Week 8: Nursing Diagnoses

Well guys, here we are! The final week of learning about diabetic nephropathy! We did it! 

For the final week I am going to be talking about what nursing diagnoses are applicable to diabetic nephropathy. Nursing diagnoses are not medical diagnoses- instead a nursing diagnoses discusses the problem within the problem. The medical diagnoses is diabetic nephropathy, but for nurses the diagnoses might talk about lack of knowledge in regards to the disease. Basically, how does diabetic nephropathy affect your life and not just your body? 

Nursing diagnoses are relative and present nurses with an opportunity to more effectively teach the patient. These diagnoses show us where to focus our attention and highlight some of the most important parts of the disease. Let's jump in! 

Knowledge deficit regarding the condition, prognosis, treatment, self-care and discharge needs related to unfamiliarity with information or resources. What this long sentence says to nurses is that you are unfamiliar with what the disease is, what it is doing to you, and what resources are available to help! This blog is a resource that you can share with your friends and there are thousands of blogs just like this! Nurses should be helping you find information like this..and let me tell you it is readily available. 

Fluid volume excess related to compromised regulatory mechanisms as evidenced by venous distention, edema, fatigue, weakness, and restlessness. What this nursing diagnoses says is that there is too much fluid in your body that the kidneys cannot get rid of since they aren't working properly. Remember some of the common effects of diabetic nephropathy were from our previous weeks? Well they are listed here again... edema (swelling), fatigue or tiredness, and weakness throughout the body. 

Risk for impaired skin integrity related to altered sensation secondary to diabetic nephropathy as evidenced by high glucose levels. What this one tells us that you have a risk for injuring your skin due to uncontrolled blood  levels. Just like we have talked about before, it is important to keep your sugar levels controlled for SO many reasons. One of those it to keep your skin intact. 

Altered fluid and electrolyte imbalance related to urinary retention as evidenced by dyspnea, decreased urine output and generalized edema. Since the kidneys aren't functioning at their maximum level your body will not produce as much urine. In turn you won't need to go to the bathroom as much. Inside your body, the increased retention of fluid can alter the electrolytes. This is something that nurses need to pay close attention to because if your electrolytes get too wacky you can have serious problems else where in your body. 

Risk for anxiety related to change in health status. Any time a patient finds out they are diagnosed with a disease or have a change in their health it is a shock. Some diseases can be life threatening and some threaten who we are as a person. It is important to recognize that your mental health is as important as your physical health. If you are feeling anxious or uncertain about your diagnosis talk to a health care provided- someone like your nurse might be a great place to start :) 

Okay guys....THANK YOU for following with me over the past 8 weeks. I hope reading this blog has been as helpful for you as it has been for me to write. Please let me know if you have any questions and I would love to help out! And remember, nurses are your best friends!

Week 7: Nursing Care

Welcome to week 7 learning about diabetic nephropathy! Only one more week after this and you can share your knowledge with the world since you'll be an expert! Hah or at least I hope you feel that way! Now that we know what the disease is, how it arises, what you should look for and how it is treated it is time to talk about the nursing care you should be receiving. What types of things should nurses (like me) be doing while you are in the hospital as well as going home? What education should you be receiving to prevent diabetic nephropathy? Are you receiving the right type of information? Let's check it out.

Nurses play a huge part in preventing diabetic nephropathy by educating their diabetic patients. Nurses are the key position to implementing good preventative care. This care is accomplished by teaching patients about a healthy diet and exercise plan while tracking and discussing a patient's weight. Nurses are able to discuss medication regimens and look at lab results to see if the medication is working properly. Most importantly, nurses are able to teach patients how to use their insulin and when it should be uses. Controlling blood sugar levels is one of the most important things you can do to prevent diabetic nephropathy!

Secondly, when a nurse sees an inappropriate lab value or notices significant changes with the patient they are able to start the referral process. Nurses are able to refer to dietitians, diabetes educators, and many more specialists that can help slow the kidney disease down. This is an important part of identifying and handling your disease and nurses can be very important in this process!

Nurses are also influential in reminding patients about when their next labs or exams should be. They are often first to tell when something is different or when something is wrong. Nurses should be your best friend and confidant through this process. Be honest with them and talk to them about your concerns. Nurses have more time to spend with you than doctors so make sure they know everything. Write down a list if you might forget about things to tell them.

During a procedure, nurses will be the one to educate and inform you before, during, and after. They will tell you what the process will be like, how you should prepare, and what the most common side effects are. Now is a great time to ask questions!

Finally, let the nursing team know what you need from them. They are on your side and your biggest advocates! I may be a bit biased but I think nurses are the best :)

References

Aiello, JH. Preventing Diabetic Nephropathy: The Role of Primary Care. Feb 23, 1998. 23 (2): 12-3, 17-8, 23-4. 

Lewis, Dirksen, Heitkemper, and Bucher. Medical-Surgical Nursing: Assessment and management of Clinical Problems. 9th edition. St. Louis, Missouri: Elsevier; 2014. 

Week 6: Treatment Options

Hey everyone! This week on the blog we are going to talk about the treatment options if you are diagnosed with diabetic nephropathy. The goals of treatment with this disease are to slow the progression of kidney damage and control a lot of the complications associated with the disease. The top of this list starts with the treatments you would use at the beginning of the kidney disease and the end of the list discusses treatments for end stage kidney disease.

The main treatment is using an ACE inhibitor, a drug that lowers resistance in the blood vessels in the kidney by dilating the blood vessels. This drug reduces protein levels in the urine and slows the progression of diabetic nephropathy. One of the common side effects of this medication is a dry cough. Keep taking your medication if you develop a cough- it is normal.

Medications to control your blood sugar like insulin slow the progression of the disorder, especially in the early stages. As you kidney disease gets worse you kidney produces less insulin so higher doses may be needed to control glucose levels.

Your diet will most likely be modified to help control your blood sugar levels. It is important to maintain a healthy weight and engage in regular physical activity.

High blood pressure needs to be controlled with medication. This reduces the risk of kidney, eye, and blood vessel in the body. When you take medications to lower your blood pressure take caution when you are standing up from bed. Blood can pool in your feet and as you stand up you may become dizzy and light headed. If this happens sit back down and wait a couple of minutes before standing again.

End stage diabetic nephropathy is treated with dialysis. Dialysis is a mechanical process that cleans your blood outside of your body. This process removes waste and excess water from the blood. Dialysis is done in a hospital and the nurses (like me) will take great care of you during the treatment. The treatment is painless and some patients see a drop in their blood pressure. If this happens, you may feel nauseous, vomit, experience headache or cramps. These problems usually go away.

At the final stage, a kidney transplant would be considered. After this surgical procedure you will be  in the hospital for about a week. The recovery period is about 6 months including regular blood tests and x-rays. Almost everyone who receives a kidney transplant feels like they have a better life afterwards. You will need to be on medication to ensure that your body accepts the new organ and doesn't reject it.

I hope talking about the treatment options is helpful for you! I learned a lot just blogging about it. Let me know if you have any questions and I will be back next week to talk about diabetic nephropathy again! Have a wonderful week!

References

American Diabetes Association: Position statement: Diabetic nephropathy. Diabetes Care 22 (Suppl 1):S66-69, 1999.

Evans, Timothy; Campbell, Peter. Clinical Diabetes: Diabetic Nephropathy. 18:1, 2008. 

Lewis, Dirksen, Heitkemper, and Bucher. Medical-Surgical Nursing: Assessment and management of Clinical Problems. 9th edition. St. Louis, Missouri: Elsevier; 2014. 

Week 5: Signs and Symptoms

Hey there! Welcome to week 5 of diabetic nephropathy! So far we have learned a LOT about diabetic nephropathy. We learned about the disease, who is at risk, what types of things put me at risk, and how the diagnosis is made. Whew that is a lot. We are almost experts now :)

This week we are going to be addressing signs and symptoms you might see if you are developing diabetic nephropathy. First off lets address what signs and symptoms are... A sign is something that is objective. Examples are: redness of the skin, vomiting, or blood in the urine. A symptom is something that is objective. This includes topics like pain, itching, and nausea. Most of the things that you are feeling are symptoms and the things that you can see are signs. Got it?

These are examples of symptoms...

This is an example of a sign....

YUCK!! I hope this doesn't happen to you! So back to diabetic nephropathy...

Symptoms of Diabetic Nephropathy include...

Early on there are no symptoms! However, later on in the disease you can see

• Swelling, usually around the eyes and/ or legs 
• Poor appetite 
• Nausea and vomiting 
• General sick feeling 
• Fatigue or tiredness 
• Headache
• Frequent hiccups 

Signs of Diabetic Nephropathy include...

Most of the signs are performed in the laboratory. The things the lab is looking for are 

• Positive microalbuminaria- too much protein in the urine 
• Glucose in the urine 
• Increased creatinine and BUN levels- kidney function markers. Having increased creatinine and BUN means the kidney function is decreasing. 
• Kidney biopsy confirms the diagnosis but is not likely performed 

Okay guys- see you next week for more lessons on the kidney and diabetic nephropathy! Again, let me know if you have any questions you want me to answer. I would love to help! 

References

American Diabetes Association: Position statement: Diabetic nephropathy. Diabetes Care 22 (Suppl 1):S66-69, 1999.

Evans, Timothy; Campbell, Peter. Clinical Diabetes: Diabetic Nephropathy. 18:1, 2008. 

Lewis, Dirksen, Heitkemper, and Bucher. Medical-Surgical Nursing: Assessment and management of Clinical Problems. 9th edition. St. Louis, Missouri: Elsevier; 2014. 

Week 4: Diagnosis 

Welcome back to our wonderful discovery of diabetic nephropathy! Today we are going to talk about the tests, signs, and symptoms that lead to this diagnosis. Let's find out what we are in for...

Early screening..if you have diabetes it is important for you to test your blood glucose levels routinely! Not just in the moment blood glucose levels, but making sure you get your HgA1C checked at least once a year. Keep those glucose levels under control!

Check your protein levels.... your doctor is probably already checking on this but make sure your results are good. The protein this test checks for is called albumin. If you excrete more than 30 mg/24 hours then your body is excreting too much protein in your urine. If there is protein in your urine that means your kidneys aren't doing their job and this increases your chances of developing diabetic nephropathy.

Imaging... Ultrasound is used to look at you kidneys. In this test we are looking directly at kidney size. If you have early stage diabetic nephropathy your kidneys will likely be larger than normal. If you have later stage diabetic nephropathy then your kidneys are likely to appear smaller. The ultrasound is also helpful in ruling out things out...like an obstruction or renal cancer.

Staging...There are 5 stages used to describe how bad the kidney failure is. Stage 1 is the best and Stage 5 is end stage kidney failure. The tests listed above are used to determine how extensive the kidney damage is. This information is helpful because it determines what treatment options are available to you.

Check out the picture below to see a simple idea of what diabetic nephropathy is doing to your kidney. I hope to see you guys back again next week! Go hawks!!!

References

Evans, Timothy; Campbell, Peter. Clinical Diabetes: Diabetic Nephropathy. 18:1, 2008. 

Lewis, Dirksen, Heitkemper, and Bucher. Medical-Surgical Nursing: Assessment and management of Clinical Problems. 9th edition. St. Louis, Missouri: Elsevier; 2014. 

Week 3: Etiology and Pathophysiology 

Week 3 of learning about diabetic nephrology...and cheering on the Hawks of course! Today we are going to learn about some of the aspects that influence and damage the kidney. There are some great videos that explain more about the subject and are really informative below!

Etiology 

The exact cause of diabetic nephropathy is unknown. Various health concerns like genetic factors and smoking contribute to the development of the disease. However, the most significant indicators are high blood glucose levels and hypertension (high blood pressure). Genetically speaking...if a family member has diabetic nephropathy you are five times more likely to develop the disease. Smoking is also a severe risk factor for developing kidney disease because it increases blood pressure. High glucose levels, HgA1C levels above 8.0%, are the strongest causative factor for developing diabetic nephropathy. High glucose levels damage the smaller blood vessels in the kidney leading to the destruction of the filtration process. High blood pressure has both a cause and effect on diabetic nephropathy. High blood pressure impedes filtration in the kidney and contributes to downhill progression of renal damage.

Pathophysiology 

The key event in kidney degradation and diabetic nephropathy is basement membrane damage. What does that even mean?! Damage to the basement membrane means there is inflammation and and disruption in the filtration process in the kidney. The declined flow of blood being filtered causes cell death and eventually kidney degradation.

Here are some GREAT videos breaking down diabetic nephropathy pathophysiology! Just click on the title and the video will open up! I hope this will make it clear and easy to understand!

Diabetic Nephropathy

Diabetic Nephropathy Pathophysiology

I hope this week's blog was helpful! Join me next week to learn more about diabetic nephropathy!

References 
American Diabetes Association: Position statement: Diabetic nephropathy. Diabetes Care 22 (Suppl 1):S66-69, 1999.

Evans, Timothy; Campbell, Peter. Clinical Diabetes: Diabetic Nephropathy. 18:1, 2008. 

Week 2: Epidemiology

Hi everyone! Welcome back to our study of diabetic nephropathy...after an amazing Seahawks win!! This week we are going to jump into the study of epidemiology. We will be looking at the different factors that contribute to the development of diabetic nephropathy like age, race, gender, etc. It is my goal to further investigate this disease with you. So here we go....

HISTORY
Diabetic nephropathy (kidney disease) is a common complication of diabetes. The disease was first discovered by the physician Clifford Wilson in 1936 but wasn't widely noted until the 1980s (NIH). The prevalence of diabetic nephropathy increased from 1988-2008 in proportion to an increase in diabetes. In fact, recent statistics say that diabetic nephropathy affects 366 million people in the United States with type 1 and type 2 diabetes (NIH). Now that is a lot of people with kidney disease! And since so many people are affected by this disease it is important that we recognize some of the factors that can influence its' prevalence.

RISK FACTORS
Several of the greatest risk factors for developing diabetic nephropathy include...

1. Poor blood glucose control. Regulating blood glucose is a big part of controlling your diabetes. You are at an increased risk for developing diabetic nephropathy if your A1C is greater than 11% (WHO).

2. Elevated blood pressure. Having uncontrolled blood pressure- or hypertension- is also a large risk factor for developing kidney disease. Consult with your physician if you repeatedly have elevated blood pressure (WHO).

3. The older you are the greater your risk of developing kidney disease. And so are the perils of life...Having diabetes for a longer period of time in coordination with getting older will increase your chance of developing diabetic nephropathy (WHO).

A combination of any of these risk factors even further increases your risk of developing diabetic nephropathy. So make sure you are paying attention to your health!

AGE 
The mean age of people affected by diabetic nephropathy is 60. Most people develop diabetic nephropathy after having diabetes for 10-20 years so like I said earlier the older you are the greater the risk.  In general, the incidence of kidney disease is higher among the elderly in general (NIH).

GENDER
Males and females have the same incidence of diabetic nehpropathy. So no matter what sex you identify with make sure you understand the risks relative to all (NIH).

RACE
African Americans, Mexican Americans and Pima Indians have a 3-6 fold higher incidence rate. This suggests that socioeconomic factors like diet, hypertension, obesity, and poor control of blood glucose levels have a primary role in the development of diabetic neuropathy. These results also show a possible genetic of familial contribution (NIH). So pay attention to your past. Does diabetic nephropathy run in your family? If so, talk to your provider sooner rather than later.

LOCATION
The United States has one of the lowest rates for kidney replacement surgery which is an indication for progressive diabetic nephropathy. Countries like Germany, Denmark and Australia have higher incidences of kidney replacement surgery for issues like diabetic nephropathy. This means that if you live in the United States you have lower risk of developing diabetic nephropathy.

It is also important to notice distribution of kidney disease throughout the United States. The southern states are more affected by diabetic nephropathy which can be attributed to higher incidences of diabetes and obesity.

MORTALITY AND MOBIDITY
As of 2013, it has beed shown that only 34% of patients live longer than five years following treatment for diabetic nephropathy and end-stage kidney disease (UpToDate). This data shows that survival rates are poor.

Okay guys...thanks again for joining me on our path to discovering diabetic nephropathy! I hope you learned from this blog post and I can't wait to see you next week! Go Hawks!



This information was provided to you from the following sources...

"Dialysis in Diabetic Nephropathy." Dialysis in Diabetic Nephropathy. N.p., n.d. Web. 13 Jan. 2015.
"About Diabetes." WHO. N.p., n.d. Web. 13 Jan. 2015.
Lewis, Dirksen, Heitkemper, and Bucher. Medical-Surgical Nursing: Assessment and management of Clinical Problems. 9th edition. St. Louis, Missouri: Elsevier; 2014. 

Chen, Jing. Diabetic Nephropathy: The Scope of the Problem. Diabetes and Kidney Disease. 2014, XIV, p. 256. 2013. 

Centers for Disease Control and Prevention. National diabetes fact sheet: national estimates and general information on diabetes and prediabetes in the United States, 2011. US Department of Health and Human Services. Atlanta, GA: Centers for Disease Control and Prevention; 2011.