Ckd Model

This assignment will critically evaluate the holistic care delivered to a patient with a Long Term Condition (LTC).In order to maintain privacy and confidentiality the patient name will be changed and will be called Gerald, a pseudonym (Nursing and Midwifery Council (NMC, 2015). LTC and Chronic Kidney Disease (CKD) will be defined and discussed, followed by an analysis of the impact of CKD on the patient and family. The patient will then be introduced followed by discussion of case management and the House of Care model which are used in patient assessment. The management of the patient care needs will then be outlined and critically analysed in the context of current guidelines and policy directives. The assignment will conclude by suggesting
Management of LTCs is one of the challenges faced by global health services and it is a key policy driver for the National Health Service (NHS) in England (Garin et al., 2016; Goodwin et al., 2010) where about 20 million people have at least a single LTC (Roddis et al., 2016) and 65% of those aged 65-84 have two or more LTCs (Barnett et al, 2012).The upward trend in LTCs prevalence, like arthritis, asthma, chronic obstructive pulmonary disease, cancer, dementia and chronic kidney disease, can be explained by population ageing and an increase in life expectancy (NHS, 2012;Rogers et al.,2011; de Silva ,2011).A LTC can be defined as a physical or mental illness that cannot be cured but can be controlled by medication and other therapies (Carroll, Kennedy and Richardson, 2016). However this definition has been criticised by Eaton, Roberts and Turner (2015) as being too narrow, as LTC impose a socio economic burden on the patient and others and there is a need to acknowledge that patients spend 99% of their time self-managing their conditions. LTC patient care itself account for 70%
Patient history also indicated oliguria which is urine output less than 0.5 mL/kg/hour for more than six hours, also indicative of AKI (Shaw, 2015; Kidney Disease Improving Global Outcomes, 2013). Gerald’s medical presentation was also consistent with the findings of the National Confidential Enquiry into Patient Outcomes and Death (2009) whereby AKI affect one in five emergency adult hospital admissions, and costing the NHS an estimated £1.02 billion. Gerald was immediately transferred to the renal ward. Urinalysis showed presence of protein and blood, which are bio-markers of AKI (Han et al, 2014).Electrocardiogram (ECG) showed changes, including peaked-T waves, indicative of hyperkalemia (Parham et al,2006) and arterial blood gas analysis showed potassium of 6.9 mEq/L ( normal range 3.5-5.5 mEq/L (Palmer and Clegg, 2015; Pham et al, 2016 and Kang et al, 2016). Urine sample was sent to biochemistry for albumin to creatinine ratio (ACR) and creatinine was 456 (normal range for men 60 - 110 micromol/L (BMJ, 2016). Subsequently a temporary dialysis access catheter was inserted, followed