Renal medicine Flashcards
What are the 3 types of risk factors for renal disease?
- Predisposing: eg age, ethnicity, family hx, Genetics
- Biomedical: CV disease, UTIs, drug toxicity eg lithium, anti-inflammatories, strep infections, glomerulonephritis
- Behavioural: Diet, inactivity, diabetes, BP, obesity, poor adherence, smoking (vessels supplying nephrons die off)
What do the kidneys do?
- Clean the blood, filter out waste products
- Control BP
- Produce hormones that regulate bones and red blood cell production
- Remove extra fluid and produce urine
- Keep body chemicals in balance
What are the social factors associated with renal disease?
- Job loss
- Financial stressors
- Role function change
- Perceived or real burden on family
- Need for travel
- Need to attend appointments
What are the six biological factors associated with renal disease?
- Reduced life expectancy
- Sexual function
- cognitive impairment
- physical functioning
- fatigue
- sleep
(Appetite, sleep, energy overlap with depressive symptoms)
(Medical condition can cause anxiety symptoms e.g. SOB, potassium too high).
What are the psychological factors associated with renal disease?
Grief, disappointment, shame Loss of independence Depression, anxiety, adjustment disorder Cognitive impairment Body image issues Sleep problems Illness beliefs e.g. cause Negative beliefs about adherence and dialysis 3 stages of adjustment to dialysis: initiation, acceptance, grappling
What are the two negative adherence beliefs?
- dietary restrictions as boring with limited understanding of mechanisms and effects. Frame as outcomes e.g. ‘If you drink less fluids you can run around after your grandsons”
- few immediate benefits, long term benefits
- Patients see themselves as ‘getting around the rules’
What are three negative dialysis-related beliefs?
- Dialysis as an inconvenience ‘It takes over my whole life’
- Dialysis as protection from in inadherence
- Dialysis as causing fatigue, dizziness, impacting on sleep
What are the three stages to adjustment to dialysis?
Initiation - fear and confusion leading to depression, anxiety about responding to treatment, denial, thoughts of death, hatred for treating team, non adherence
Appreciation - Perceived improvement in health and functioning, adherence improves
Grappling - a focus on negative aspects of treatment and stressors e.g. cramps, nausea, fatigue, length and frequency of treatment. “This is endless”, “no end to it”, hard to find balance
Not a linear cycle
What are the issues associated with adjustments to transplant?
Pre-transplant
- Ax leads to Inhibited self-advocacy, power differential
- Anxiety and depression increase
- Fear of procedure, infection, organ rejection, medication side effects
Post-transplant
- Initial sense of relief and well being
- Medicalisation, fear, gratitude, coping, self-care preoccupation to maintain kidney health.
- People over-estimate positive impact of transplant and recall pre-transplant quality of life as poor
- Unrealistic expectations about changes in life that do not occur
What precipitates ceasing dialysis?
Nausea Pain Chronic co-morbidities New medical complications Death of spouse Depression Women more likely to cease
What are the issues associated with ceasing dialysis?
Are they withdrawing from tx or attempting suicide?
Ambivalence about treatment.
What are some cognitions associated with inadherence?
I have nothing left, not even food HP control me I don't feel different when I eat what I shouldn't No one can live on one L per day It's unbearable, I can't stand it Mr X puts on more than me What can it hurt if I am a bit over?
