...The economics of end-stage renal disease Introduction According to the Centers for Disease Control and Prevention (CDC) 2010, 10% of adults in the United States have chronic kidney disease (CKD). That is estimated at about 20 million people. People with CKD may not feel any symptoms in the early stages, so treatment most likely has not been started. When a person often finds out they are in need of treatment, they may already be in kidney failure or end stage renal disease (ESRD). This paper will discuss the reimbursement mechanisms presented in the Sullivan article, the economics of providing ESRD treatment from the organization's point of view, patients options and potential trade-offs related to cost, quality, and access to treatment, and the ethical implications of treatment options based on cost evaluation. Reimbursement Mechanisms The major reimbursement mechanism presented in article End Stage Renal Disease Economics and the Balance of Treatment Modalities is Medicare. The system in place at this time is the fee for service with additional charges for medication and medical testing (Sullivan, 2010). The current reimbursement structure is based on a three times a week structure, because hemodialysis (HD) is the primary treatment for ESRD (Sullivan, 2010). According to Sullivan (2010) "The most ideal treatment for patients with ESRD is transplantation" (p.45). The reimbursement for peritoneal dialysis (PD) is the same as that of HD. With the passing of The Medicare...
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...Hemodialysis and Its Impact to end Stage Renal Disease Patients Student’s Name University Contents 1.0 Background to the Study.........................................................................................3 2.0 Introduction.............................................................................................................3 3.0 Problem Statement..................................................................................................4 4.0 Data Collection........................................................................................................4 5.0 Data Management and Analysis..............................................................................5 6.0 The Protection of Human Rights.............................................................................6 7.0 Interpretation of Findings........................................................................................7 8.0 Conclusion...............................................................................................................7 References.....................................................................................................................8 Hemodialysis and Its Impact to end Stage Renal Disease Patients 1.0 Background to the Study The final stage of chronic kidney diseases is when the kidneys can longer support their functions; this is the end stage where organs are pronounced to have failed completely (Esra, 2013)...
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...The urinary system is another one of the major organ systems that is essential to life. It eliminates nitrogenous wastes from the body and regulates water, electrolytes, and acid-base balance of the blood (pg. 7 textbook). However, such diseases can affect people both physiologically and psychologically. End-stage renal disease (ESRD) is known to have a poorer result related to the person’s health-related quality of life (HRQOL) and also have depression (Park). According to the author of this article, Ji In Park states that these issues should be noted as “physical problems” since they are “related to morbidity and mortality rates.” According to Park, a hypothesis was made about whether planned dialysis makes a difference with the quality...
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...Week 13: Symptoms Associated with Renal and Hepatic Disease 1 Symptoms Associated with Renal and Hepatic Disease Case Study November 23, 2013 Week 13: Symptoms Associated with Renal and Hepatic Disease 2 Renal Case Study Introduction Glenda is a 41 year old woman with end stage renal disease related to polycystic kidney disease. She has been on dialysis for ten years while waiting for a donor. She has recently made the choice to stop her dialysis sessions and her medications. She acknowledges this will mean the end of her life, but she has come to feel that she has no quality. She has come to discuss what you can do for her current symptoms and what death might look like. Glenda tells you she is chronically fatigued, has diminished appetite and is always constipated. She reports getting a little foggy before her dialysis and sometimes has neuropathy in her fingers and feet. She goes crazy from the uremia. She is currently on an ACE inhibitor to control her blood pressure, calcium carbonate PO TID to bind phosphate, docusate 100 mg TID for constipation. Medication and Dosing Considerations Since Glenda has chosen to stop her dialysis treatments as well as her medications, I would first review the medical treatments that Glenda is currently receiving and discontinue ...
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...Abstract: Renal failure can take its toll on those affected patient and family. At the end of 2009, there were 572,569 U.S. resident under treat for End-stage Renal Disease (ESRD). Among the U.S resident with ESRD, there were 150.5 deaths per 1,000 patient totaling 88,620 deaths in all patients undergoing ESRD treatment. With so many experiencing the disease, understanding how it occurs and progresses might prove useful. Table of Contents Introduction…………………………………………..…………………………………..4 Mechanisms of Fluid Regulation………………………………………..7 Discussion……………………………………………………………………………….8 Etiology/Cause……………………………………….………….............8 Clinical Manifestations…………………………………………………11 Labs and Diagnostic Tests……………….……………………………..11 Treatment……………………………………………………………………………......13 Pharmacological…………………………………………………..……15 Nutritional………………………………………………..…………….15 Dialysis…………………………………………………………………16 Introduction The kidneys are bean shaped organs that are approximately 12cm long, 6cm wide and 2.5 cm thick. They are highly vascular, receiving 25% of cardiac output. The kidneys efficiently separate the excess of fluids, electrolytes, and metabolic by-products to produce urine. The kidneys’ location is described as retroperitoneal which means they are located outside and posterior to the abdominal cavity but lateral and anterior to the lumbar spine. Both kidneys are protected by the posterior rib cage; with the right kidney slightly lower then the left because of liver...
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...assistance of a walker. Because of her obesity, Ms. C has several skin folds throughout her body, which make a great medium for fungal infections. The area underneath her skin folds is red and irritated. Ms. C has had oliguria for the past several days and is outputting very little to no urine. A foley catheter has been placed in order to remove any urinary retention. However, very minimal urine seems to be coming out of foley. The doctors have requested labs to be drawn on a regular basis to check her kidney function and to also monitor her electrolytes. Her admitting diagnosis is Acute Renal Failure. Past Medical History: o Essential Hypertension o Hyperlipidemia o Diabetes Mellitus Type 2 o Stage 3 Diabetic Chronic Kidney Disease o Severe Obesity Present Medical History: o Severe abdominal pain o Dehydration o Oliguria o Uncontrolled Diabetes o Chronic Kidney Disease o Hypertension o Obesity Active Orders: o Foley Catheter o Oxygen 2 L NC o Blood Sugar Monitoring AC and HS o Insulin Regular o Insulin NPH 10 units in AM o Insulin NPH 5 units before bed time o Flucanozole 100 mg IV o D5W 1000 mL with Sodium Bicarb 100 mEq IV solution running at 75 ml/hr o Albuterol 2.5 mg/0.5 mL Nebulizer 2.5 mg o Morphine Inj Syg 2mg PRN Q4H o Morphine Inj Syg 4 mg PRN Q4H o Lotrimin Cream o Ondansetron inj 4mg o Levothyroxine tab 175 mcg o Acetaminophen 650 mg o D50W Inj Syg o Glucagon Inj 1 mg o QVAR 80 o Famotidine 20 mg o Albuterol o Lasix...
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...Test 1 Review 1. The atmosphere one a newly discovered planet has the following mixture of gases. 37 % O2 , 20 % CO2, 15 % H2 10% Ar, 18% N2 Given a Patm of 450 mmHg (assume 0% humidity) what is the partial pressure of O2 and Co2. 2. Marco tries to hide at the bottom of a swimming pool by breathing in and out through a 6 ft garden hose. What happens to following parameters? Ignore chemoreceptors compensation and be sure to provide a brief rationale for the changes you identify. Systemic arterial PO2 Systemic arterial PCO2 [HCO3-] plasma Plasma pH Total pulmonary ventilation % saturation of hemoglobin 3. An individual has the following measured respiratory elements. All units has to be in L and min VT= 200 ml/breath IRV =3 L ERV= 2 L Anatomic dead space = 150 ml Residual volume= 1 L Respiration rate = 5 breaths/ 7 seconds What is pulmonary ventilation? What is alveolar ventilation? What is her vital capacity? What is her inspiratory capacity? What is her expiratory capacity? What is her total lung volume? What is the function of the conduction portion of the respiratory tract? Describe the anatomical structures that accomplish this. What is the function of the respiratory portion? Describe the anatomical structures that accomplish this. Draw the HB saturation curve. Be sure to identify the X and Y axis and labels where the systemic and pulmonary blood sits and where the normal systemic venous blood...
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...Congestive heart failure: a fluid overload condition associated with heart failure. -inadequate tissue perfusion. -result when the heart cannot generate a CO sufficient to meet the body's demands. -myocardial disease in which there is a problem with the contraction of the heart, systolic or filling. -LF. Sided HF: pulmonary congestion occurs when the LF ventricle cannot effectively pump blood out of the ventricle into the aorta and the systemic system. Pulmonary venous blood volume and pressure increases, forcing fluid from the pulmonary caps into the pulmonary tissues and alveoli, causing pulmonary interstitial edema and impaired gas exchange. Dyspnea, cough, crackles, low O2, extra heart sound S3, may need pillows (difficulties breathing while lying down). -RT. sided HF: congestion of the peripheral tissues and the viscera predominates. Right side cannot eject blood and cannot accommodate all the blood that normally returns to it. Edema of lower extremities, hepatomegaly (venous engorgement of the liver) ascites (gastro distress), anorexia, weakness. Th increased pressure interferes with the livers function, increased pressure in the portal veins-forcing fluid into the abdominal cavity. Hepatomegaly may also cause pressure on the diaphragm-resp distress. Medical Management -if possible, eliminate or reduce contributing factors. Reduce the workload of the heart - preload, after load. -prevent exacerbation of HF. -ACE inhibitors: promote diuresis by decreasing...
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...COURSE INFORMATION | IG NUMBER | | COURSE | NUTRITION THERAPY II | TOPIC: | NUTRITIONAL MANAGEMENT OF CARDIO-VASCULAR DISEASES | TERM | Prelim | WEEK NO | 2 | SESSION | 2 | DURATION | 5 hrs. | INTENDED LEARNINGOUTCOMES | COURSE OUTCOMES | 1. Explain the pathophysiology, the effects of the disease on patient’s nutritional status and the and the required dietary management. 2. Discuss the principles involved in the dietary management of a patient’s disease. 3. Design a nutritional therapy program for patient with cardio-vascular disease. | UNIT OUTCOME/S | 1. Discussion on cardio-vascular diseases and their nutritional therapy management. 2. Develop nutritional therapy program for a patient with cardio-vascular disease. | MATERIALS AND RESOURCES NEEDED | MATERIALS | * Overhead Projector/Laptop and LCD, Laboratory Manual in Nutrition Therapy | TEXTBOOK | Ruiz, Adela J. (2010). Basic Diet Therapy for Filipinos | SUBTOPICS | * TEACHING ACTIVITY | * LEARNING ACTIVITY | * TIME | * OLFU VMV * PEO, CEO * Course Outline | Interactive Lecture | Interactive Discussion | 1.5 hrs. | * OLFU VMV * PEO, CEO * Course Outline | Problem-solving: Organization of laboratory activities | Laboratory Activity: Class organization and Kitchen brigade system | 2.5 hrs. | SUBTOPICS | * ASSESSMENT TASKS | * ASSESSMENT TOOLS | * TIME | * OLFU VMV * PEO, CEO * Course Outline | * Objective test | * *...
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...1.Describe process of referral and management of renal dialysis patients. Nephrology referral is especially indicated when there is a rapid decline in kidney function, and elevated albumin and creatinine in stage four of chronic kidney disease. Also, when the kidney function is severely reduced. 2. Discuss the nursing role in care and management of clients in renal dialysis center. The nursing role in nursing care and management of clients in renal dialysis center: assess vital signs including blood pressure, respirations, apical pulse, and lung sounds. Record weight before and after treatment, assess vascular access site for a palpable pulsation or vibration and an audible bruit. Also, alert all personal to avoid using the extremity with...
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...hypothalamic heat-regulating center to cause vasodilation and sweating, which helps dissipate heat.Carvedilol causes vasodilation by blocking the activity of α-blockers, mainly at alpha-1 receptors. It exerts antihypertensive effect partly by reducing total peripheral resistance and vasodilation. It is used in patients with renal impairment, NIDDM or IDDM.Promotes incorporation of water into stool, resulting in softer fecal mass, may also promote electrolyte and water secretion into the colon. It increases the amount of water and fat absorbed by the feces, softening the stool and making it easier to pass.Inhibits the reabsorption of sodium and chloride from the loop of Henle and distal renal tubule. Increases renal excretion of water, sodium, chloride, magnesium, potassium, and calcium. | Contraindicated with allergy to acetaminophen. Use cautiously with impaired hepatic function, chronic alcoholism, pregnancy, lactation. Adverse effects CNS: Headache CV: Chest pain, dyspnea, myocardial damage when doses of 5–8 g/day are ingested daily for several weeks or when doses of 4 g/day are ingested for 1 yr GI: Hepatic toxicity and failure, jaundice GU: Acute kidney failure, renal tubular necrosis Contraindications Hypersensitivity; severe chronic heart failure, bronchial asthma or related bronchospastic conditions; severe hepatic impairment. Adverse effects Bradycardia, AV...
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...performinghazardous activities until adverseCNS effects of drug are known. | SIDE EFFECTS | Adverse ReactionsCNS: Abnormal thinking, amnesia, anxiety,asthenia, chills, depression, dizziness,headache, insomnia, paresthesia, somnolence,suicidal ideation, syncope, tremorCV: Chest pain, hypertension, palpitations,peripheral edema, vasodilationEENT: Abnormal vision, dry mouth,pharyngitis, rhinitis, taste perversionGI: Abdominal pain, anorexia, constipation,diarrhea, flatulence, increased appetite,indigestion, nausea, vomitingGU: Acute renal failure, decreased libido,impotenceHEME: Leukopenia, lymphocytosis, thrombocytopeniaMS: Arthralgia, back pain, myalgiaRESP: Bronchitis, cough, dyspneaSKIN: Diaphoresis, pruritus, rash | INDICATION | To maintain abstinence from alcohol foralcohol-dependent patients who areabstinent at the start of treatment CONTRAINDICATIONHypersensitivity to acamprosate or its com- ponents, severe hepatic (Child-Pugh classC) or renal impairment | ACTION | AntialcoholicChronic alcoholism may alter the balancebetween excitation and inhibition in neuronsin the brain; acamprosate restores it.When the neurotransmitter gammaaminobutyricacid (GABA) binds to itsreceptors in the CNS, it opens the chlo chlorideion channel and releases chloride(Cl-) into the cell (below left), therebyreducing neuronal...
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...Diet is the primary cause of Cd exposure and poisoning in non smoking humans. Oral ingestion through Certain plants like rice, wheat and other cereal grains which take cadmium in more readily than they do other heavy metals for example lead and mercury (Satarug 2003). In a study carried out by (Jarup 2001) in Sweden which has high Cd exposure levels; it was found that people with a rich fibre and rice diet had higher levels of blood cadmium concentration. DETECTION OF CADMIUM Once cadmium is absorbed it can be eliminated from the body via urine however, the excretion rate is very low as a result of cadmium being bound tightly to metallothionein (a cysteine-rich, metal binding protein), which is virtually always reabsorbed into the renal tubules. Although Cd excretion through urine is slow, it is the main source of Cd detection and elimination. As a result of Cd...
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...Revista de Psicología ISSN: 0254-9247 revpsicologia@pucp.edu.pe Pontificia Universidad Católica del Perú Perú Cassaretto, Mónica; Paredes, Rosario Afrontamiento a la enfermedad crónica: estudio en pacientes con insuficiencia renal crónica terminal Revista de Psicología, vol. XXIV, núm. 1, 2006, pp. 109-140 Pontificia Universidad Católica del Perú Lima, Perú Disponible en: http://www.redalyc.org/articulo.oa?id=337829536005 Cómo citar el artículo Número completo Más información del artículo Página de la revista en redalyc.org Sistema de Información Científica Red de Revistas Científicas de América Latina, el Caribe, España y Portugal Proyecto académico sin fines de lucro, desarrollado bajo la iniciativa de acceso abierto Afrontamiento a la enfermedad crónica Revista de Psicología de la PUCP. Vol. XXIV, 1, 2006 Afrontamiento a la enfermedad crónica: estudio en pacientes con insuficiencia renal crónica terminal Mónica Cassaretto1 y Rosario Paredes2 Pontificia Universidad Católica del Perú Esta investigación identifica y describe los principales estilos y estrategias de afrontamiento utilizados por un grupo de pacientes diagnosticados con insuficiencia renal crónica terminal. Participaron 40 pacientes mayores de 20 años, aceptados al programa de transplante de riñón del hospital de seguro social. Se utilizaron una encuesta personal y el Inventario sobre Estilos y Estrategias de Afrontamiento (Carver, Scheier & Weintraub, 1989). Los hallazgos...
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...Introduction to Clinical Practice 543-104 Medication Sheet |Medication |furosemide | |Trade and generic |Lasix | |Dose Frequency |Oral solution, tablets | |& Safe Dose Range |Adults. | | |20 to 80 mg as a single dose, increased by 20 to 40 mg every 6 to 8 hr until desired response | | |occurs. Maximum: 600 mg daily. | | |Children. | | |2 mg/kg as a single dose, increased by 1 to 2 mg/kg every 6 to 8 hr until desired response | | |occurs. Maximum: 6 mg/kg/dose. | | |I.V. infusion, I.V. or I.M. injection | | |Adults. ...
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