Diabetes is the leading cause of end-stage renal disease (ESRD). This is because of several factors, including an increase in diabetes prevalence, improved longevity, and an increase in the number of patients with ESRD being accepted into dialysis treatment programs, whereas some had previously been ineligible. More than half of the new patients in dialysis centers have type 2 diabetes.9 For individuals on hemodialysis and home care nursing, the nurse communicates with the dialysis center, coordinating transportation when appropriate and coaching the patient and/or caregiver regarding fluid restrictions, dietary adherence, and prescribed medications. Communicating about home management, as well as monitoring body weight changes, blood pressure, and glucose control, closes the loop and keeps the entire health care team, especially the patient, actively involved.
Home care nurses can also be proactive in helping to prevent diabetic kidney disease by monitoring blood pressure and glucose and encouraging patients to communicate with their physicians regarding the need for an annual screening for microalbuminuria. In addition, because albuminuria is a marker for greatly increased cardiovascular morbidity and mortality in patients with either type 1 or type 2 diabetes, home care nurses can also promote screening for possible vascular disease and aggressive intervention to address cardiovascular risk factors.
Home care nurses have the unique opportunity to view patients' home settings and thereby record an inventory of all the medications a patient may be taking. Provision of care by a variety of health care professionals often translates into a potentially unsafe situation in which multiple and competing medications are prescribed simultaneously. Patients generally assume that providers communicate with each other regarding their medication prescriptions, but this is often not true. In addition, many patients take a variety of over-the-counter medications and herbal products that may have adverse interactions with prescribed medications.
When a patient is no longer homebound, a follow-up referral to an outpatient diabetes self-management education program or nutrition services can be of great value. Episodes of home care are of relatively short duration. Ongoing support helps patients maintain momentum and improve their diabetes outcomes and quality of life.