# Full-Spectrum Nursing Model With Blake

## Full-Spectrum Nursing Model With Blake

### Instructions

Using the client information provided, respond to the critical thinking questions. Each response should be original (in your own words) and a minimum of three sentences in length.

### Client Information

You have just received a report from the emergency department (ED) on a client named Blake. According to the ED report, Blake is being admitted due to chronic renal failure. He is married and an employed 58-year-old man, and he has a long-standing history of Type 2 diabetes mellitus (DM). During the past three days, he reports that he has developed swelling and decreased sensation in his legs and has difficulty walking, which he describes as “slight loss of mobility.”

### Critical Thinking Questions

1. List five questions that will help you assess and plan immediate and long-term care for Blake.
2. Based on the information provided and the questions listed, what are the priority problems?
3. Identify at least two resources you can use to find out more about the pathophysiology of renal failure. How do you know the sources are credible? As you are assessing Blake, who is your best source and why?
4. Write one collaborative problem statement for Blake. If you do not know the potential complications of chronic renal failure, look them up in a medical-surgical or pathophysiology resource. Explain why you would not use a nursing diagnosis to describe the problem.
5. Aside from his physical condition, what is at least one psychosocial concern Blake might have right now? In other words, what else might Blake want to have resolved that could–for him–be more important than his chronic renal failure?

CHRONIC KIDNEY DISEASE(CKD)

• Chronic kidney disease is a progressive ,irreversible deterioration of kidney function or GFR less than 60ml/min/1.73metresquare,persisting for 3 months  or more.

ETIOLOGICAL CAUSE IN THIS PATIENT :  Long term Diabetes mellitus.

QUERIES TO THE PATIENT:

1. HOW LONG WAS YOU DIAGNOSED WITH DIABETE MELLITUS?
2. WHAT WAS YOUR PREVIOUS HbA1c value? Was it below 6.5?
3. DID YOUR LAST REPORTS SHOWED A NORMAL  BLOOD PRESSURE?
4. DO YOU FEEL DIZZY OR EXTREME FATIGUE SOMETIMES AFTER A SHORT WALK OR STANDING? -due to electrolyte imbalance(Low sodium levels in blood)
5. HAVE YOU EVER BEEN DIAGNOSED WITH ANY RENAL COMPLICATIONS LIKE GLOMERULONEPHRITIS /RENAL CALCULI?

• Based on the information provided, the most crucial etiological reason is: Long standing diabetes.

COMPLICATIONS OF LONG STANDING DIABETES:

1. Nephropathy
2. Retinopathy
3. Peripheral neuropathy (pain, itching or burning sensation particularly in feet and legs) – neuromuscular finding in this patient .

PATHOPHYSIOLOGY OF DIABETES MELLITUS INDUCED RENAL FAILURE FOR BLAKE

 HYPERGLYCEMIA  $\rightarrow$ RENAL HEMODYNAMIC CHANGES $\rightarrow$ EFFERENT ARTERY CONSTRICTION $\rightarrow$ GLOMERULAR BLOOD       PRESSURE RISE $\rightarrow$ GLOMERULAR HYPERTROPHY(increase size) $\rightarrow$  DIABETIC RENAL FAILURE

NORMAL PATHOPHYSIOLOGY:

• Kidney damage is manifested by the pathological abnormalities or markers of damage- abnormal blood or urine analysis or imaging studies.
• CKD if left untreated, results from stage 1 to stage 5
• Renal function diminishes as about 75% of kidney tissue fails, ultimately results in fibrosis of the organ.

The first and foremost step:

A) Manage diabetes mellitus –

1. A1C TEST – Below 7%
2. Fasting blood sugar – 80 130 mg/dl or below
3. Post prandial -less than 180 mg/dl

B) Manage diabetic neuropathy:

1. Glycemic control
2. Foot care and safety measures
3. Symptomatic treatment of sensation of feet ,if severe.

PSYCHOSOCIAL CONCERN OF BLAKE

• Pedal edema as well as decreased sensation in feet.
• Patient is concerned about his walk.

MANAGEMENT

• Take Neurobione forte (Vitamin B6) that may help relieve the symptom.
• Control of diabetes mellitus.