Author: Claire

Claire Galea is the Owner and Director of Mariposa Holistic Care, through which she provides holistic care services tailored to her clients' personal needs. She is also in her final year following a Degree in Nursing at the Faculty of Health Sciences, University of Malta. Claire is keen about public education on health-related subjects as well as holistic patient-centered care. She is also passionate about spreading positivity and awareness on various subjects through her blog Student Nurse Life.

Common Kidney Diseases

In normal renal physiology, the kidneys remove waste and excess water from the body and release hormones such as renin (which regulates blood pressure), erythropoietin (which stimulates red blood cell production), and vitamin D (which promotes normal bone structure). However, when kidney disease is involved, renal function becomes compromised and waste products and toxic materials start to accumulate rather than get excreted. This may cause permanent irreversible damage to the body’s cells, tissues, and organs. In this blogpost we are going to go through the most common kidney diseases.

Common Kidney Diseases

Polycystic Kidney Disease
Hypertensive Nephrosclerosis
Glomerulonephritis / Glomeruloscleroisis
Urinary Tract Infections
Kidney Stones
Diabetic Kidney Disease
Analgesic Nephropathy

Polycystic Kidney Disease

One of the most common kidney diseases is polycystic kidney disease, which is acquired genetically. In polycystic kidney disease, fluid-filled cysts develop within the kidneys. These cysts replace normal kidney tissue, leading to end-stage renal disease.

Polycystic Kidney Disease can be either DOMINANT or RECESSIVE. In the Dominant form, a parent who has the genetic disease passes it to the child (50% chance).

Signs & Symptoms

dull pain at the side of the abdomen and the back
upper abdominal discomfort
frequent UTIs
haematuria (blood in the urine)
hypertension

Treatment

control hypertension
treat UTIs with antibiotics
maintain kidney health if diagnosed with chronic kidney disease
provide dialysis or opt for kidney transplantation if diagnosed with end-stage renal disease
administer analgesics for pain relief or opt for the shrinking or resection of the cysts through surgery

Hypertensive Nephrosclerosis

Hypertensive Nephrosclerosis is progressive kidney damage resulting from untreated longstanding hypertension due to blood vessel thickening.

Signs & Symptoms

headaches
neck discomfort
nausea
vomiting
easily tired
proteinuria (protein in the urine)

Treatment

encourage regular exercise
encourage decrease in dietary salt (maximum 2g daily)
administer hypertensives to control hypertension

Glomerulonephritis & Glomerulosclerosis

Glomerulonephritis is the inflammation of the glomeruli (where filtration takes place) in the kidneys. The onset of glomerulonephritis can be either chronic or acute. It can be caused by IgA nephropathy (inflammation in the kidney tissue), Streptococcus bacteria, and autoimmune disease. Similarly, Glomerulosclerosis is the scarring of the glomeruli in the kidneys.

Signs & Symptoms

swelling in the leg/s
haematuria
proteinuria (produces frothy urine)
dark or pink-coloured urine
additional signs in relation to comorbidities such as diabetes or autoimmune disease eg. weight loss, skin rash, arthritis…

Treatment

control hypertension
suggest dietary modifications
promote a better lifestyle
administer medication for the reduction of urinary protein
administer medication for inflammation suppression eg. steroids

Urinary Tract Infections (UTI)

Urinary Tract Infections occur when microorganisms attach to the urethra and start multiplying. This is a common occurrence in women. If left untreated, urinary tract infections may result in pyelonephritis – an infection of the kidneys, which can cause permanent kidney damage.

Conditions such as diabetes, use of a urinary catheter, abnormalities of the urinary tract, pregnancy, or obstructed urine flow (due to kidney stones or an enlarged prostate) increase the risk of acquiring a urinary tract infection.

Signs & Symptoms

increased frequency of urination
increased urgency to urinate
painful urination
pain in the lower abdomen
hot foul-smelling urine
nausea
vomiting
haematuria
fever

Treatment

encourage increased fluid intake
administer antibiotics to treat infection

Kidney Stones

Kidney stones a.k.a. renal calculi, nephrolithiasis or urolithiasis, are hard deposits of minerals and salts which form within the kidneys. Kidney stones are more common in men between 20-40 years of age.

Signs & Symptoms

extreme localised pain
painful and/or difficult urination
inability to pass urine (if kidney stone obstructs urine outlet completely due to large size)
haematuria (due to abrasion caused by the traveling kidney stone)

Treatment

encourage increased water intake (most stones may pass through if not too big)
administer pain relief
administer medication to break down large kidney stones
shockwave therapy
surgery (cystoscopy or open surgery)

Diabetic Kidney Disease

One of the most common kidney diseases is Diabetic Kidney Disease. Diabetes is the most common cause of end-stage renal disease. Diabetes (type 1 and type 2) damage the blood vessels in the kidneys. Additionally, hypertension in diabetics increase the risk for diabetic nephropathy. Diabetic Kidney Disease is most commonly found in chronic and poorly controlled diabetics.

Signs & Symptoms

itching
lethargy
nausea
vomiting
weight loss
nocturia (increased need for urination at night)
swelling in the leg/s
proteinuria (produces frothy urine)
hypertension

Treatment

treat urinary tract infections if present (common occurrence in diabetics)
diabetes control
blood pressure control
encourage low protein diet
administer medication to reduce protein excretion

Analgesic Nephropathy

Long-standing analgesic ingestion is a risk factor for chronic kidney disease. Analgesics such as NSAIDs are commonly used by individuals with conditions that require constant need of pain relief, but such medications increase the risk of end-stage renal disease.

Signs & Symptoms

haematuria
proteinuria (produces frothy urine)
lethargy
lack of appetite
nausea
vomiting
swelling of the leg/s

Treatment

reduce as much as possible the use of analgesics
special precaution should be taken by individuals with known kidney disease so as to reduce or possibly eliminate the use of analgesics

Additional Notes…

In patients with kidney disease:

teach patient about the importance of fluid restriction – patient should not drink more than 1.5ltr per day
teach patient about sodium restriction
with regards to nursing documentation, food charting as well as intake & output charting are important

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Eating Disorder Signs, Symptoms & Recommended Treatment

An eating disorder is a psychiatric disorder in which severe disturbances in eating behaviours and related thoughts and emotions are experienced. Most often, signs and symptoms of an eating disorder are first experienced in adolescence or early adulthood, with the onset usually being a stressful life event. Eating disorder types include:

Anorexia Nervosa
Bulimia Nervosa
Binge Eating
Pica
Pervasive Arousal Withdrawal Syndrome (PAWS)

An Eating Disorder is NOT a Lifestyle Choice!

Anorexia Nervosa

An individual with anorexia nervosa aims to lose weight deliberately through restricted dietary choices, excessive exercise, induced vomiting, appetite suppressants, and diuretics.

Anorexia Nervosa symptoms include:

muscle weakness
irregular menstrual cycle
hair thinning
dental problems
impaired functioning of the immune system

Common comorbidities of anorexia nervosa include depression, OCD, social phobia, and PTSD.

Bulimia Nervosa

Bulimia Nervosa features similar psychological features in anorexia nervosa. An individual with this eating disorder experiences excessive worry about ways to control body weight, and so, aims to eat excessive amounts of food, followed by induced vomiting. These bingeing episodes usually happen several times a week.

Individuals with bulimia nervosa may have a history of anorexia nervosa, with the switch to bulimia nervosa frequently resulting from worrying of family members or friends.

NOTE: Body weight of individuals with bulimia nervosa may range from slightly underweight to obese.

Pica

Pica, which is an eating disorder that commonly affects children under the age of 6, is the persistent eating of substance which have no nutritional value such as clay, dirt, and flaking paint. Pica can feature as an individual psychopathological behaviour, or as one of the symptoms of another psychiatric disorder, such as autism.

Common causes of Pica include malnutrition and iron-deficiency anaemia.

Diagnosis requires the eating disorder to be developmentally inappropriate, and to persist for at least a month.

Pervasive Arousal Withdrawal Syndrome PAWS

Pervasive Arousal Withdrawal Syndrome (PAWS) a.k.a. Pervasive Refusal Syndrome is characterised by food and drink refusal with sudden onset following a tough health-related situation such as illness, pain or virus, or a traumatic event. PAWS is in fact commonly experienced by child refugees.

Refusal of food and drink may also be accompanied by social withdrawal, partial or complete lack of self-care, and partial or complete mobilisation refusal.

An individual with Pervasive Arousal Withdrawal Syndrome quite commonly resists any encouraging attempts of interaction or food/drink intake.

Eating Disorder Treatment

Psychopharmacology

Anti-depressants
Anti-psychotics
Mood stabilisers

Psychosocial Interventions

Individual psychotherapy
Group psychotherapy
Family psychotherapy
Medical care
Nutritional Counseling
Cognitive Behavioural Therapy CBT

In Malta, individuals with eating disorders can be referred to Dar Kenn Għal Saħħtek, which offers day services as well as in-patient services.

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Obsessive Compulsive Disorder OCD and Dissociative Disorder DD

Obsessive Compulsive Disorder OCD

Obsessive Compulsive Disorder a.k.a. OCD is a common chronic long-lasting disorder in which an individual experiences uncontrollable repeated obsessions or behaviours. Children and adolescents may experience Obsessive Compulsive Disorder too, with multiple obsessions and compulsions possibly changing content over time.

Common obsessions include excessive fear of dirt, germs or sickness, excessive fear of a loved one being in danger, obsessions related to religion or sex, as well as an uncontrollable need for symmetry and exactness.

Common compulsions include ritualistic handwashing, repetitions, checking, counting, ordering, hoarding, and touching.

Tic Disorder

Tourette Syndrome (TS) is a condition related to the nervous system which causes individuals to experience tics. Tics are sudden, rapid, non-rhythmic twitches and movements (motor tics) or sounds (vocal tics) that affected individuals repeat over and over, with no control whatsoever. Children who are diagnosed with tic disorder can also exhibit associated behavioural difficulties.

Dissociative Disorder DD

Dissociative disorder is a mental disorder involving disconnection and lack of continuity between thoughts, memories, surroundings, actions and identity. Individuals with dissociative disorders experience problems with day-to-day functioning as they tend to escape reality involuntarily. This disorder has been linked with childhood trauma.

Dissociative disorder symptoms may include amnesia, disturbances in sense of self, trance-like states, rapid mood shifts and behaviour, knowledge-memory-skills access fluctuations, hallucinations (auditory and visual), and vivid imaginary friendships (in children and adolescents). Stress tends to exacerbate these symptoms.

Treatment for dissociative disorders includes a combination of psychotherapy and medication. Although difficult to treat, early identification and intervention increases the chance of affected individuals being able to lead healthy and productive lives.

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Anxiety and Depression in Children and Adolescents

Depression in Children

One of the top 5 most common mental health disorders in children is depression. Diagnosing depression in children is quite challenging since they may still experience periods of normal functioning despite their underlying disorder. As for diagnosing depression in adolescents, it becomes difficult to distinguish between the normal teen-related mood changes and those that come with depression. Nevertheless, early diagnosis is important since if depression in children is overlooked, it may persist through adulthood.

Signs and Symptoms of Depression in Children

persistent low mood
persistent sadness
lack of interest in activities they used to enjoy
a lingering feeling of tiredness and exhaustion
lethargy
agitation
sleeping too much or too little
eating too much or too little
feeling numb/emotionless
ongoing guilty feelings
poor memory
poor concentration
lack of self-esteem
lack of self-confidence
self-harming thoughts
suicidal thoughts

Anxiety and Depression in Children

Anxiety Disorders in Children

Separation Anxiety Disorder – child experiences fears related to an attachment figure being harmed or dying

Social Phobia a.k.a. Social Anxiety Disorder – fear of being watched and judged by others

Generalised Anxiety Disorder – worrying on different events or circumstances

Specific Phobia – fear of a particular object or stimulus

Panic Disorder – sudden panic attacks related to somatic and cognitive sensations

Emotional Unstable Personality Disorder EUPD

Emotionally Unstable Personality Disorder a.k.a. Borderline Personality Disorder is the most common type of personality disorder. EUPD causes intense fluctuating emotions that may last for a few hours to several days at a time. Emotions experienced may include impulsivity, risky behaviour, suicidal thoughts, and possibly self-harm.

A diagnosis of Emotionally Unstable Personality Disorder is usually given in adulthood as the related symptoms are associated with a lifelong personality disorder.

Substance Abuse

Substance abuse refers to the use of illegal drugs or prescription drugs or over-the-counter drugs or alcohol for purposes other than those for which they are meant to be used, or in excessive amounts.

Alcohol, marijuana and opiates mimic depression symptoms, causing lack of concentration, lack of motivation, and low energy. On the other hand, Amphetamine and Cocaine mimic mania symptoms. Substance abuse tends to trigger social, physical, emotional, and occupational problems.

Individuals with Bipolar Disorder and Depression have an increased risk of substance abuse.

NOTE: Substance abuse does not rule out a mood disorder.

Self-Harm

Self-harm a.k.a. self-injury is a behavioural act in which an individual intentionally harms him/herself, usually without suicidal intention. Adolescents may seek to self-harm as a way of expressing tension, low self-esteem, physical discomfort, and pain. At times, self-harm is sought as a risk-taking act, rebellion against parents, or as an attention-seeking behaviour. However, self-harm can indicate severe psychiatric disorders such as depression, psychosis and PTSD.

Self-harming behaviour is also associated with children having developmental delays, including Autism Spectrum Disorder, and those who have experienced abuse or abandonment.

Suicide

Suicide is one of the main causes of death in children and adolescents. Severe bullying increases the risk of suicide. Additionally, being diagnosed with depression, ADHD, anxiety disorder, Attention Deficit Disorder (ADD), bipolar disorder, or schizophrenia during childhood also puts the child at a higher risk of suicide.

Reference: https://save.org/about-suicide/

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Conduct Disorder CD and Oppositional Defiant Disorder ODD

Conduct Disorder

Conduct Disorder (CD) is the most common psychiatric disorder in the world. It is characterised by persistent anti-social behaviour where social rules are repeatedly broken and aggressive acts are repeatedly performed with the aim of upsetting others. Many children and adolescents with a Conduct Disorder diagnosis grow up into anti-social adults.

Conduct Disorder Signs & Symptoms

repetitive and persistent violation of societal norms, rules, laws, and basic rights of others
aggression, property destruction, theft, and deceitfulness
behavioural severity that leads to significant impairment in various areas of functioning
prolonged behavioural pattern lasting a year or more (thus, isolated criminal acts do not lead to a Conduct Disorder diagnosis)

Reference: https://www.icd10data.com/ICD10CM/Codes/F01-F99/F90-F98/F91-

Oppositional Defiant Disorder

Oppositional Defiant Disorder (ODD), a disruptive disorder which often accompanies ADHD, features ongoing behavioural patterns that cause significant impairment in a child’s social, academic and occupational life.

Oppositional Defiant Disorder Signs & Symptoms

bad temper
easily annoyed
angry or resentful
spiteful or vindictive
defying rules
refusing to comply with requests
argumentative with adults
deliberately seeks to annoy others
blaming others for own mistakes

Reference: https://icd.who.int/browse10/2019/en#/F91.3

Overview of CD, ODD & More…

Risk Factors for Conduct Disorder & Oppositional Defiant Disorder

anti-social parents
anti-social peers
lack of parental supervision
disruptive family behaviour
child abuse
child neglect
negative parental discipline
cold parental attitude
parental conflict
low family income
low IQ / low academic achievement
impulsiveness
attending high-crime-incidence schools
living in a high-crime-incidence neighbourhood

Treatment for CD & ODD

Psychosocial Interventions

Parental Training
Limit Setting Implementation
Cognitive Behavioural Therapy (CBT)
Family Therapy

Psychopharmacology

Stimulants – help reduce aggression
Anti-Depressants – SSRIs help reduce impulsive and aggressive behaviour
Lithium and Anti-Convulsants – help reduce aggression
Clonidine – help reduce impulsivity and aggression

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Attention Deficit Hyperactivity Disorder ADHD

Attention Deficit Hyperactivity Disorder (ADHD) is one of the most common neuro-developmental disorders related to childhood. Although ADHD is most commonly diagnosed in childhood, it usually lasts well into adulthood. Children diagnosed with ADHD tend to find it hard to pay attention, are prone to controlling impulsive behaviour without any form of reflection, and are usually overactive.

Understanding ADHD – Simulation

Varying Types of Attention Deficit Hyperactivity Disorder

Predominantly Inattentive Presentation – characterised by distractibility, lack of organisational skills, lack of inability to complete tasks, and inability to follow instructions.

Predominantly Hyperactive-Impulsive Presentation – characterised by difficulty in being still, excessive fidgeting and movement, restlessness and impulsivity.

Combined Presentation – characterised by a combination of all symptoms: inattention, hyperactivity and impulsivity.

ADHD Diagnosis

For a child to be diagnosed with ADHD, the following must be evident in multiple settings eg. at home, at school, with friends, with family, even if in varying degrees:

at least 6 months of inattention (distractibility and organisational problems) with or without hyperactivity (lack of behavioural self-control/difficulty remaining still/excessive motor activity) and impulsivity (reacting to surrounding stimuli without thinking/reflecting on possible outcomes)
such behaviour needs to have a direct negative impact on the child’s functionality academically/occupationally or socially
deficit related to inattention, hyperactivity and impulsivity should be over the limit expected per child’s age

Reference: https://www.icd10data.com/ICD10CM/Codes/F01-F99/F90-F98/F90-

Attention Deficit Hyperactivity Disorder Risk Factors

Genetics
Premature birth / low birth weight
Head trauma
In-utero or childhood exposure to environmental toxins
In-utero exposure to alcohol and/or tobacco

ADHD Treatment

Psychosocial Interventions

Behaviour Management training for parents
Behavioural Interventions in the school setting
Organisational Skills Training

Psychopharmacology

Stimulants (fast effect) eg. Ritalin and Concerta
Non-Stimulants (slow-release yet longer effect) eg. Strattera (SNRI), and Clonidine (alpha-adrenergic agonist)

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Autism Spectrum Disorder

Autism Spectrum Disorder (ASD) is a developmental disorder in which both communication and behaviour are affected. Signs and symptoms tend to start showing up during the first two years of life. A child with ASD exhibits issues related to social interaction, communication and play, and interest restrictions.

Autism Spectrum Disorder is considered to be a chronic disability. Through early intervention, symptoms can be improved.

Reference: https://www.nhs.uk/conditions/autism/

Understanding Autism – Simulation

Autism Spectrum Disorder Diagnosis

For an accurate Autism Spectrum Disorder diagnosis, a child’s developmental and behavioural history is required, from which certain criteria can be evident by the age of 3. These include:

inability to initiate and maintain social interaction
inability to initiate and maintain communication
behavioural patterns which are restrictive, repetitive and inflexible
unusual interests or activities which at times may seem excessive
impairment in functional abilities related to self, family, and society, including school/work

Note: Child may still exhibit intellectual functioning and language abilities.

Reference: https://icd.who.int/browse10/2019/en#/F84.0

Autism Spectrum Disorder Risk Factors

Genetic – having a sibling with ASD, or having certain chromosomal conditions such as tuberous sclerosis (genetic disorder which causes benign tumors to develop in various parts of the body) or fragile X syndrome (genetic condition which causes developmental issues such as learning disabilities and cognitive impairment).
Drugs – intake of certain drugs in pregnancy such as valproic acid (Epilim) and thalidomide (Thalomid)
Parental Age – the older the parents are when a child is born, the greater the risk for the child to develop ASD

Note: There is no scientific evidence suggesting that vaccines cause ASD.

Reference: https://www.cdc.gov/vaccinesafety/concerns/autism.html

Autism Spectrum Disorder Treatment

Psychopharmacology

ASD is linked to symptoms such as aggression, repetitive behaviour, irritability, anxiety and depression, hyperactivity, and attention deficit. Treatment for ASD may be prescribed with the aim of targeting such symptoms.

Psychosocial Interventions

Therapy can help a child with ASD to develop life skills, social skills, communicative skills, and language skills. Suggested therapy includes Behavioural Therapy, Psychological Therapy, and Educational Therapy.

Reference: https://www.nimh.nih.gov/health/topics/autism-spectrum-disorders-asd

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WASP Scientific Paper Writing Course

The last online WASP Scientific Paper Writing Course was once again a huge success, and so, another WASP International is going to be held between the 21^st and 23^rd February 2022.

WASP Scientific Paper Writing Course is an intensive three-day event with formal lectures & interactive sessions delivered by highly experienced researchers and journal editors. All aspects of paper writing are covered, from proposals, to presenting to dealing with journal editors. Statistical analysis is demonstrated within Excel® and includes hands on sessions on attendees’ own laptops. Excel modules used for analysis are given to attendees along with soft copies of the presentations.

WASP Scientific Paper Writing Course is suitable for all individuals in the sciences who wish to enhance their paper writing skills by acquiring sound competences in academic writing. WASP is not only intended for the medical profession: engineers, architects, pharmacists, nurses etc. have all joined, enjoyed and benefited from WASP.

At the end of the WASP event, attendees are also presented with a certificate of attendance attesting to the 18 EACCME (CME) points that are allotted to this event via the Medical Association of Malta (MAM).

More details about the WASP Faculty can be found here.

We practice what we preach in WASP – all of the talks (as well as related topics) have been published in the peer-reviewed journal (impact factor 2.2) Early Human Development in a series of medical education sections in consecutive issues of the journal. See PubMed link.
Prof. Victor Grech, creator and director of WASP.

WASP has CPD approval from the Royal College of Physicians of London. In addition, the course is also endorsed by the following international and local bodies:

Now is your chance to learn scientific paper writing the proper way. An early bird registration and discount are currently available. You may register at http://www.ithams.com/wasp/ (there is an early bird registration and discount…make sure you don’t miss out!!)

Are you organising events or have products or information that can enhance the knowledge of local and international student nurses on their way to registration? I’d love to hear from you! Contact me here…

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Pain Management Nursing Interventions

According to IASP, pain can be defined as “an unpleasant sensory and emotional experience arising from actual or potential tissue damage or described in terms of such damage”. Choosing the ideal pain management nursing interventions for a patient in pain depends on the accuracy in which pain assessment is carried out, correct diagnosis and adequate nursing care plan.

Pain Classification

Pain can be classified as ‘acute’ or ‘chronic’.

Acute pain acts as a warning, signalling that you’ve been hurt. It is typically mild and short-lasting, or severe, lasting for a few weeks or months, disappearing when the underlying cause of pain is treated (eg. surgical wounds, broken bones and childbirth). Acute pain is the result of noxious stimuli that activate nociceptors.

On the other hand, chronic pain can last for months or years, and has no definite cause (eg. arthritis, back and neck pain, fibromyalgia, CRPS and headaches). Chronic pain is the result of visceral or somatic nociceptors.

Acute Pain Management Goals

Analgesics: analgesia should be administered in a dose that is both effective yet minimal, so as to lessen the incidence of side effects;
Effectiveness: effective pain control promotes early mobilisation, less arising complications, shorter period of hospitalisation leading to lower costs, and more importantly, increased patient satisfaction.

Analgesics administered can be:

Multimodal Analgesics – a combination of different medicinal groups of pain relief such as local anaesthetics, opioids and NSAIDs;
Preemptive Analgesia – treatment is started prior to a surgical procedure so as to reduce sensitisation, which promotes a protective effect on the nociceptors and provides a reduction in post-operative pain and at times prevents chronic pain development;
Parenteral Analgesia – indicated for patients experiencing severe pain with associated nausea and vomiting who are unable to tolerate oral medication;
PCA (Patient-Controlled Analgesia) – a method which allows patients to self-administer predetermined doses of analgesia for pain relief;
Epidural Analgesia – administration of analgesics or anaesthetics into the epidural space for short-term and long-term pain management;

Retrieved from https://www.cfp.ca/content/56/6/514/tab-figures-data on 16th December 2021

Analgesic Medications

non-opioids

Non-narcotic, peripheral, mild and anti-pyretic agents…

pain management nursing interventions — Retrieved from https://knowledgeplus.nejm.org/blog/non-opioid-analgesics-role-in-pain-management/ on 16th December 2021

Opioids

Narcotic, central or strong agents…

Opioid Side Effects:

respiratory depression
sedation
nausea
vomiting
constipation
inadequate pain management
allergies
pruritis (irritation)
urinary retention
tolerance to medication
addiction to medication

Adjuvant pain medication

Corticosteroids a.k.a. steroids are anti-inflammatory agents prescribed for a wide range of conditions including auto-immune diseases (attn. may cause hyperglycaemia, moodiness, irritability, insomnia, bone weakness, immunocompromisation – prednisolone, prednisone, cortisone
Anti-Convulsants a.k.a anti-epileptic / anti-seizure drugs are pharmacological agents used to treat epileptic seizures- carbamazepine, valproate, clonazepam, phenytoin, gabapentin
Tricyclic Anti-Depressants – amitriptyline, desipramine, imipramine, nortriptyline
Bisphosphonates can help prevent or slow down osteoporosis, treat some types of cancer that cause bone damage, and treat high levels of calcium in the blood – pamidronate, calcitonin
Neuroleptics a.k.a. anti-psychotic medications are used to treat and manage symptoms of many psychiatric disorders – haloperidol, chlorpromazine, risperidone
Anxiolytics help prevent or treat anxiety symptoms or disorders – lorazepam

Non-Pharmacological Pain Management

heat
cold
laughter
music
physical therapy
massage therapy
aromatherapy
acupuncture
self-hypnosis
TENS (Transcutaneous Electrical Nerve Stimulation)
SCS (Spinal Cord Stimulation)

Pain Management Nursing Interventions

The nurse’s role with regards to pain management include:

acute pain management
help with self-care
providing reassurance to counteract anxiety
assisting at times of ineffective coping and fatigue
assisting with mobilisation
ensuring adequate nutrition
ensuring adequate sleep
providing education and assistance in a holistic manner

Maslow’s Hierarchy of Needs

Retrieved from https://www.simplypsychology.org/maslow.html on 16th December 2021

The Role of Psychosocial Care in Nursing

Psychosocial care involves the provision of care in a holistic way such that the psychological, social and spiritual requirements of the patient are collectively met. For the provision of psychosocial care, the nurse needs to:

have good verbal and non-verbal communication skills
be empathic and supportive
have the required knowledge and the ability of conveying medical information in an easily understood way

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Renal Physiology – Glomerular Filtration, Tubular Reabsorption & Secretion

Renal physiology is the study of the physiology of the kidney, specifically at the level of the nephron, which is the smallest functional unit of the kidney where blood entering the kidney goes through the process of filtration.

Overview of Renal Physiology

3 Important Functions of the Nephrons:

control blood concentration and volume through selected removal of water and solutes
regulate blood pH
remove toxic waste from the blood

Through these functions, materials from the blood is removed, others which are required are returned, and the remaining unneeded material is excreted collectively as urine. In other words, urine formation requires Glomerular Filtration, Tubular Reabsorption and Tubular Secretion.

Renal Physiology – Glomerular Filtration

Glomerular Filtration occurs in the renal corpuscle of the kidneys across the endohelial-capsular membrane, which results in the fluid called glomerular filtrate ( 150 lt in adult females; 180 lt in adult males). The blood plasma in the afferent arterioles which become the glomerular filtrate is called the filtration fraction.

Understanding the Glomerular Filtration Process

Pressures Causing Filtration & GFR Regulation

The Glomerular Filtration Rate (GFR) is the amount of filtrate formed in all the renal corpuscles of both kidneys per minute (rate in males = 125ml/min; rate in females = 105ml/min). Maintenance of a constant GFR ensures that useful substances are not lost.

A change in GFR indicates a change in the net filtration pressure – if the glomerular blood hydrostatic pressure (GBHP) falls to 45mmHg, the filtration process is halted as the opposing pressures equal to 45mmHg.

There are 3 mechanisms which control GFR by adjusting the blood flow into and out of the glomerulus, and by altering the glomerular capillary surface area for the process of filtration:

Renal Autoregulation: Through the Myogenic Mechanism, stretching triggers contraction of smooth muscle cells in the afferent arteriole wall, causing normalisation of the renal blood flow and GFR within seconds following a change in blood pressure. Additionally, through the Tubuloglomerular Feedback, increased distal tubular sodium chloride concentration causes the release of adenosine, leading to a series of events that help regulate the GFR.
Neural Regulation: The Sympathetic Nervous System, which supplies the renal blood vessels, is responsible for the release of norepinephrine. Through Moderate Sympathetic Stimulation, norepinephrine activates the a₁(alpha-1 adrenergic) receptor in the afferent and efferent arterioles, causing vasoconstriction, causing blood flow restriction, leading to a slight GFR decrease. In Greater Sympathetic Stimulation, vasoconstriction of the afferent arterioles predominates; blood flow in the glomerular capillaries is decreased, leading to a decrease in GFR.
Hormonal Regulation: Angiotensin II, which is a vasoconstrictor, acts on the afferent and the efferent arterioles, reducing blood flow leading to a decrease in the GFR. Additionally, Atrial Natriuretic Peptide (ANP) is released through the stretching of the atrial walls when there is an increase in blood volume, leading to an increase in capillary surface area, causing an increase in the GFR.

Renal Physiology – Tubular Reabsorption

In the average adult, the Glomerular Filtration Rate (GFR) is approximately 125ml/min, meaning that around 180 litres are filtered in one day. However, only around 1ltr a day is excreted as urine by the body. This happens because throughout the filtration process, around 99% of the filtrate is reabsorbed back into the blood in what is called tubular reabsorption.

In tubular reabsorption, the proximal convoluted tubule cells process and reabsorb over 80% of the glomerular filtrate, whilst other parts of the nephron ensure homeostasis by controlling excretion amounts of electrolytes, water and hydrogen ions. Through tubular reabsorption, the following are reabsorbed back into the blood stream:

Sodium
Potassium
Calcium
Chloride
Bicarbonate
Phosphate

Peptides and small proteins are also reabsorbed through pinocytosis.

Substances completely reabsorbed from the filtrate are:

Water
Proteins
Chloride
Sodium
Bicarbonate
Glucose
Potassium

Urea and Uric Acid are partially reabsorbed from the filtrate.

Renal Physiology – Tubular Secretion

Tubular Secretion, which occurs in the proximal and distal tubules as well as in the collecting dugt, removes certain materials from the body such as Potassium ions, Hydrogen ions, Ammonium ions, Creatinine, and drugs.; it also helps control the blood’s pH.

Renin-Angiotensin-aldosterone System (RAAS)

Aldosterone causes increased sodium and water reabsorption from the distal tubule and collecting ducts, leading to an increase in the extracellular fluid volume. This allows the restoration of the blood pressure to its normal state. Additionally, Aldosterone has an affect on the secretion of potassium by the distal convoluted tubule and collecting duct.

Antidiuretic Hormone

The AntiDiuretic Hormone, which is produced by the hypothalamus, controls the concentration of the urine to be excreted.

When the blood-water concentration is low, ADH is released, which increases the permeability of the plasma membranes of the cells of the distal tubules and the collecting ducts. Increased permeability causes more water molecules to pass into the cells, and then into the blood.

With no ADH, the ducts become impermeable to water, causing water to be expelled into urine.

Atrial Natriuretic Peptide

Increased blood volume causes the atrial walls to stretch, leading to the release of the Atrial Natriuretic Peptide (ANP). ANP inhibits the reabsorption of sodium and water in the proximal convoluted tubule and collecting duct, suppresses the secretion of aldosterone, and suppresses the secretion of ADH. This results in increased excretion of sodium ions (natriuresis) and increased urine output (diuresis), leading to a decrease in the blood volume and blood pressure.

Note…

Tubular Reabsorption REMOVES substances from the filtrate into the blood… Tubular Secretion ADDS materials to the filtrate from the blood.

Renal Physiology – Solute Reabsorption

Solute Reabsorption happens within the ascending limb of the loop of henle.

Summary…

Retrieved from https://www.researchgate.net/figure/Nephron-segments-and-their-main-physiological-function-The-nephron-is-the-functional_fig1_321907177 on 15th December 2021

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