incidence of diabetic nephropathy, its etiology, its comorbidities, and how to control it. The best type of ‘cure’ is, as always, prevention, and close regulation of the disease which is particularly important since diabetic nephropathy can be fatal.
Diabetic nephropathy is the primary etiology of chronic kidney disease and kidney failure. Unfortunately, type 2 diabetes mellitus is skyrocketing in the United States alone to over 21 million cases, it is imperative for health care professionals to understand the mechanisms of diabetic nephropathy. This is particularly so since early recognition and prevention of the disease as well as tight serum glucose control can help prevent diabetic nephropathy from occurring thereby leading to potentially longer life for its carriers.
The authors describe the characteristics and etiology of diabetic nephropathy explaining how and why it can result in kidney disease and kidney failure.
Understanding these mechanisms can help us prevent kidney failure from occurring since the way to do so is by monitoring serum concentrations of AGEs so that nephropathy can be caught in its early stages.
Education on diabetes is important not only for nurses but also for patients and should be ongoing covering all aspects of the disease. It is also crucial that the health care provider act in a trusting and supportive manner towards the patient.
Since curing and regulating the disease is so difficult, the best step is prevention, and type 2 diabetes can be prevented by diet, exercise, and medications. Following that, and in the case of diabetes, rigid control of hyperglycemia prevents diabetic nephropathy. And even in the worst cases, renal replacement therapy should be accompanied with intensive emotional support from the nurse team and intensive glycemic control.
Early detection of the disease not only prevents possible fatality but also huge economic burden and endless suffering and travail.
b. Critique the article — for example, what is the strength of the evidence, is it supported by the literature, how clearly was the article written, what more could be said, what was clearly explained, etc. (1 page)
The Abstract provided a clear summation of the article. However, the Abstract left out salient points of the article, for instance omitting the importance of patient receiving close emotional support from the nurse team — a point that was covered more than once and seemed to be salient to the topic.
The article, as a whole, was clear, but I thought that it would benefit more from subheadings and that it seemed to zigzag back and forth in no clear direction. It may, in fact, have benefitted form an Introduction that would have served to have tied the article together and given the reader direction regarding the points that it would cover.
The meandering of the essay can be seen in the way that it described the etiology of nephrology before explaining how it could lead to kidney failure that could be best detected and regulated by measuring serum concentrations of AGEs. The etiology and mechanisms of the disease was clearly described in a way that the average reader could understand. The authors remark that “This test, however, is far from being available in general medical reference laboratories,” and proceed to abruptly describing end-stage kidney failure and ending the paragraph on that note. It seems to me that what the authors wish to indicate is the necessity for prevention particularly given that the test is so rare and expensive. The entire paragraph would have been clearer had the author clarified their intention.
The central theme of “Implications for Nursing Practice” appears to be importance of a trusting and supportive nurse manner, but this theme is obstructed by the authors meandering off on a tandem about incidental points that determine patient compliance before returning to their overall theme of prevention. The authors would have achieved greater clarity had they focused exclusively on their theme of manner of healthcare provider, denoted how that aids prevention of diabetes, and relegated the last two paragraphs of that section (prevention and cost of diabetes) to the conclusion.
The Conclusion itself was too short and, in fact, arguably left out some points (again that of the necessity of receiving support from health care provider) that was intrinsic to the article.
The shortfalls, in other words, dwell more on style and format than on clarity. The writing was clear; the disease and its mechanisms were comprehensively delineated. The authors would have produced a clearer article had they structured it according to an outline with each section exclusively adhering to one particular theme that would have been connected, and flowed back, to the whole.
c. Explore clinical application to your practice and/or other practice areas. (1 page)
My area of practice is nephrology (dialysis). The article has at least two applications to my practice. Firstly, it gives me a clearer understanding of the mechanisms of nephrology and the severity of the disease — that if not regulated (and better still prevented), mortality can be an outcome. Knowing this, can make me more motivated and earnest in attempting to teach patients about the need to prevent diabetes from occurring.
The need for prevention seems lucid and simple enough: tight serum glucose control, exercise, diet, and medications. Nonetheless, large cohorts of people fail to follow through. The article did mentions 4 steps of factors that determine patient compliance and concluded that the most effective of all is “a trusting relationship with the health care provider.” This is where I come in.
My practice makes me in constant contact with patients who need to regulate their diabetes in order to prevent complications from occurring. Since patient compliance is irregular and challenging to achieve, and since the emotional and economic costs of diabetes — as pointed out — are huge — it is my responsibility to attempt to help the patient as much as I can. Rather than feeling frustrated and helpless, the article shows me that I can do something: simply by being warm and caring. I can — and do — educate the patient on the complications of their disease. I can go beyond that in providing them with empathy, patience, and the time to listen to and refer them to available assistive agencies. In this wait, my practice extends far beyond the practical duties of nephrology. It lingers onto social work, counseling, and teacher. But, then again, these are the duties of the nurse who literally has to ‘nurse’ the patient back to health.
Sego, Sherril (2007) Pathophysiology of Diabetic Nephropathy Nephrology Nursing Journal, 34(6), 631 — 633
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