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).
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).
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.
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.
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…