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).
General Information
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 Help 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.
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This essay aims to provide a comprehensive analysis of a case study involving a patient with chronic kidney disease (CKD). The patient, assigned the pseudonym John, has been selected for this study to explore the complications associated with CKD and critically analyze the management interventions provided. The essay will begin with a brief case history summary, highlighting John’s current renal health condition, relevant past and present history, and the nursing, medical, allied health professional, and pharmacological management he has received. Subsequently, the essay will review the physiological basis of the complications, including hypertension, anemia, and metabolic bone disease, associated with CKD. The management interventions will be critically analyzed based on evidence-based findings, and recommendations for future practice will be proposed, if applicable. The conclusion will summarize the relevance of the care provided to John’s condition.
Case History Summary:
John is a 55-year-old male with a medical history significant for hypertension and type 2 diabetes mellitus. He was diagnosed with CKD five years ago and has been under the care of a nephrologist. John’s renal health condition has gradually deteriorated, resulting in a decline in kidney function and the development of various complications. His current renal health status is characterized by stage 4 CKD, with an estimated glomerular filtration rate (eGFR) of 25 ml/min/1.73m². He experiences persistent hypertension despite pharmacological management with antihypertensive medications, including angiotensin-converting enzyme inhibitors (ACE inhibitors) and diuretics.
In addition to hypertension, John has developed anemia as a complication of CKD. His hemoglobin levels have progressively declined over the past year, with the most recent measurement indicating a value of 10 g/dL. To manage his anemia, John has been receiving erythropoiesis-stimulating agents (ESAs) to stimulate red blood cell production. However, his response to ESAs has been suboptimal, as evidenced by persistent anemia and the need for frequent blood transfusions.
Furthermore, John has been experiencing symptoms of metabolic bone disease, including bone pain and fractures. His recent bone mineral density scan revealed osteoporosis, indicating compromised bone health. John has been prescribed calcium and vitamin D supplementation, along with bisphosphonates, to reduce the risk of fractures and manage his metabolic bone disease.
Review of Complications and Physiology:
Hypertension is a common complication in CKD due to alterations in renal hemodynamics and increased activation of the renin-angiotensin-aldosterone system (RAAS). As kidney function declines, the kidneys are less able to regulate blood pressure, leading to persistent hypertension. The impaired excretion of sodium and water contributes to volume expansion and vasoconstriction, further exacerbating hypertension in CKD.
Anemia in CKD occurs primarily due to inadequate production of erythropoietin by the kidneys, resulting in decreased red blood cell production. Additionally, CKD is associated with increased destruction of red blood cells and deficiencies in iron, folate, and vitamin B12. These factors contribute to the development of anemia in CKD patients.
Metabolic bone disease in CKD is multifactorial and encompasses disorders such as osteoporosis, osteomalacia, and secondary hyperparathyroidism. In CKD, impaired renal function leads to alterations in calcium, phosphorus, and vitamin D metabolism, resulting in mineral and skeletal abnormalities. Reduced activation of vitamin D, elevated phosphate levels, and secondary hyperparathyroidism contribute to the development of metabolic bone disease in CKD patients.
Critical Analysis of Management Interventions:
The management interventions provided to John for hypertension include the use of ACE inhibitors and diuretics. These medications aim to control blood pressure by
