REPLY 1 Elimination disease like chronic kidney disease, cancer have multiple repercussions on the quality of life and productivity of people. Although most of the elimination diseases can be controlled or corrected like GERD, Hernias, appendicitis other disease like late stage cancer and CKD which leads to progressive and irreversible loss of renal function cannot be cured. As such this illness put tremendous stress to the patient and families. The experience and reaction to the diagnosis of some of the diseases lead to intense suffering These families are affected the emotional, physically socioeconomically as they are required to adjust and incorporate new habits and the adapt to new family in roles. The patients and their families suffer psychological and behavioral impact- effective management of the conditions require individuals to take their medications according to schedule, regular lab tests, restricted diets, exercise regularly while negotiating regular dialysis or chemotherapy and radiation sessions and balancing the complex dietary requirements (Maria et al., 2018). Due to the treatment and its side effect, the patient has to deal with multiple issues such as disfigurement of her body, sexual intimacy and the ability to care for her children This leads to psychological disturbance, 38% of the cancer patients are identified with anxiety and depression, and also to distress, adjustment disorders, delirium and posttraumatic stress disorder (Alexander et al., 2019 Caregivers are subject to enormous stressors and a face emotional, physical and financial strain due to high cost of treatment and care (families lack health insurance and have to find the resources for treatment by paying out-of-pocket). High levels of burden, increased risk for depression, interpersonal conflict, poor quality of life and poor health. Such effects have also been linked to patients institutionalization and exit from caregiving role. (Lee et al., 2016) Nurses see patients at their worst and at their best; from diagnosis, through treatment, through to cure or palliative and end of life care. in order to recognize distress nurses need communicate both verbally and non-verbally to their patients and treat each patient individually according to their needs. Communication convey empathy, support and enhances understanding of medical information. Good psychosocial care has been shown to be beneficial for patients by reducing both psychological distress and physical symptoms through increasing quality of life, enhancing coping and consequent reduction on demands for hospital resources (The impact of breast cancer on the patient and the family in Indian perspective., 2019). Alexander, A., Kavule, R., Prabhu, J. S., Korilmaria, A., Srinath, B., Manjunath, S., Sridhar, T. (2019). The impact of breast cancer on the patient and the family in Indian perspective. INDIAN J PALLIAT CARE, 25(1), 6672. https://doi.org/10.4103/IJPC.IJPC_158_18 Lee, V. Y. ., Seah, W. Y., Kang, A. W. ., Khoo, E. Y. ., Mooppil, N., & Griva, K. (2016). Managing multiple chronic conditions in Singapore Exploring the perspectives and experiences of family caregivers of patients with diabetes and end stage renal disease on haemodialysis. PSYCHOL HEALTH, 31(10), 12201236. https://doi.org/10.1080/08870446.2016.1203921 Maria Virgínia Filgueiras de,Assis Mello, & Angelo, M. (2018). The impact of chronic kidney disease: Experiences of patients and relatives from the extreme north of brazil. Investigación y Educación En Enfermería, 36(1) Retrieved from https://lopes.idm.oclc.org/login?url=https://search-proquest-com.lopes.idm.oclc.org/docview/2138070623?accountid=7374 The impact of breast cancer on the patient and the family in Indian perspective. (2019). INDIAN J PALLIAT CARE, 25(1), 6672. https://doi.org/10.4103/IJPC.IJPC_158_18 REPLY2 Many disease factors can affect an individuals elimination processes, including the renal, pancreatic, hepatic, biliary, and gastrointestinal systems (Whitney, S. 2018). These systems are vital organs that aid in the elimination and contributing to the maintenance of a healthy body. When an individual loses the ability to eliminate, it can contribute to embarrassment and self-confidence properly. As humans, we take these elimination process for granted. Elimination complexities can affect the lives of patients and families in numerous ways because of the limited choices due to their diagnoses, such as renal failure, pancreatitis, and cancer. Treatment can be costly, and many patients dont have insurance, so paying out of pocket for these treatments can be expensive. Other ways patients and families are affected are, the procedure can be time consuming and inconvenient for the parties involved. The patient and the family will have to learn a new way to adjust the elimination complexities. The nurse must educate the patient and their families about how kidney disease will physically, emotionally, and even financially affect the patient as nurses are the main people who provide care for the patients affected by End-Stage Renal Disease. It is the nurses role to identify what care needs to be provided for their patients to reduce their fears, support their decisions, provide emotional support, and education (Shahdadi, Rahnama, 2018). A nurses role is to be sensitive to the patients condition by address their needs in a therapeutic manner and aid in the steps of restoration, such as planning, utilizing collaborative care, and recognizing any complications (Whitney, S. 2018). An example of the nurse role in supporting the patient during their elimination complexities is the nurse educating the patient and family by offering sources such as pamphlets, websites, printed materials, books, or booklets and encouraging the participants to ask questions upon future visits (Whitney, S. 2018). Nurses need to provide care that is specific to the individuals needs. They also play a vital role in managing elimination complexities upon the initial presentation, during treatment, and upon discharge (Whitney, S. 2018). Patients and their families will need support and education about their disease process. References Whitney, S. (2018). Pathophysiology: Clinical applications for client health. Retrieved from https://lc.gcumedia.com/nrs410v/pathophysiology-clinical-applications-for-client-health/v1.1/ Shahdadi, H., & Rahnama, M. (2018). Experience of Nurses in Hemodialysis Care: A Phenomenological Study. Journal of clinical medicine, 7(2), 30. doi:10.3390/jcm7020030
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