Posted: September 6th, 2023
Select a patient for case study who has experienced either acute kidney injury
Assessment 3: Essay 40%
Select a patient for case study who has experienced either acute kidney injury or chronic kidney disease through disease or trauma. Review their medical records and you can also interview them if it is helpful.
At all times you must maintain patient and organisational confidentiality by assigning the person a pseudonym and abiding by your organisation’s ethics policy on using patient information.
1. Write a brief introduction to highlight the main content of your paper (100 to 200 words).
2. Write a brief case history summary (no more than 400 words) of the patients current renal health condition, relevant past and present history and any relevant nursing, medical, allied health professional or pharmacological management provided. This should relate to the complications of the renal condition. Complications could include a selection from hypertension, anaemia, metabolic bone disease, metabolic acidosis, altered mental state, sexual dysfunction and altered fluid or electrolyte state or any others your patient is experiencing directly caused by the renal health condition.
Note: this paper is not to include management of the disease specifically (i.e. management of diabetes) or management by long term dialysis therapies or transplantation as these are covered in another unit of study.
3. Review each chosen complication and link these to the physiology of the renal condition (approx 400 words).
4. Critically analyse the management interventions that the patient was or is still experiencing using evidence based findings. Justify and critique the interventions above by drawing on recent evidence based scholarly literature and propose recommendations for future practice if indicated (1000 words).
5. Provide a short conclusion summarising the relevance of the care provided (100 words)
For example if you chose metabolic bone disease as one of your complications the case history review should include their bone disease symptoms and related treatments. Current blood results or observations can be included. Your essay should briefly review the pathophysiology of why your patient has bone disease. The main discussion should review what management/treatments they are receiving, how these work and a critique of their effectiveness in your patient (blood results and ongoing symptoms) including other options if available. Repeat this for all your chosen complications (It is recommended you limit to two or three complications so you can explore in enough depth). Finally your conclusion should reference key points such as the effectiveness of management (or not).
Your essay should be written in formal academic style. Avoid headings but your paragraphs should be clear to your reader to show what is being covered.
All your work must be substantiated by support from relevant, contemporary scholarly literature*. You are expected to show your understanding of all concepts by writing in your own words. Please paraphrase ideas you glean from literature and provide in-text citations. Direct quotations should only be used very occasionally (less than 5%) and only when you cannot paraphrase with your own words. Quotes used should be short as only your own original work counts towards your final mark.
*Please use the detailed resources available under Content then Assessment Resources in MyLO to assist you with planning, literature searching, developing, writing and referencing written assignments.
Sample paper and rubrics
Please view this sample paper to get an idea of how you should complete this assessment task. DO NOT copy any aspects of the content. This is purely to help you set out your paper.
This essay presents a case study of a patient, Mr. Smith, who has experienced chronic kidney disease (CKD). The aim is to review Mr. Smith’s medical records and provide an overview of his current renal health condition, relevant past and present history, and the complications associated with his CKD. The complications to be discussed include hypertension and metabolic bone disease. The essay will explore the physiology of these complications in relation to the renal condition and critically analyze the management interventions provided to Mr. Smith. Evidence-based findings will be used to justify and critique these interventions, and recommendations for future practice will be proposed if necessary. The conclusion will summarize the relevance of the care provided to Mr. Smith.
Case History Summary:
Mr. Smith, a 55-year-old male, was diagnosed with chronic kidney disease (CKD) five years ago. He has a history of hypertension, which is a common comorbidity associated with CKD. Mr. Smith’s renal function has gradually declined over the years, with a current estimated glomerular filtration rate (eGFR) of 25 ml/min/1.73m². He has been experiencing persistent hypertension, with blood pressure consistently above the target range despite antihypertensive medication.
Complication 1: Hypertension
Hypertension is a prevalent complication of CKD, affecting approximately 85% of CKD patients. In Mr. Smith’s case, his hypertension is primarily a result of impaired renal function leading to sodium and fluid retention, activation of the renin-angiotensin-aldosterone system (RAAS), and sympathetic overactivity. The reduced excretion of sodium and water by the kidneys contributes to increased intravascular volume, leading to elevated blood pressure.
Management interventions for Mr. Smith’s hypertension have included lifestyle modifications such as dietary sodium restriction and regular exercise, as well as pharmacological therapy. He has been prescribed an angiotensin-converting enzyme (ACE) inhibitor and a diuretic to manage his blood pressure. These medications target the RAAS and enhance sodium and water excretion. However, despite the interventions, Mr. Smith’s blood pressure remains uncontrolled.
Critically analyzing the management interventions, recent evidence suggests that achieving optimal blood pressure control is crucial in slowing the progression of CKD. Alternative pharmacological options, such as angiotensin receptor blockers (ARBs) or calcium channel blockers (CCBs), may be considered in patients who do not respond to ACE inhibitors or diuretics. Lifestyle modifications should also be reinforced, emphasizing the importance of dietary sodium restriction, regular exercise, and weight management. Additionally, close monitoring of blood pressure and regular medication adjustments are necessary to optimize management.
Complication 2: Metabolic Bone Disease
Metabolic bone disease, particularly renal osteodystrophy, is another complication associated with CKD. In Mr. Smith’s case, he has been experiencing bone pain, muscle weakness, and fractures. The underlying pathophysiology involves alterations in calcium and phosphate metabolism, reduced activation of vitamin D, and secondary hyperparathyroidism.
Mr. Smith’s management interventions for metabolic bone disease include calcium and vitamin D supplementation, along with phosphate binders to control hyperphosphatemia. The goal of these interventions is to maintain calcium and phosphate balance, enhance vitamin D activation, and prevent the development of renal osteodystrophy. However, despite these interventions, Mr. Smith continues to experience bone pain and fractures.
The effectiveness of the management interventions in Mr. Smith’s case raises concerns. Recent evidence suggests that optimizing mineral and bone disorders in CKD patients requires an individualized approach. Regular monitoring of calcium, phosphate, parathyroid hormone (PTH), and vitamin D levels is essential. If hyperparathyroidism persists, interventions such as calc