Critical Pathway: End Stage Renal Disease

I. INTRODUCTION Mr. D is a 57-year-old Hispanic male and moves to an emergency room through an ambulance with a femoral fracture. One of his employees found him on the floor of the accounting firm 's bathroom. Mr. D looked very sleepy after arriving at the hospital. His speech was ambiguous, and he lost sight of the way. For vital signs and laboratory work for evaluation. Vital: Height 6'2 "Weight 220 lb BP 180/90 HR 104 Resp. 24 Temp. 100.1 Laboratory: K + 6.1 Na 149 Ca 1.4 P 04 4.6 Glucose 255 Hgb 12 Hct 26 protein 6.0 Albumin 2.7 BUN 101 Creatinine 49 GFR 12 Mr.

Note: Co-morbidities include diabetes, cardiovascular disease (ischemic heart disease, congestive heart failure), and end stage chronic kidney disease. The minimum physical activity reported by bPatient is defined as the time spent in a lounge chair or bed more than during the day. c There are St George Respiratory Questionnaire, Chronic Respiratory Disease Questionnaire, and Respiratory Questionnaire as methods for assessing health-related quality of life. In addition to those at high risk of death next year, patients with symptoms that are difficult to treat with early treatment will benefit from early palliative care. As mentioned above, patients with COPD have multiple symptoms including dyspnea, cachexia, anxiety and depression. Some patients may respond quickly to medication, opioid and oxygen therapy, but other patients are still affected after taking the first step.

Morbidity and mortality of patients with end stage renal disease remain high and the medical, social and economic impact of this disease is widespread. Heart disease is the leading cause of death in patients with end stage renal disease (Macias, Steward, & Oreopoulos, 2008). Primary care physicians and kidney specialists are essential to comprehensive care from the initial stage. Disease management is a dynamic process and dialysis or kidney transplantation is the only cure for this condition, but there is a conservative cure. It refers to management without dialysis, including aggressive management of kidney disease to delay the deterioration of kidney function and minimize the complications of the disease. It also includes proactive management of symptoms, psychological care, social support, family support. This includes detailed communication with patients and families, and pre-care planning. (O'connor &, Corcoran, 2012)

African Americans have the highest incidence of end stage renal disease in the United States. Blacks with chronic kidney disease are at high risk of dying before end stage renal disease and end stage renal disease. In 2004, the adjustment of age and sex of end-of-black renal disease was 6 times higher than non-black age (Derose, Rutkowski, Levin, Liu, Shi, Jacobsen, and Crooks, 2009). The race differences in the incidence of terminal kidney disease seems to be due to several population differences, including complications that affect the risk of kidney disease, the type and severity of kidney disease, and the mortality rate of end stage renal disease I will. Differences in these populations may be due to more distant causes such as fluctuations in gene expression, exposure to the environment, health-related behaviors, access to and access to health care, response to treatment (Derose, Rutkowski, Levin, Liu, Shi, Jacobsen). , & Crooks, 2009)