Palliative Nursing Care for Patients with End-Stage Chronic Kidney Disease Who Decline Renal Replacement Therapy in a Community Setting : A Comparative Case Study of Two Patients.

Abstract

     This study was 2 cases study aimed to compare the application of the nursing process and palliative care in patients with end-stage chronic kidney disease (CKD) who declined renal replacement therapy. Two patients residing in Phra Yuen District and receiving care at Phra Yuen Hospital were studied. Data were collected from medical records, patient and family interviews, and assessment tools. Health status was analyzed and compared using Gordon’s 11 Functional Health Patterns. Nursing care planning was based on a holistic nursing process and palliative care guidelines.

     Results: Case 1: A 68-year-old Thai female with a 20-year history of diabetes mellitus and hypertension, hyperlipidemia, CKD stage 5, and anemia. Initially, she sought treatment at a private clinic, consumed a regular local diet without restrictions, preferred sweet flavors, and exercised irregularly. Upon detection of high blood sugar by primary care staff, she was referred to the hospital. Holistic nursing and palliative care were implemented to address clinical issues and support lifestyle modification. Case 2: A 68-year-old Thai female with a 25-year history of diabetes mellitus and hypertension, hyperlipidemia, and CKD stage 5. She consumed strongly flavored foods, sticky rice daily, and did not follow dietary restrictions. Her blood sugar remained poorly controlled, impacting kidney function, and insulin therapy was initiated. Holistic nursing and palliative care were provided to manage clinical problems and encourage behavioral changes.