Type: Exploratory
Pages: 5 | Words: 1372
Reading Time: 6 Minutes

The violations of the functions of kidneys are often met at the patients with cardiovascular diseases, arterial hypertension, and especially in the combination with diabetes, heart failure, etc. The involvement of kidneys into many diseases makes a necessary development of the unified approaches to the treatment of the patients with chronic renal failure (CRF).

Chronic renal failure is a syndrome caused by the irreversible decrease in the function of kidneys owing to a considerable (not less than by 30 %) reduction of the weight of active operating nephrons. This reduction is shown by the shifts of the parameters of a homeostasis regulated by kidneys with the accompanying violations of metabolism and the pathological development of the organism’s bodies and systems.

Approximately 40 million Americans have chronic diseases of kidneys. Afro-Americans and Spanish-speaking Americans have a risk of a fatal outcome twice and thrice higher than the whites of the European origin.

“African Americans are disproportionally affected by disability and chronic illness when compared to Whites and other ethnic minority groups. Approximately one out of every seven African Americans has an impairment that affects functioning in activities of daily living. This means in reality that almost every African American is touched by disability and chronic illness through direct experience or by the disability and chronic illness of a family member. Moreover, each of us will almost certainly have a disability or chronic illness in our lifetime if we live long enough”.

The group of the professors of the US National Health Care Institute discovered new important genetical data, which explains high prevalence rates of renal failure among people of the African origin. The American researchers discovered the gene, called MYH9, on the chromosome 22. It had the traces of mutations, which explained high prevailance rates of kidney diseases among the Afro-Americans (1.010 per a million, in comparison with 520 per a million among the Latin Americans and 279 per a million among the white Europeans).

They also found out that the Spanish-speaking Americans, who have the mixed ancestors — the Africans, the Europeans and the American Indians, are also predisposed to renal failure; however, they are not as vulnerable as the Afro-Americans, especially those from them, whose ancestors are the natives of the Central Africa. About 30 % of a genetic family tree of Spanish-speaking Americans can be included into the African genetic component.

There are also researches directed at the determination of the genes which contribute to more serious complications of the diseases of kidneys as lupus-nephrite and chronic renal failure. The scientists have specified the gene associated with an increase of a risk of kidneys affection at the Americans of the African origin. The changes in this gene affect the ability of the immune system to remove potentially harmful immune complexes from an organism.

“African – American women are fighting an uphill battle against renal failure. They are two to three times more likely to be afflicted, are diagnosed at an earlier age, often suffer kidney damage and die more often from the chronic inflammatory autoimmune disease. Lupus, which usually develops between ages 15 to 44, inexplicably forces the body’s immune system to attack cells and tissues such as the kidneys and lungs. One in 250 Black women suffers from lupus, compared to one in 400 White women. It gets worse. Women of all ages are 10 to 15 times more likely than men to get lupus. Death rates are five times higher in women than men and Blacks die three times more often from systemic lupus, according to the Centers for Disease Control and Prevention (CDC). Systemic lupus, the most common and serious form, affects any system or organ including the lungs, kidneys, central nervous system and heart”.

The treatment tactics of kidney diseases is strictly individual and can change in a due course of the disease. The diagnostics and treatment are the combined efforts of a patient and doctors, experts of various specialties.

The appearance of the new directions and efficiency of renal failure treatment give a bigger choice for doctors in the approach to disease treatment. It is very important for the patient to work in a close contact to the doctor and to take an active part in treatment. Having diagnosed renal failure once, a doctor plans treatment, being based on a sex, age of the patient, the patient’s state of health at the moment of a medical check-up, the beginning of disease, clinical symptoms and living conditions.

The development of a treatment plan has some goals: to prevent exacerbation, to treat it when it occurs, and to reduce aftereffects to the minimum. A doctor and a patient should regularly estimate a treatment plan in order to be convinced that it is the most effective one. One of the most important treatment methods includes vegetarianism.

At present, vegetarianism gains the increasing popularity in many countries and among different categories and segments of the population. Generally, vegetarianism can be characterized as a power supply system and a way of life, at which the person meaningly refuses the products of an animal origin in favor of the products of a vegetative origin. The philosophy of vegetarianism becomes more and more popular direction in nutrition. The real vegetarians use only vegetative food, allowing a thermal processing for it. The vegetarian diet is offered as a diet number one at chronic renal failure and other kidney diseases.

While treatment and nursing process of the kidney diseases among the African Americans, the Roy’s Adaptation Model can be applied.

According to this concept, there is a condition of a relative balance both for the physiological and psychological systems which the person can achieve. This balance is unique for each person. The Roy’s Adaptation Model distinguishes three factors, influencing the level of adaptation, which are called irritants:

1) focal – is in the environment of a person;

2) situational – arises while rendering the nursing help and influences a focal irritant;

3) residual — follows from the experiences and beliefs.

In combination with focal and situational irritants, the residual one influences the adaptation level.

Thus, there are four ways of adaptation influencing behavior: physiological system, I-concept, role function, and interdependence.

The physiological system includes the reactions of the person to temperature, humidity, atmospheric pressure, food, liquid, oxygen, carbon dioxide and other sensor irritants. The ability to cope with new, unusual physiological irritants is caused not only by them, but also depends on the possibilities of the physiological system of a specific person’s adaptation.

“I-concept” is the desire of a person to understand oneself: both spiritually, and corporally. This system of adaptation also has borders, within which people can cope with the psychological and corporal changes. This system is very important when a person has chronic diseases, like a chronic renal failure.

Role function is the system, which presupposes the change of the role of a person caused by the circumstances (for example, a socially active person is in a hospital and has to adapt to the passive role of a patient). A person can be beyond the frameworks of own adaptational possibilities.

Interdependancy is the system, which presupposes the desire of people to achieve the state of the relative balance in mutual relations, like “mother-son”, “wife-husband”, or “nurse – patient”. Familiarity, neglect, pressure are inadmissible at the communication of a nurse with a patient. After all, a patient is in complete or partial dependence on medical workers. It is necessary to remember a threshold of adaptation and not to reduce it by the wrong actions. The nursing personnel should consider the limitation of the adaptation possibilities in the situations when a patient tests the pressure, contempt, loneliness, rejection, familiarity, etc.

The main task of a nurse is the rendering of a help to a patient, especially in the critical periods of life. A medical nurse should promote the adaptation of a patient during his illness and healthy periods.

Different methods of stimulation and support of a patient are applied. A nursing process is aimed at the irritants, which are beyond a patient’s adaptation level. Estimating the quality of a nursing care, a nurse and a patient pay attention to the positive changes in the system of adaptation. The best ways of intervention is unobtrusive conversations with a patient during the nursing care and manipulations. A nurse should direct a patient’s efforts on the spreading of the adaptational limits.

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