagnostics, and clinical manifestations of any two disorders. What specific information would you give students on genitourinary and reproductive disorders?
Balanitis is the inflammation of the glans penis and Balanoposthitis is the name for the inflammation of the glans penis and prepuce. Symptoms include itching of the area, pain, blistering, ulceration, dysuria, and malodorous discharge. Although more common in uncircumcised males, these disorders stem from poor hygiene, immunosuppression, sexually transmitted infections, and yeast (Norris, 2019). A small known fact is that symptoms of diabetes can vary, and for the young and elderly, balanitis is a sign of undiagnosed abnormally high and uncontrolled glycemic control indicating diabetes (Fischer et al., 2017). To find the exact cause, the patient will undergo a series of tests, from urine samples to urethral and ulcer swabs, to identify the correct causative factor so that treatment can be appropriately started. Additionally, the blood glucose level will be check if diabetes is of concern.Vaginitis can be a result of chemical irritants, foreign bodies, bacteria, yeast, or sexually transmitted infections (Paladine & Desai, 2018). In the younger population, vaginitis occurs because of improper hygiene, parasites, or foreign bodies. As women age, vaginitis can also be the result of a decrease in estrogen, making the tissues in the vagina more susceptible to infections. Vaginitis is a broad term used to note the irritation and inflammation of the vagina, and it is “characterized by vaginal discharge and burning, itching, redness, and swelling of vaginal tissues” (Norris, 2019, p. 1287). Since vaginitis can be caused by many factors, it is important for a physical examination to be executed. This examination also includes an in-depth history, diagnostic workups from wet-mounts and smears, and evaluation of health habits.I would educate students on the need to routinely evaluate their genital area and make an appointment with their provider for any abnormalities. As young, probably sexually active students, I would educate them on the need to protect themselves if choosing to engage in sexual intercourse. Pain is never normal, and I would encourage the students to remember this.
4.
Review the etiology, epidemiology, diagnostics, and clinical manifestations of any two disorders. What specific information would you give students on genitourinary and reproductive disorders?
Balanitis is the inflammation of the glans penis and Balanoposthitis is the name for the inflammation of the glans penis and prepuce. Symptoms include itching of the area, pain, blistering, ulceration, dysuria, and malodorous discharge. Although more common in uncircumcised males, these disorders stem from poor hygiene, immunosuppression, sexually transmitted infections, and yeast (Norris, 2019). A small known fact is that symptoms of diabetes can vary, and for the young and elderly, balanitis is a sign of undiagnosed abnormally high and uncontrolled glycemic control indicating diabetes (Fischer et al., 2017). To find the exact cause, the patient will undergo a series of tests, from urine samples to urethral and ulcer swabs, to identify the correct causative factor so that treatment can be appropriately started. Additionally, the blood glucose level will be check if diabetes is of concer
Vaginitis can be a result of chemical irritants, foreign bodies, bacteria, yeast, or sexually transmitted infections (Paladine & Desai, 2018). In the younger population, vaginitis occurs because of improper hygiene, parasites, or foreign bodies. As women age, vaginitis can also be the result of a decrease in estrogen, making the tissues in the vagina more susceptible to infections. Vaginitis is a broad term used to note the irritation and inflammation of the vagina, and it is “characterized by vaginal discharge and burning, itching, redness, and swelling of vaginal tissues” (Norris, 2019, p. 1287). Since vaginitis can be caused by many factors, it is important for a physical examination to be executed. This examination also includes an in-depth history, diagnostic workups from wet-mounts and smears, and evaluation of health habits.I would educate students on the need to routinely evaluate their genital area and make an appointment with their provider for any abnormalities. As young, probably sexually active students, I would educate them on the need to protect themselves if choosing to engage in sexual intercourse. Pain is never normal, and I would encourage the students to remember this.
COLLAPSE
Adrenal insufficiency is a disorder of the endocrine system defined as a deficiency of the adrenal cortical hormones and elevated levels of adrenocorticotropic hormone (ACTH) (Norris, 2019). One of the hormones that the adrenal gland produces is aldosterone (John Hopkins Medicine, 2021). The deficiency of aldosterone is only present with adrenal gland destruction such as in Addison Disease (Scott et al., 2021). Aldosterone is produced from the outer portion of the adrenal gland called zona glomerulosa. Release of the hormone regulated via the renin-angiotensin II-aldosterone system (Scott et al., 2021). The rennin-angiotensin II –aldosterone system controls blood pressure. Aldosterone is also responsible in sending signals to the kidneys to absorb sodium while excreting potassium (John Hopkins Medicine, 2021). Effects from this hormone deficiency can result in hyponatremia and hyperkalemia as well as poor blood pressure control that are thought to be the reason for lack of perfusion of the kidneys which is ultimately the cause of the acute renal failure (Fofi et al., 2019). Treatments for Addison disease include glucocorticoid; hydrocortisone is usually the drug of choice (Norris, 2019). Caution must be observed with this type of treatment as that is lowers the immune response which makes those being treated higher risk for contracting infection.
6.COLLAPSE
Adrenal insufficiency is a condition that occurs when the adrenal glands don’t produce an adequate amount of hormones that are produced by adrenal glands. The adrenal glands are located above the kidneys and are responsible for the secretion of multiple hormones such as cortisol and aldosterone. A decrease amount of these hormones results excessive tiredness, weight changes and decreased appetite, hyperpigmentation, changes in blood pressure, abdominal pain, irritability, muscle and joint pain, gastrointestinal symptoms of nausea, vomiting, and diarrhea (Addison’s Disease, n.d).
A secondary diagnosis to adrenal insufficiency could present with acute kidney injury due to the fluid imbalances often resulting in hypovolemia including hyponatremia (Connor, Care & Taylor, 2010). As noted above, aldosterone aids in management of sodium and blood pressure regulation. The regulation of hormones produced by the adrenal glands greatly affects the function of the renal system. Therefore, changes in status can lead to acute kidney injury. Symptoms that present with acute kidney injury are almost identical to that of adrenal insufficiency (Hertzberg et al, 2017). Acute kidney injury is often misdiagnosed with patients who have a known diagnosis of adrenal insufficiency.
