Objective 4 Discharge teaching and planning needs and community resources
Although acute and chronic renal failure are both very serious conditions, that require considerable education to prevent reoccurrences in discharge planning CKD has more emphasis, since it has a lifelong effect on the individual affected as well as the family and support system. There can be a considerable stress to interpersonal relationships as patients may have treatments that become time consuming, taxing on energy, and costly if out-of-pocket costs mount up. Treatments alone are not the only solution, but a change in lifestyle is absolutely necessary to prolong life and maintain what is left of what one perceives as maintaining a quality of life.
For CKD, it is essential to start new productive habits to as early as possible, which will take a considerable amount of effort, since it may have been intentionally or unintentionally previous life choices which may have been contributed to the state of renal failure in the first place. The patient may be prescribed ACE inhibitors or angiotensin receptor blockers (ARB) which facilitate the rennin-angiotensin-aldosterone system to dilate the blood vessels for and subsequently improve renal perfusion and decrease the blood pressure to a therapeutic level (Management, 2006). In some cases, depending on the cause of nephrotoxicity, it’s important for the patient to be informed of the specific purpose of treatment, based on different etiologies. It is important for patients to quit smoking, consume low fat foods with antilipidemics, to increase physical activity as tolerated and as instructed by physician. Blood sugar control is crucial especially if the patient is diabetic. Limiting and not adding sodium and potassium to foods is necessary. Patients must be especially cautious with packaged and preserved food which contains high amounts of sodium and potassium (Eat Right, 2008).
Knowing what a person already consumes on a daily basis would be useful to know a basic understanding of foods that standout in being contraindicated in a renal diet. For example, a person who consumes a lot of meat may need to balance meals to contain foods low in protein to prevent and increase in nitrogenous waste in the blood (i.e. urea, uric acid, and albumin), (Eat Right, 2008). Medications that bind to elements such as phosphorous to prevent leaching of calcium from bones and potassium from increasing to toxic levels dangerously affect cardiac function control levels in the body. Kayexalate is one such binding medication that excretes potassium through the large intestine (Management, 2006).
One of the symptoms of as described previously is thirst, which can pose as a demotivating factor for a patient to comply with fluid restrictions. Reinforcement of the importance fluid restriction is necessary to help the patient make a connection with excess consumption with fluid overload which cascades into the discomfort of shortness of breath, insomnia, and fatigue (Eat Right, 2008).
A food diary may be essential to keep track of foods, fluid intake and output, and weight changes. For some patients who are already having diabetes, the same principles of logging values could be applied.
Depending on the need for frequency of hemodialysis, a patient will need to have arrangements to keep appointments for dialysis, this includes having a clinic in close proximity and the transportation arrangement for the patients to attend and return home. Locations for hemodialysis take place in outpatient clinic settings or inpatient hospitals. On rare occasions hemodialysis can be done at home. Peritoneal dialysis is still done preferably at home Lewis et al (2007, p.1223).
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