This morning I was with the nephrology nurse specialist as she saw CKD patients who were
referred for kidney health education. Most of the patients were those
identified by the nephrologist to be in need of kidney health education,
but some were also referred by their internal medicine physician. At
these visits, the patients first get weighed and then the nurse takes a
brief social and medical history. For new patients, the nurse also takes
their waist and hip circumference. She also checks for leg edema as an
indication of microalbuminuria. Patients are asked about their water
intake, diet and exercise habits. She advises patients to drink water,
limit tea and milk, and avoid soft drinks.
The nurse specialist told
me that older Taiwanese patients often believe that the "Western"
medications prescribed by their doctors are harmful and decide to seek
out herbal medicine instead, which are often unregulated or obtained
from unknown sources. However, when asked about herbal medicine usage at
doctor's visits, they tend to deny it and so patient education at these
visits is extremely important in ensuring that patients are compliant
with prescribed medications and refrain from using prescription-free
herbal medicines.
{Later in the day, I was rounding with Dr. Chen in the inpatient ward and there was a patient with a renal hematoma,
who had denied taking any herbal medicines when asked by Dr. Chen.
However, the patient's family members were there today and after we left
the room, the daughter approached Dr. Chen in the hallway and informed
him that her mother did in fact take herbal medicines, so it is
important to educate the patient's families as well, so they can help
make sure their family members are taking the right medications}
After
the patient meets with the nurse educator, they go over to the
nutritionist who advises the patient on their diet and recommends a
limited protein intake of 4-6 servings per day (37.5g per serving) and
uses plates with plastic food on them to demonstrate portion sizes. One
chicken drumstick or fish fillet = 2 portions, 1 egg or 1 glass of milk =
1 portion. Some older patients in Taiwan are accustomed to drinking
soup with every meal, and the nutritionist advised them to omit the soup
with each meal to diminish salt intake. Additionally, some patients
tend to drink milk or soymilk instead of water so the nutritionist must
inform them of the protein content in these drinks and the benefit of
switching to water instead. I think the plastic food is really effective
in helping patients visualize the appropriate portions.
The hospital's CKD education program has been in place for over 10 years. They modeled their program after their diabetes education program,
and they did a study in 2006 that found it was effective in stablizing
creatinine in patients with CKD and delaying the need for dialysis. I think this is an example of how patient education is a great way to empower patients to take an active role in their health and should be implemented wherever possible.
 |
A kidney health education booklet distributed by the Bureau of Health of Taiwan's Department of Health
|
In
the evening, I went to the ER, which is split into an internal medicine
side and a trauma/surgery side. I decided to shadow on the surgery side
tonight and saw many patients who had scooter/motorcycle accidents,
which I was told is a very common occurrence, given the widespread use
of scooters and motorcycles. One elderly male patient had fallen down
the stairs and had a periorbital hematoma that was so large he could not
open his right eye. A head CT was ordered, which showed the massive
hematoma but an intact eyeball. Unfortunately his right frontal sinus
was fractured, but surprisingly the ER physician discharged the patient
to go home and instructed him to come back in the morning for further
management. The patient seemed confused and asked the doctor why he wasn't being admitted, but the doctor was too busy to respond. I wonder if this would happen at an ER in the US... Another
woman suffered a fall and the doctor could palpate a hematoma on the
back of her head, but the head CT revealed a subdural hematoma on the
counter-side of the impact. He showed me that there was no midline shift
of the brain, which indicates that emergency decompression was not
needed, but she would need to be admitted for monitoring and to
receive coagulation factors. A few of the less serious cases I saw were
children brought in by their parent with scratches and bruises, due to
conflicts at school, but the CXRs that were ordered for them revealed
no abnormalities. Interestingly, imaging studies are ordered for everyone who comes in to the trauma side, which is different than in emergency rooms in the US. A relative of mine was recently hit by a car while riding his bike and had bleeding, swelling and bruising of his lower leg, but the ER discharged him without doing an X-ray. Shadowing in the ER was an interesting experience, and the ER physician said that it was quite busy for a Wednesday
night and that the trauma side is usually busiest on weekends and during national
holidays when people have more free time during which they can injure themselves.
No comments:
Post a Comment