The client has had major feelings of not being able to cope with what is happening to him. He has "forgotten" about dialysis appointments and has even avoided doctors' phone calls. I have told him that they way he behaves will have a direct impact on his physical condition. When a kidney patient becomes ambivalent about his diet, forgets to take his medication, or abandons fluid restrictions, all of these things put strain on the patient's body (Stein & Wild 2007: 100). I have reiterated these facts to him and he seems to listen, but there is an overall sense of helplessness coming from him -- as well as a bit of ambivalence.
Client's overall reaction.
The client has the support of his wife and his children (however, they do not live close by) and he does have a good insurance plan so it doesn't seem like he is feeling stressed about the financial aspect of hemodialysis. The client has worked for the same company for 30 years and so he has a very good relationship with the company. The company does know about his illness and they are willing to do whatever they need to do to work with him and make sure that he gets healthy again. The client appears to be very happy with the support he's getting from his workplace as well as from his family and friends.
The client's main disability has been lethargy and feelings of hopelessness. This has impacted his life greatly because he doesn't have the energy to work or to do much of anything. He becomes worried that he's always going to feel like this and that he will lose his job and his family. He knows that this isn't true, but he doesn't like the idea of becoming a burden to anyone. He is struggling with the idea that this is a chronic illness; he has yet to find a way to accept it.
Right now the patient seems to be coping by using avoidance. Though he is aware and following most dietary restriction, he often "forgets" about certain restrictions and becomes angry when his wife notices. He would like to believe that he is the same as before his kidney failure and this angers him a great deal. He feels that life has been unfair to him. When he gets very angry, he often gets very sad right after and he has feelings of hopelessness and ambivalence. He doesn't talk to his wife much about his feelings as he doesn't want to "burden" her -- although she has expressed that she wants him to share those feelings with her. The client is not using any problem-solving strategies to cope with his illness. He also uses isolated thoughts to deal with what he is going through.
The client is heuristic beliefs in his health decision-making. He doesn't have any set beliefs, per se, about health decisions and he is listening to doctors about how to get his body back to health. He would like to follow the "rules" and get healthy again. He admits that he becomes angry and hopeless at times, which is why he has missed hemodialysis appointments and "forgotten" dietary restrictions, but overall, he is trying to follow all the rules he needs to become healthy.
The client has said that he feels like he is not an active part of society anymore. He feels that people feel sorry for him -- especially at work because he can't do a lot of the same tasks he did before; he tires quickly. He feels that he has aged tremendously during this and that people look at him differently. He said that he feels he has let his wife down because she is vibrant and he's worried that she will realize that he is old and ill and not want to be with him. Society looks down on those who are ill, he thinks, and this has made him self-conscious about his illness.
The client is not socializing with friends like he used to. He used to be an avid golf player, but he no longer has the energy. He can't go out and get a beer or watch a game with his friends because he gets too tired. He has the liquid restrictions as well and he feels like it is too much work to explain to friends. Besides, he feels that if he can't have some beers, then why go out at all?
He and his wife are not going out as much as they used to - hardly at all now, mainly because of dietary restrictions and the fact that he gets so tired so quickly. His wife doesn't mind; in fact, he says that she is learning how to make different foods to accommodate his restrictions. He has admitted to feeling very isolated. Work is not the same as it used to be. He feels self-conscious and like everyone is pitying him.
The client has not yet found a way for how he is going to deal with this illness over the course of his life. He is still working out how he is going to manage his liquid restrictions and diet. The client didn't have a very set regimen for health before kidney failure. He ate and drank what he wanted and he wasn't a very physically fit person. The way he thinks about his health now has definitely changed because he has been forced to change his health regimen so drastically. He is worried about not doing certain things right and this will have detrimental effects on his health. But he is confident that with the help of his wife, he will be able to manage.
The client has experienced bouts of major anxiety while undergoing hemodialysis. We have discussed the impact of stress and anxiety on the body and he is aware that the better he can cope with these stressors, the better his body will be at getting healthy. He has begun meditation while he is undergoing the dialysis to calm himself as he finds the actual process quite tiring and depressing. He is using visualization techniques to help calm his mind. He notices that he physically feels better after when he employs these techniques. The client is dealing with pain by taking acetaminophen, but he hasn't really found any great ways to deal with his pain. He doesn't want to become so reliant on drugs to make him feel better and he is actively looking for ways to help.
He has recently started doing more research on his illness, which he finds very effective for easing his mind. I have reiterated to him that knowledge is power and it is the best thing he can do to not feel so hopeless. I have also stressed that he can take control of his health by knowing what exactly is going on at appointments, etc. He can even take responsibility for his dialysis.
Health behavior needing change.
The client needs to be better at dealing with his stress. He gets very stressed out and then angry and this weakens him physically. He wants to learn how he can get rid of the angry feelings and go to a place where he can take control over his emotions.
Cameron, J. Stewart. (1996). Kidney failure: the facts. Oxford University Press, USA; 1st edition.
Chen, Shuang. (2008). The guide to nutrition and diet for dialysis patients. Metier Books.
Daugirdas, John T., Blake, Peter G., & Ing, Todd S. (2006). Handbook of dialysis.