Management Information Systems For The Information Age 9th Edition Pdf 37
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To reduce the risk of cardiovascular disease, individuals with CKD should be offered angiotensin-converting enzyme inhibitor or angiotensin receptor blocker. Other antihypertensive medications should be used for blood pressure control. Patients with CKD should be encouraged to discuss their disease management strategy and preferences with their health care team. To delay the need for dialysis, patients with CKD should receive comprehensive education on the disease and its management, particularly the benefits of blood pressure control, strict glycemic and blood pressure control, and avoidance of smoking. Referral to a dietitian to provide an initial assessment of dietary intake, followed by more intensive nutrition therapy as indicated, is recommended. Referral to a physical therapist is recommended to provide advice on the benefits of exercise. Referral to a psychiatrist to provide education about depression and anxiety, cognitive behavioral therapy, and/or brief cognitive therapy is recommended in the presence of severe depression or anxiety. In addition, referral to a social worker to address issues of financial burden and social support is recommended.
Receipt of kidney transplantation should be considered for patients who are at stage 3 CKD but have a limited life expectancy, a high likelihood of failure of the remaining kidney, or inadequate social support to enable them to be managed with maintenance dialysis (e.g., residents of nursing homes with multiple comorbid conditions). Important considerations for the physician who refers a patient to the program include patient satisfaction, determination of need for long-term dialysis, willingness to pay for transplantation, time-consuming travel for the patient, and whether insurance or Medicare will cover the expenses.
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