NSG 5003 Kidney Transplant New Opportunities and Challenges Discussion

NSG 5003 Kidney Transplant New Opportunities and Challenges Discussion

Sample Answer for NSG 5003 Kidney Transplant New Opportunities and Challenges Discussion Included After Question

NSG 5003 Kidney Transplant New Opportunities and Challenges Discussion

Description

. Respond to at least two of your classmates. Participate in the discussion by analyzing each response for completeness and accuracy and by suggesting specific additions or clarifications for improving the discussion question response. Complete your participation for this assignment by the end of the week.

Question #1

Carolina Tusha posted

 

• Explain what happens physiologically with chronic renal failure and the GFR. Support with evidence. Include important labs that are monitored in the process.

A Sample Answer For the Assignment: NSG 5003 Kidney Transplant New Opportunities and Challenges Discussion

Title: NSG 5003 Kidney Transplant New Opportunities and Challenges Discussion

Chronic Kidney failure is characterized as a gradual impairment of the kidney function. This disease is characterized by the presence of markers of kidney disease present in urine, blood, or on ultrasound with or without impaired Glomerular Filtration rate (GFR) for at least 3 months (Lowth, 2016). Symptomatic changes result from increase levels of creatinine, urea and potassium. There are different theories for the adaptation to renal loss function. The first theory is the intact nephron hypothesis, which results in loss of nephron mass with progressive kidney damage, the nephrons that are not damage are able to sustain normal kidney function. With severe or repeated injury, epithelial cells have an impaired proliferative response resulting in interstitial capillary loss and fibroblast proliferation. The progressive process of glomerulosclerosis and tubulointerstitial fibrosis contributes to end-stage kidney disease. The location of kidney damage also can influence loss of kidney function (McCance & Huether, 2018, p. 1267). Creatinine is always being released by the muscle and excreted primarily by glomerular filtration, as the GFR declines in Chronic kidney failure, the serum creatinine level increases by a good amount to maintain a constant rate of excretion, therefore amounts of plasma creatinine can serve as a sign of glomerular function rate (McCance & Huether, 2018).

• Explain the role of Angiotensin II and proteinuria as they relate to advancing renal disease.

Both Angiotensin II and proteinuria have consistently been recognized as two factors related with advanced renal disease. According to McCance and Huether (2018) glomerular hyperfiltration and increase capillary permeability leads to proteinuria. Proteinuria is associated with tubulointerstitial damage by collecting in the interstitial space and triggering proteins and other mediators and cells, such as macrophages, that stimulate inflammation and progressive fibrosis. Proteinuria serves as a marker of the severity of glomerulopathy, is associated with progression of renal injury through multiple pathways, including induction of tubular chemokine expression and complement activation that leads to inflammatory cell infiltration (Kitai et al., 2015).Angiotensin II encourages glomerular hypertension and increase in filtration caused by efferent arteriolar vasoconstriction and can cause circulatory hypertension (McCance & Huether, 2018).

• List at least three other body systems that are impacted by chronic kidney disease and why.

Three other body systems that can be affected severely by CKD is cardiopulmonary, hematologic and immunologic (McCance & Huether, 2018). Cardiopulmonary may be triggered by the direct consequence of circulating uremic toxins or may be indirectly caused by fluid overload, anemia, immune suppression, extraosseous calcification, malnutrition, electrolyte disorders, and/or acid-base imbalances, which are common issues in hemodialysis patients, also elevated blood pressures exist with CKD (Kabil, Basiony, Nour & Makboul, 2019). Hematologic system is affected by the reduced erythropoietin secretion and reduced red cell production; uremic toxins shorten red blood cell survival and alter platelet function. Immunologic system is also affected by CKD by suppressing cell-mediated immunity; reduction in number and function of lymphocytes, diminished phagocytosis, treatment for all body systems as mentioned is dialysis (McCance & Huether, 2018, p. 1269).

Reference

Kabil, A. E., Basiony, F. S., Nour, M. O., & Makboul, K. S. (2019). Prevalence of Pulmonary

Disorders in Patients with End Stage Renal Disease on Hemodialysis. Egyptian Journal of Hospital Medicine, 76(1), 3232–3236.

Kitai, Y., Doi, Y., Osaki, K., Sugioka, S., Koshikawa, M., & Sugawara, A. (2015). Nephrotic

range proteinuria as a strong risk factor for rapid renal function decline during pre-dialysis phase in type 2 diabetic patients with severely impaired renal function. Clinical and Experimental Nephrology, 19(6), 1037-1043. doi:10.1007/s10157-015-1094-2

Lowth, D. M. (2016). Chronic kidney disease. Practice Nurse, 46(8), 28–32.

McCance K., L., & Huether, S., E. (2018). Pathophysiology: The biologic basis for disease in adults and children (8th ed.) St Louis, MO: Mosby Inc; ISBN-13: 978-0323583473

Question #2

Lindsay Jakovac posted

 

A 51-year-old female presented to the emergency department with complaints of a headache, intermittent chest pain, blurry vision, elevated blood pressure, edema up to her mid-thighs, and episodic abdominal pain with nausea. She has a history of Type I DM and impaired renal function that has progressed to a chronic stage. She has admitted to not taking her blood pressure medication, which puts into question her medication compliance in general. The patient is being admitted to the hospital for hemodialysis and for blood pressure management.

Within the kidney’s, “the filtration rate of the plasma per unit of time is known as the glomerular filtration rate (GFR), which is directly related to the perfusion pressure in the glomerular capillaries” (McCance & Huether, 2018, p. 1234). Renal blood flow is directly related to the GFR, and the GFR is the best way to estimate how the kidneys are functioning (McCance & Huether, 2018). Chronic kidney disease is measured in stages, and can be measured by reviewing the GFR. With kidney disease; at stage I, the GFR is greater or equal to 90, stage II ranges from 60-89, stage III ranges from 30-59, stage IV ranges from 15-29, and end-stage kidney disease (stage V) is less than 15 (McCance & Huether, 2018). Unfortunately, when a person progresses to stage V, they will need to be on dialysis, and eventually they will need a kidney transplant (“Calculate a GFR Value”, 2020).

Several factors can contribute to the progression of kidney disease. Angiotensin II and the development of proteinuria are two factors that affect the disease progression. Long, Price, Herrera-Acosta, & Johnson (2004) discussed how angiotensin II and proteinuria can contribute to renal injury. It was noted that “angiotensin II may cause pressure-induced renal injury via its ability to induce systemic and glomerular hypertension or cause ischemia-induced renal injury secondary to intrarenal vasoconstriction and decreased renal blood flow” (p. 722). Long et al., (2004) also noted that “angiotensin may also cause tubular injury secondary to angiotensin-induced proteinuria” (p. 722).

While the function of the kidney’s decline, several other systems in the body can become affected. O’Lone et al., (2020) concluded that people with chronic kidney disease have an increased prevalence of ischemic heart disease. The vasculature system can also be affected, and chronic kidney disease can increase the risk for blood clots (“Blood clots and chronic kidney disease”, 2020). Karasavvidou (2018) also discussed the incidence of cognitive deficits related to chronic kidney disease. These are just a few of the examples of how kidney disease can affect the body, but ultimately, all body systems will be affected and decline. The patient’s situation is dire, and she should prepare herself for a long road ahead. She will need a nephrologist, a comprehensive plan, and a support system. She will also need support with her diet, medications, and long-term prognosis. Kidney disease is complicated, but it can be managed if the patient is committed to doing so.

References

Blood clots and chronic kidney disease. (2020). Retrieved from https://www.kidney.org/sites/default/files/Blood_C…

Calculate a GFR Value. (2020). Retrieved from https://www.davita.com/tools/gfr-calculator.

Karasavvidou, D., Boutouyrie, P., Kalaitzidis, R., Kettab, H., Pappas, K., Stagikas, D., Antonakis, N., Tsalikakis, D., Elisaf, M., & Laurent, S. (2018). Arterial damage and cognitive decline in chronic kidney disease patients. Journal of Clinical Hypertension, 20(9), 1276-1284.

Long, D. A., Price, K. L., Herrera-Acosta, J., & Johnson, R. J. (2004). How does angiotensin II cause renal injury? Hypertension, 43(4), 722–723.

McCance K., L., & Huether, S., E. (2018). Pathophysiology: The biologic basis for disease in adults and children (8th ed.). St Louis, MO: Mosby Inc.

O’Lone, E., Kelly, P. J., Masson, P., Kotwal, S., Gallagher, M., Cass, A., Craig, J. C., & Webster, A. C. (2020). Incidence of ischaemic heart disease in men and women with end-stage kidney disease: A cohort study. Heart, Lung and Circulation. 1443-9506, (20), 1-10.

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Late Policy

The university’s policy on late assignments is 10% penalty PER DAY LATE. This also applies to late DQ replies.

Please communicate with me if you anticipate having to submit an assignment late. I am happy to be flexible, with advance notice. We may be able to work out an extension based on extenuating circumstances.

If you do not communicate with me before submitting an assignment late, the GCU late policy will be in effect.

I do not accept assignments that are two or more weeks late unless we have worked out an extension.

As per policy, no assignments are accepted after the last day of class. Any assignment submitted after midnight on the last day of class will not be accepted for grading.

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Communication

Communication is so very important. There are multiple ways to communicate with me:

Questions to Instructor Forum: This is a great place to ask course content or assignment questions. If you have a question, there is a good chance one of your peers does as well. This is a public forum for the class.

Individual Forum: This is a private forum to ask me questions or send me messages. This will be checked at least once every 24 hours.

Important information for writing discussion questions and participation

Welcome to class

Hello class and welcome to the class and I will be your instructor for this course. This is a -week course and requires a lot of time commitment, organization, and a high level of dedication. Please use the class syllabus to guide you through all the assignments required for the course. I have also attached the classroom policies to this announcement to know your expectations for this course. Please review this document carefully and ask me any questions if you do. You could email me at any time or send me a message via the “message” icon in halo if you need to contact me. I check my email regularly, so you should get a response within 24 hours. If you have not heard from me within 24 hours and need to contact me urgently, please send a follow up text to

I strongly encourage that you do not wait until the very last minute to complete your assignments. Your assignments in weeks 4 and 5 require early planning as you would need to present a teaching plan and interview a community health provider. I advise you look at the requirements for these assignments at the beginning of the course and plan accordingly. I have posted the YouTube link that explains all the class assignments in detail. It is required that you watch this 32-minute video as the assignments from week 3 through 5 require that you follow the instructions to the letter to succeed. Failure to complete these assignments according to instructions might lead to a zero. After watching the video, please schedule a one-on-one with me to discuss your topic for your project by the second week of class. Use this link to schedule a 15-minute session. Please, call me at the time of your appointment on my number. Please note that I will NOT call you.

Please, be advised I do NOT accept any assignments by email. If you are having technical issues with uploading an assignment, contact the technical department and inform me of the issue. If you have any issues that would prevent you from getting your assignments to me by the deadline, please inform me to request a possible extension. Note that working fulltime or overtime is no excuse for late assignments. There is a 5%-point deduction for every day your assignment is late. This only applies to approved extensions. Late assignments will not be accepted.

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Plagiarism is highly prohibited. Please ensure you are citing your sources correctly using APA 7th edition. All assignments including discussion posts should be formatted in APA with the appropriate spacing, font, margin, and indents. Any papers not well formatted would be returned back to you, hence, I advise you review APA formatting style. I have attached a sample paper in APA format and will also post sample discussion responses in subsequent announcements.

Your initial discussion post should be a minimum of 200 words and response posts should be a minimum of 150 words. Be advised that I grade based on quality and not necessarily the number of words you post. A minimum of TWO references should be used for your initial post. For your response post, you do not need references as personal experiences would count as response posts. If you however cite anything from the literature for your response post, it is required that you cite your reference. You should include a minimum of THREE references for papers in this course. Please note that references should be no more than 5 years old except recommended as a resource for the class. Furthermore, for each discussion board question, you need ONE initial substantive response and TWO substantive responses to either your classmates or your instructor for a total of THREE responses. There are TWO discussion questions each week, hence, you need a total minimum of SIX discussion posts for each week. I usually post a discussion question each week. You could also respond to these as it would count towards your required SIX discussion posts for the week.

I understand this is a lot of information to cover in 5 weeks, however, the Bible says in Philippians 4:13 that we can do all things through Christ that strengthens us. Even in times like this, we are encouraged by God’s word that we have that ability in us to succeed with His strength. I pray that each and every one of you receives strength for this course and life generally as we navigate through this pandemic that is shaking our world today. Relax and enjoy the course!

Hi Class,

Please read through the following information on writing a Discussion question response and participation posts.

Contact me if you have any questions.

Important information on Writing a Discussion Question

• Your response needs to be a minimum of 150 words (not including your list of references)
• There needs to be at least TWO references with ONE being a peer reviewed professional journal article.
• Include in-text citations in your response
• Do not include quotes—instead summarize and paraphrase the information
• Follow APA-7th edition
• Points will be deducted if the above is not followed

Participation –replies to your classmates or instructor

• A minimum of 6 responses per week, on at least 3 days of the week.
• Each response needs at least ONE reference with citations—best if it is a peer reviewed journal article
• Each response needs to be at least 75 words in length (does not include your list of references)
• Responses need to be substantive by bringing information to the discussion or further enhance the discussion. Responses of “I agree” or “great post” does not count for the word count.
• Follow APA 7th edition
• Points will be deducted if the above is not followed
• Remember to use and follow APA-7th edition for all weekly assignments, discussion questions, and participation points.
• Here are some helpful links
• Student paper example
• Citing Sources
• The Writing Center is a great resource