Kidney failure and hemodialysis

Kidney Failure and Hemodialysis

The main difference between health and illness is health is when one is free from disease while illness is when there is an impairment in normal physiological functioning. Health is important because it is what keeps us functioning in a manner that is not impaired and what has happened to you with your kidney failure is that this part of your body has become impaired. What has happened to you is there has been a sudden loss in your kidneys' ability to perform their chief function, which is to eliminate excess fluids and salts and waste from an your blood. Kidney failure means that your kidneys cannot filter anymore or they are severely impaired and can't filter what your body needs them to in order for you to be healthy. When your kidneys aren't functionally healthily, dangerous levels of fluid may occur, and salt and waste will begin to accumulate in the body. This can happen quickly, or it can take a few days. Intensive treatment will be needed; however, the good news is that kidney failure can be reversible when a person is in otherwise good health.

Feelings like you experienced -- shortness of breath and lethargy -- are some of the symptoms of kidney failure. These types of feelings normally don't cause a person to be alarmed, however, with kidney failure, many times there are very clear symptoms to let you know that something is going wrong in your body. The generalized weakness that you were experiencing was because of anemia; basically, your red blood cell count was decreasing and it made your body get tired much quicker than it would if you were healthy. Your loss of appetite is also a symptoms of kidney failure.

Kidney failure doesn't happen on it's own, so it's important that we do some tests to find out what is happening inside or body. Kidney failure is almost always in relation to another medical condition or event (MFMER 2010).

We are going to walk through all of the steps together because I feel that knowledge is the best way for you to understand what is going on in your body and how you can become healthy again. Kidney failure is very serious -- however, there is hope for turnaround and being positive is very important to a successful and healthy recovery.

Hemodialysis will be prescribed but before beginning, we will need to undergo an extensive blood work-up. This will assess different levels in your blood so that we can see how progressed the kidney disease is (Daugirdas, Blake, & Ing 2006: 109). Urine samples will also be collected and this will be done over a 24-hour period because it's the best way to determine protein loss and can help us determine what the cause of the kidney failure was (MMFER 2010). Hemodialysis is often a treatment that you will undergo three times a week, averaging three to four hours per "run" -- but this could change depending on the dialyzer we use.

Some of the questions you've had so far are completely normal. I know that you are having fearful thoughts. (He's already asked me if he will die from this, how his life will change, and what kind of pain will he experience). All patients undergoing kidney failure treatment have these kinds of questions. They are very normal, but I'd like you to know that it is my job to help you understand what is going on and if you have any questions for me, I will always answer them in a way that makes sense to you.

It is part of the my job treating a patient with kidney failure to understand how to speak to patients in language that doesn't require a science or healthcare education background in order to make sense of what is happening to them and their bodies as well as what they need to do to measure their health on a daily basis. It is of the utmost importance that I help you gain knowledge so that you know what to expect so that I can help you along the way of your dialysis journey. There are many factors that will need to be addressed pertaining to your health.

Patients who are undergoing hemodialysis can face a plethora of emotional issues that is caused by their illness and every patient needs assistance in psychological adjustment (Sullivan 1975). For many people, major anxiety is an issue because you may feel that the state of your health can change from one day to the next and the feeling of not knowing what is happening to you is overwhelming at times. While you have mentioned your fear of death, we can work today to help calm these fears and focus on ways to best get your body back to health. As I have mentioned to you, complete turnaround is a very possible with hemodialysis.

It is absolutely necessary that you monitor your health while on hemodialysis and this is something that you will have to do for the rest of your life -- on or off hemodialysis. Blood and urine tests are the best way to figure out how the kidneys are functioning. Blood tests can indicate whether or not the kidneys are functioning properly or if they are failing to eliminate waste. Urine tests can also show how quickly bodily wastes are being eliminated, and whether or not the kidneys are leaking abnormal amounts of protein (Walser & Thorpe 2004: 38).

Physical Reaction.

The client's psychological and emotional well-being has had major impact on his physical well-being, which is normal (Stein & Wild 2007: 100). For the client, playing sports and engaging in other physical activities is impossible so has can lead to profound frustration and depression in the client (Sullivan 1975). Suicidal thoughts have come up now and again as he has mentioned to me. The client has mentioned that hemodialyis is a very uncomfortable process and because of this he often feels anxiety, fear, and ambivalence before undergoing his dialysis. He has also suffered from a certain amount of anxiety.

The impact of hemodialysis can be quite destructive on the ego (Sullivan 1975) and the client's adaptation and rehabilitation depends on several factors, some of which include: ego strength of the patient, the environment and its influence, the family's attitude, emotional support from family and friends, and the patients relationship with the staff doing their dialysis (1975).

Emotional Reaction.

The client's emotions have been quite varied. He expressed a bit of denial when first finding out that he would have to undergo hemodialysis. He then got angry about how much this would upset his life. He has the support of his wife and his two now adult children, but he feels that everyone is making such a big deal out of the illness. The clients has stated that he has felt depressed, disappointed, and frustrated and I have explained that these feelings are completely normal as there are so many limitations that are being imposed by his illness.

Cognitive Reaction.

The patient is worried about losing his job and his financial stability; he also feels incredibly limited by what he can do physically. It has drastically changed the way that the patient sees himself. There has been a cognitive change in how he sees his life -- unworthy vs. worthy. While some hemodialysis patients have changes in the way they see their bodies -- healthy vs. unhealthy, the client doesn't seem to have changed the way he sees his body. He understands that he is sick, but he looks at it more as an inconvenience.

Probably one of the biggest cognitive discoveries in patients who go through kidney failure and subsequent hemodialysis is that there is a new awareness of an early death. People who are undergoing dialysis know that if they don't undergo the treatment, they will die (Stein & Wild 2007). The client is aware that hemodialysis is a requirement for survival.

Behavioral Reaction.

Dependency feelings have come up for the client and these, I have assured him, are very common in patients of hemodialysis. Because of his feeling that there is a lack of control on his part, can lead to aggressive and hostile behavior (Sullivan 1975). He has said that he has been particularly hostile to his wife, even though he is not angry with her. He feels out of control and sometimes he just "snaps" with her. I have explained to the client that the way that a person feels impacts the way they behave. For example, if the client was feeling depressed, he may drink to cheer himself up. If he is feeling stressed out, he may start a fight with his partner (Stein & Wild 2007: 100). I told him that he should let his wife know how he is feeling and let her know that it is because he is feeling a bit helpless about his situation. Simply expressing those feelings may help him cope better.

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.

Disabilities.

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.

Coping strategies.

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.

Health decision-making.

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.

Cultural impacts.

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.

Socialization.

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.

Lifespan.

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.