# Case Study Analysis: Sarah Collins
## Introduction
Chronic Kidney Disease (CKD) is a progressive condition characterized by the gradual loss of kidney function over time. In the case of Sarah Collins, a 70-year-old female with a medical history that includes Type 2 diabetes and obesity, the symptoms of fluid volume overload are evident, particularly given her recent weight gain of three pounds since the last dialysis session and elevated blood pressure of 145/90 mm Hg. The kidneys play a crucial role in maintaining homeostasis, including fluid and electrolyte balance. When renal function declines, as seen in CKD, the body’s ability to excrete excess fluid diminishes, leading to complications such as hypertension and shortness of breath, particularly during physical activity.
### Pathophysiology of CKD
The pathophysiology of CKD involves a progressive decline in glomerular filtration rate (GFR), leading to the accumulation of metabolic waste products in the body. In Sarah’s case, the increased weight and her diabetes likely contribute to glomerulosclerosis, a condition that damages the filtering units of the kidneys. The fluid overload that Sarah is experiencing results from the kidneys’ inability to filter out excess sodium and water, which can manifest as hypertension and edema.
### Additional Assessment Findings
To further assess Sarah’s condition, additional findings to look for include the presence of edema, lung sounds indicating fluid overload (e.g., crackles), and vital signs indicating tachycardia or changes in respiratory rate. Laboratory abnormalities would likely reveal elevated serum creatinine and blood urea nitrogen (BUN) levels, indicating decreased kidney function. Electrolyte imbalances such as hyperkalemia (high potassium) may also be present, as impaired renal function affects potassium excretion.
### Anticipated Diagnostics
Diagnostics that the healthcare team might order include a comprehensive metabolic panel to evaluate kidney function and electrolyte levels, a urinalysis to check for proteinuria or hematuria, and possibly imaging studies such as an ultrasound to assess kidney structure. These assessments will help to clarify the extent of Sarah’s CKD and guide her treatment plan.
## Implications for Self-Care
In considering Maslow’s hierarchy of needs, Sarah’s current state indicates she is at the physiological level, where basic needs such as adequate fluid balance, nutrition, and health are paramount. Her inability to walk to the mailbox due to shortness of breath reflects a significant disruption in her basic needs, impacting her overall healing and care. This physiological distress underscores the necessity for immediate interventions to stabilize her health.
The disease process complicates Sarah’s ability to care for herself, as chronic fatigue, dietary restrictions, and fluid limitations may lead to increased dependency on family members and healthcare providers. This increased dependence can affect her psychological well-being and overall quality of life.
## Patient Education Strategy
### Nursing Interventions and Teaching Points
1. **Fluid Management:** Educate Sarah about fluid restrictions to prevent overload. Teach her to monitor her fluid intake daily.
2. **Dietary Education:** Provide guidance on a renal-friendly diet low in potassium, phosphorus, and sodium. Discuss the importance of following dietary recommendations to manage her condition effectively.
3. **Medication Adherence:** Ensure she understands her medication regimen, particularly the importance of antihypertensive and diabetes medications in managing her CKD.
4. **Symptom Monitoring:** Encourage Sarah to report any new symptoms such as increased shortness of breath, swelling, or changes in urine output, facilitating early intervention.
5. **Physical Activity:** Discuss the importance of regular, light physical activity tailored to her abilities to improve overall health and mobility.
### Educational Strategies
When building a plan of care, it is essential to utilize teach-back methods to confirm understanding. Visual aids, such as dietary charts and fluid intake logs, can enhance comprehension. Involving her husband and grandson in education sessions can foster a supportive home environment, facilitating adherence to lifestyle changes.
## Interdisciplinary Collaboration
### Team Members
1. **Dietitian:** A dietitian specializing in renal nutrition can develop an individualized meal plan that accommodates Sarah’s dietary restrictions and preferences, ensuring adequate nutrition while preventing complications.
2. **Social Worker:** A social worker can assist in addressing financial implications related to ongoing treatments and provide resources for community support services.
3. **Pharmacist:** A pharmacist can review Sarah’s medication regimen, ensuring it is optimized for her renal function and addressing any potential drug interactions.
### Care Considerations
While inpatient, Sarah will require close monitoring of her vital signs and laboratory values to assess her fluid status and renal function. Upon discharge, community services such as home health care may be necessary to support her self-management strategies, particularly given her mobility issues and need for assistance in adhering to dietary and medication regimens.
## Conclusion
This case study of Sarah Collins underscores the complexities of managing chronic kidney disease, particularly in the context of comorbid conditions such as diabetes and obesity. By understanding the pathophysiology, recognizing the implications for self-care, implementing appropriate nursing interventions, and fostering interdisciplinary collaboration, healthcare providers can significantly enhance the quality of care for patients like Sarah. Effective management strategies not only improve clinical outcomes but also promote the patient’s overall quality of life.
## References
– **American Diabetes Association.** (2021). Standards of medical care in diabetes—2021. *Diabetes Care*, 44(Supplement 1), S1-S232. https://doi.org/10.2337/dc21-Sintroduction
– **National Kidney Foundation.** (2022). *KDOQI Clinical Practice Guidelines for Nutrition in Chronic Kidney Disease: 2020 Update*. Retrieved from https://www.kidney.org/professionals/kdoqi/guidelines/nutrition
– **Centers for Disease Control and Prevention.** (2023). Chronic Kidney Disease in the United States. Retrieved from https://www.cdc.gov/kidneydisease/index.html
Assignment Instructions:
This assignment utilizes TurnItIn. When you submit this assignment to the assignment drop box, it will automatically be submitted to TurnItIn.
Review the case study scenario below and the client’s medical profile
information.
Sarah Collins (Medical Profile)
Age: 70
DOB: December 17
Gender: F
Height: 5’ 5”
Weight: 224 lbs
Language: English
Medical History/Risk Factors:
• Diabetes Type 2
• Obesity
• CKD
Personal/social: N/A
Next, write a 6-8-page paper analysis of the client (including title and reference page)
Case Study 1 Scenario:
Client, Sarah Collins, has chronic kidney disease. She receives dialysis twice a week. Today when Mrs. Collins arrives at the dialysis clinic, the nurse assesses Mrs. Collins and notes her blood pressure is 145/90 mm Hg and she has gained three pounds since her last visit. Mrs. Collins tells the nurse she was trying earlier to walk to her mailbox at the end of the driveway and couldn’t because she was out of breath. Mrs. Collins’ husband and 16-year-old grandson are at the clinic with her.
Note: Sarah Collins is presenting symptoms of fluid volume overload as a complication of her chronic kidney disease.
Case Study Analysis Assignment Outline:
The case study analysis paper should include the following sections with responses and rationales for all the prompts.
Introduction (3-5 paragraphs)
Provide an overview of the pathophysiology of the disease exhibited by the client. Include:
What additional assessment findings would you look for?
What lab abnormalities would you expect to see?
What diagnostics would you anticipate the healthcare team ordering?
Provide a rationale for your answers.
Implications for Self-Care (2 paragraphs)
Consider Maslow’s hierarchy of needs and describe where the client falls in that hierarchy and how this will impact care and healing.
How does this disease process impact the client’s and/or their care provider’s ability to care for themselves?
Patient Education Strategy (2-3 paragraphs)
Identify 3-5 appropriate nursing interventions and teaching points for your client based on the pathophysiology and assessment findings.
Describe the educational strategies that should be incorporated when building a plan of care for your client.
Support with rationale.
Interdisciplinary Collaboration (2-3 paragraphs)
Identify 2-4 interdisciplinary team members who need to be included in the care of the client. Include rationale.
Consider the care the client will need while inpatient and upon discharge.
Consider nutrition, community services, and financial implications.
Conclusion
Summarize the key concepts of this disease process and client case study scenario.
References
A minimum of three references should be used in this paper.
References should be no more than five years old. Exceptions include seminal works, such as original publications by nurse theorists.
One reference must be your textbook,
One reference must be from a peer-reviewed journal,
One reference must be from an authoritative website such as the CDC, NIH or Healthy People 2030.
APA Formatting
All papers should be written in APA formatting. This paper should include:
Formal components, such as a title page, and APA formatting with an introductory and conclusion paragraph that summarizes the key concepts
APA-formatted level headings
APA margin, font, and paragraph spacing
Include page numbers
Appropriate in-text reference citations
A reference page, in correct APA format
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