Calciphylaxis: a case study

Caring for J.D. was a stressful experience. The extent of her wounds, pain, and limited options for treatment was very frustrating for the nursing staff. Although she did not survive, patient outcomes were met to some degree. Her pain was controlled to a greater extent, and there was less infection present in her wounds. The nurses worked with J.D. closely to improve her pain control and facilitate less painful dressing changes. They were vigilant in assessing the progress of her wound healing and communicating any increased signs of infections from her wounds. They sang with her to help distract her from the pain she was experiencing and to help her cope with her lengthy 8-month hospitalization. Providing care for J.D. was also a very important learning experience for nurses in terms of appropriate pain management for patients with CUA, wound care, and the need to sustain adequate nutrition to promote wound healing. CUA is a rare but potentially fatal disease that occurs in patients with end stage renal disease (ESRD). Early diagnosis and treatment are essential to prevent the devastating effects of this disease. Nephrology nurses need to reinforce the importance of keeping calcium, phosphorous, and parathyroid levels within normal ranges for their patients on dialysis. They also need to be vigilant in monitoring for potential CUA skin lesions to prevent and treat it early. To date, treatment options are mostly based on findings from case reports. Treatment requires a multidisciplinary approach with input from nephrologists, nurses, pain specialists, infectious disease specialists, and surgeons. The major goals of treatment are controlling risk factors, controlling pain, and preventing wound infection and possible sepsis. More studies need to be conducted to test interventions that may help treat CUA.