According to the Australian Institute for Health and Welfare, data shows that the incidence rate for end-stage renal disease for Indigenous Australians more than doubled between 1991 and 2008, from 31 to 76 per 100,000 population. And in 2008–09, the hospitalisation rate for regular dialysis treatment among Indigenous Australians was 11 times as high as for other Australians. According to a study in 2008, Australian Aboriginal children living in remote communities still experience a high burden of common infectious diseases which are generally attributed to poor hygiene and unsanitary living conditions (McDonald, Bailie, Brewster and Morris, 2008). When a patient has end stage renal failure, their health will progressively deteriorate in a matter of months or years because of the loss of kidney function leading to a high vulnerability in getting infections.
In almost 3 years working as a Renal Dialysis Nurse in a remote area, I understand the impact of this program in the general health of the aboriginal community with renal failure. Because of the renal failure, patients have poor immune systems which often causes infections and every month, few of our patients are being admitted in the hospital or outpatient department due to various infections. One of the most concerning infection that is common on dialysis patients is dental infection. However, this type of infection is preventable by providing early and proper dental care and treatment if needed. The aim of this project is to prevent dental infection in renal patients and to prepare the hemodialysis patients to reach transplantation stage with better oral health.
All patients undergoing renal dialysis are being tested for routine monthly and quarterly blood tests to monitor the improvement or decline of their health. One of the blood tests being done is the C-Reactive Protein or CRP. It is a type of protein found in the blood plasma wherein it elevates in response to an inflammation or infection. In our dialysis unit, we have found that most patients have high CRP and in some patients, with no apparent infections only to find out that they have dental abscess. Research studies prove that infection rates in end stage renal disease population have reached in dangerous level. Studies also shows that 43% overall increase in infection rates in dialysis patients. This is the second most cause of hospitalization and death of dialysis patients. (Ball et al, 2014). Research studies shows that periodontal disease (bleeding and calculus) is significantly higher is patients with renal disease. (Bhambal et al, 2013) Dental issues are most associated issues with renal disease. Researched estimates that up to 90% of patients with renal diseases shows oral symptoms. CRF will damage oral tissues and lead to gingival enlargement, xerostomia and alterations in salivary composition and flow rate. Disturbed calcium and phosphate metabolism in renal patients will also will cause many other dental issues as well. So awareness must be increased in dialysis patients and nursing staff about the need for primary prevention of dental disease. (Agarwal et al, 2014). Also, patients are getting anticoagulants during dialysis which also contributes to gum bleeding in patients with dental issues. Diabetes is one of the disease condition which cause chronic kidney failure in aboriginal community. Periodontal disease, tooth decay, fungal infections and delayed healing are associated with diabetes. Another co-morbidity in Renal Failure is poor calcium absorption which also contributes to more dental issues.
Renal Dialysis patients who are keen to have a kidney transplant must also have good dental hygiene. To be eligible, these patients must first get a dental clearance from the dentist. Once a patient becomes eligible and ready for transplant, all of the patients dental problems will be treated aggressively prior to transplant. The reason for this is that, after the transplantation, the immune system is suppressed and the ability of the body to cope with systemic infections is reduced, therefore putting the transplant organ at risk for rejection. ( Georgakopoulou et al, 2011).
Providing dental care education with dental care pack is very important and cost effective rather sending patients with infections to ED or to a major hospital in Alice Springs (500km away). Only few of our patients are working and most of our patients are not happy to spend money to buy toothpaste and toothbrush due to the fact that they are not aware of the importance of dental care and personal hygiene. Once I spoke to them about this and they replied that if hospital can provide all of these care pack, they are happy to brush their teeth every day and take better care of the oral health. The project involves initial assessment with education and provide basic dental care tools such as toothbrush and toothpaste with monthly reviews for 3 months and final assessment is planning on the 6 month. The patients for this project are regular dialysis patients in our unit and also we can monitor the outcome. The outcome of this program can be assessed by monthly blood tests results along with regular dental appointments that the unit can organize for them. Refer to the Assessment Guidelines for detailed instructions and advice relating to how to resolve
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Using the Project Proposal template located in MyLO assessment resources, construct and
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