...between the heart and kidneys. (Krishnan, 2007). Over time, worsening heart failure coupled with progressive kidney failure leads to diuretic resistance, consistent fluid volume overload and refractory heart failure. (Francis, 2006). Fluid balance is a goal for ESRD patients and should be one of the priorities for health promotion and prevention education. Fluid Overload and the Peritoneal Dialysis Client It is important to note that the client in this paper was diagnosed in 2007 for ESRD and hemodialysis treatment was initiated for this client right away. Initially, patient was getting three times a week dialysis treatments in-center. However, in the last three years, the client’s dialysis treatments were raised to four times per week to avoid fluid overload. Per client’s report, within the last year he would have 1-2 episodes of shortness of breath every three months ending in hospitalizations for congestive heart failure (CHF). In one of the client’s hospitalizations early this year, he was introduced to another treatment modality for ESRD patients. Client pursued peritoneal dialysis based on his nephrologist’s recommendation of said modality. The client’s perception of illness is greatly tied in to his hospitalizations and symptoms associated with CHF. These symptoms are what patient considers hindrance to his ability...
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...“How to Perform Peritoneal Dialysis” General Purpose: To demonstrate Specific Purpose: To demonstrate to my audience how to hook up to a peritoneal dialysis machine. Central Idea: Of the many people in the USA on hemodialysis, going 3-4 times a week may not be convenient for everyone. There is an alternative option though. INTRODUCTION: I. Did you know that there are over 350,000 people on hemodialysis in the United States of America? Hemodialysis is where the blood circulates outside the body of the patient - it goes through a machine that has special filters. The blood comes out of the patient through a catheter (a flexible tube) that is inserted into the vein. The filters do what the kidney's do; they filter out the waste products from the blood. The filtered blood then returns to the patient via another catheter. The patient is, in effect, connected to a kind of artificial kidney. A patient usually has to go to the dialysis center about 3 times a week and can be hooked up to the dialysis machine anywhere from 1 to 4 hours each time. That can be a very inconvenient to some people. There is however an alternate option for those that are willing to be involved in their dialysis treatment. This option is automated peritoneal dialysis and the patient, family member, or home health care provider can perform it in the home setting. It may seem difficult at first, but many dialysis patients say that peritoneal dialysis has made life much less complicated due to the...
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...Depression and decreased perception of social support are associated with mortality in several studies of ESRD patients (Cukor, Cohen, Peterson, & Kimmel, 2007). Decreased marital satisfaction, lower socioeconomic status, and disturbances in family dynamic can affect how a patient perceives social support (Cukor et al., 2007). Social support is intended to benefit the patient and their ability to cope with stress of having ESRD (Cukor et al., 2007). Support is divided into three types: instrumental, informational, and emotional (Cukor et al., 2007). Instrumental support provides material aid, such as financial assistance (Cukor et al., 2007). Since Medicare supports all renal dialysis patients of any age, this is an example of instrumental support for Amanda. Informational support refers to providing helpful information such as guidance (Cukor et al., 2007). Studies show that religious and spiritual beliefs are associated with decreased perception of burden of illness, decreased depression, and increased perception of social support, and better satisfaction with life (Spinale et al., 2008). The social worker can help bring a Chaplin to speak to Amanda about her spirituality. Another form of guidance is having a patient who had similar experiences with End Stage Renal Disease talk to the patient through a mentor program. Emotional support involves expressing empathy and providing encouragement of emotional expression (Cukor et al., 2007). Health-care professionals can intervene...
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...potential trade-offs related to cost, quality, and access to treatment, and the ethical implications of treatment options based on cost evaluation. Reimbursement Mechanisms The major reimbursement mechanism presented in article End Stage Renal Disease Economics and the Balance of Treatment Modalities is Medicare. The system in place at this time is the fee for service with additional charges for medication and medical testing (Sullivan, 2010). The current reimbursement structure is based on a three times a week structure, because hemodialysis (HD) is the primary treatment for ESRD (Sullivan, 2010). According to Sullivan (2010) "The most ideal treatment for patients with ESRD is transplantation" (p.45). The reimbursement for peritoneal dialysis (PD) is the same as that of HD. With the passing of The Medicare Improvements for Patients and Providers Act of 2008, the payment structure will eventually become a bundled rate (Sullivan, 2010). This should help to control cost associated with additional medications, and also create a quality environment through quality measures to make sure care is not being reduced (Sullivan, 2010). "The current Medicare payment is $20.3 billion for 437,334...
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...Goodpasture’s Syndrome Goodpasture’s syndrome is a rare disease caused by an autoimmune disorder. The history and disease process will be reviewed during the education process. Following the review, this education plan will direct methods of learning, challenges, impact of quality of life for a 44-year-old male patient, named Jim. Shah, M, and Hugghins, S (2002) describe case results of a study completed about Goodpasture’s syndrome. Based on their study, the median age of a patient presenting with Goodpasture’s syndrome was 44 and the patients were predominantly male. This gentleman is the manager of a shoe store and has a history of good health. This Caucasian gentleman also has a wife of Spanish descent, and a teenage daughter. Shah, M., & Hugghins, S (2002) found the first reported case of Goodpasture's syndrome was found in an 18-year-old male patient coughing blood and presenting with renal failure. During this presentation of symptoms the pandemic of 1919 was also taking place, 2002. Stanton and Tange, 1958) used the term "Goodpasture's syndrome" to identify patients with pulmonary hemorrhage and damage to the filtrating system of the kidneys called, glomerulonephritis. In 1967 the autoimmune quality of Goodpasture's syndrome was discovered after finding antiglomerular basement membrane antibodies. Presentation of Symptoms Like most patients, Jim, presented with hemoptysis, a cough, shortness of breath on exertion, and fatigue. Other symptoms include signs and symptoms...
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...Lakeside Hospital A hospital just can’t afford to operate a department at 50 percent capacity. If we average 20 dialysis pa- tients, it costs us $425 per treatment, and we’re only paid $250. If a department can’t cover its costs, includ- ing a fair share of overhead, it isn’t self-sufficient and I don’t think we should carry it. Peter Lawrence, M.D., Director of Specialty Services at Lakeside Hospital, was addressing James Newell, M.D., Chief Nephrologist of Lakeside’s Renal Division, concerning a change in Medicare’s payment policies for hemodialysis treatments. Recently, Medicare had begun paying independent dialysis clinics for standard dialysis treatments, and the change in policy had caused patient volume in Lakeside’s dialysis unit to decrease to about 50 percent of capacity, producing a corresponding increase in per-treatment costs. By February of the current fiscal year, Dr. Lawrence and Lakeside’s Medical Director were considering closing the hospital’s dialysis unit. Dr. Newell, who had been Chief Nephrologist since he’d helped establish the unit, was op- posed to closing it. Although he was impressed by the quality of care that independent centers of- fered, he was convinced that Lakeside’s unit was necessary for providing back-up and emergency services for the outpatient centers, as well as for treatment for some of the hospital’s seriously ill inpatients. Furthermore, although the unit could not achieve the low costs of the independent cen- ters, he disagreed...
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...Causes for stones in kidney and how to treat the kidney stones - The cause of kidney stone and its cure Kidney stones / kidney stones are very painful if they are not properly treated at the right time. It can also damage your system. Kidney stone is formed by calcium oxalate compound, which is considered to be stored in the mineral's kidney. The function of kidney is to remove impurity from the blood as urine. In the problem of kidney stones, molted minerales, which are present in urine, together form a big stone in the kidney, which does not come out easily by urine and hence the blockage is generated. When a kidney stone / kidney stone is produced then the person does not know that they suffer when the blockage is generated. Extraction of kidney stones as urine is very painful if they are bigger size. The size of the kidney stone can range from the size of sugar to the size of the golf ball. Before knowing about the treatment of Kidney Stone, you should know about the causes that cause them, you can get help from this and you can remove the problem of kidney stones in the early stages. Causes of formation of kidney stones If you know the cause of the kidney stone, then you can stop this problem from coming. Below are some common reasons for which kidney stones can arise. Drinking less water The main reason behind which the kidney stone is produced is to reduce the intake of water. According to research, people who drink less water are the victims of Kidney Stone...
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...as the Dialysis Center. The Outpatient Clinic, which makes up about 80 percent of the outpatient services section, has recently grown in volume and has created a need for 25 percent more space than it currently has. Moving the Dialysis Center to a new building was decide to allow expansion of the Outpatient Clinic. A change and focus on the allocation of costs has some department heads angry and claiming of unfairness; and some are less likely to receive their end-of-year bonus. Rick Simmons, CFO, is completely in charge of how indirect costs are allocated, but the only restriction was they must be done within outpatient services. Before leaving Big Bend, Rick drafted an indirect cost allocation that had concerned the Director of the Dialysis Center, John Van Pelt. His concerns must be taken into consideration as well as fairness and promoting overall cost savings for the organization while a new allocation is created and Executive Summary The Dialysis Center at Big Bend Medical Center performs hemodialysis and peritoneal dialysis, which are alternative processes that remove wastes and excess water from the blood for patients with end-stage renal (kidney) disease. In hemodialysis, blood is pumped from the patient’s arm through a shunt into a dialysis machine, which uses a cleansing solution and an artificial membrane to perform the functions of a healthy kidney. Then, the cleansed blood is pumped back into the patient through a second shunt. In peritoneal dialysis, the cleansing...
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...Peritoneal Dialysis Dialysis is an artificial way to remove waste and extra fluid from the blood when the kidneys can no longer do so on their own. The main types of dialysis are hemodialysis and peritoneal dialysis. When someone has kidney failure and need to have dialysis to stay alive, they are given two choices. Both treatments require your active participation, however peritoneal requires more than hemodialysis. Hemodialysis is more for one who does not wish to have much responsibility in their treatment. Peritoneal dialysis will be more for someone who doesn’t mine playing an active role in their treatment daily. Although many people chose hemodialysis, I believe peritoneal dialysis gives you more freedom in your life. Hemodialysis requires an access to be placed in the forearm or upper arm. This is for the hemodialysis needles that will be inserted in the vein for the treatments. It uses a man-made membrane dialyzer to filter wastes and remove extra fluid from the blood. These treatments are three times a week and in some rare cases it is needed daily, six times a week and typically last for three to four hours each treatment. Sometimes these centers are located far from where the person may lives. This can be very time consuming. You don't have to do it yourself, as you do with peritoneal dialysis. It is done in a dialysis center by trained health professionals who can watch for any problems. It allows you to be in contact with other people having dialysis, which...
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...ACUTE RENAL FAILURE Overview Acute renal failure is the most common disease in the acute care setting. It is estimated that acute renal failure occurs in up to 25% of all patients admitted to the hospital with a critical illness (Broden, 2009). It is even noted that patients who are admitted to the intensive care unit with no prior renal insufficiencies seem to have worse outcomes than do patients who have preexisting acute renal failure (Broden, 2009). Acute renal failure is a rapid decrease in kidney function, leading to collection of metabolic waste in the body. The pathophysiology of acute renal failure is reduced blood flow to the kidneys, toxins, infections and obstruction (Broden, 2009). There are three types of acute renal failure. They are pre-renal azotemia. This is caused by poor blood flow to the kidneys. The most common causes of this are hypovolemic shock and heart failure. The second type is intra-renal acute renal failure. This is caused by infections, drugs, tumors, glomerulonephritis, and obstruction. The third type is post-renal azotemia. It is caused by an obstruction outside of the kidneys (Dirkes, 2011). Assessment Data Ongoing comprehensive assessments are critical for the acute renal failure patient. The nurse must be attentive to the signs and symptoms of renal disease as well as complications with other organs and systems. The primary effect of acute renal failure is a decrease in urinary output that leads to fluid retention and edema. Oliguria...
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...a good review over renal failure and organ transplantation. By the end of our presentation, students will be able to grasp the most important concept of renal failure and transplantations. We have gathered resources from our text books, lecture notes, trusted web pages, and YouTube videos for demonstration. Kidney Failure Overview Kidney failure is the partial or complete impairment of kidney function. It results in an inability to excrete metabolic waste products and water, as well as contributing to disturbances of all body systems. Kidney disease can be classified as acute or chronic. Acute renal failure (ARF) has a rapid onset. Chronic kidney disease usually develops slowly over months to years and renal replacement therapy (dialysis or transplantation) is needed for long-term survival (Lewis 1165). ARF is a clinical syndrome characterized by a rapid loss of renal function with progressive azotemia, such as BUN and increasing levels of serum creatinine. ARF is often associated with oliguria and usually develops over hours or days. It most commonly follow severe, prolonged hypotension, hypovolemia, or exposure to a nephrotoxic agent. Chronic kidney disease (CKD) is defined as the presence of kidney damage for at least 3 months with functional or structural abnormalities of the kidneys, with or without decrease GFR. CKD is also defined as a GFR of less than 60 ml/min/1.73 m2 for at least 3 months. Five stages of CKD have been identified based on the level of kidney...
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...such as hemodialysis. “Hemodialysis is a process that uses a man-made membrane dialyzer to remove wastes, such as urea, from the blood, restore the proper balance of electrolytes in the blood, and eliminate extra fluid from the body”(Poinier). In order for this process to work, the person with the failed kidneys has to be attached to the filter by tubes that are directly connected to hemodialysis machine. The blood of the person is evacuated from the body into the machine. “The average person has about 10 to 12 pints of blood; during dialysis only one pint (about two cups) is outside of the body at a time”(What is hemodialysis?). The dialysis machine has a blood pump that keeps the blood flowing by creating a pumping action on the blood tubes that carry the blood from the body to the dialyzer and back to the body (Poinier). The machined kidney filters the blood and then inserted back in to the person’s body filtered and restore. The dialysis machine keeps track of blood flow, blood pressure, how much fluid is removed and other vital information. So with that being said, blood does not actually go through the machine. The...
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...end-stage renal failure. According to the National Kidney Foundation (2005), more than 378,000 Americans suffer from chronic kidney failure and need dialysis or kidney transplantation to stay alive. End-stage renal disease is the name for kidney failure so advanced that it cannot be reversed. Renal is another word for kidney. The “renal” name is appropriate due to the fact that the kidneys in end- stage renal disease functions so poorly that they can no longer keep you alive (McDonnell & Mallon, 2005). End-stage renal disease cannot be treated with conventional medical treatments such as drugs. In chronic kidney disease only two treatments allow you to continue living when your kidneys stop functioning: dialysis and kidney transplantation, but only one offers a longer chance of survival. Dialysis is the term for several different methods of artificially filtering the blood (McDonnell & Mallon, 2005). Dialysis is a procedure that replaces some of the kidney’s normal functions, but does not cure the disease or prevent possible complications. It may even cause those complications and even reduce one’s quality of life. Dialysis is performed when a person’s own kidneys can no longer function adequately to maintain life. People who require dialysis are kept alive but give up some degree of their freedom because of their dialysis schedule or...
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...renal disease is interchangeably used for CKD but to be unifom in usage, we will use the term Chronic Kidney Disease or CKD. In the U.S., there are 20 million adults who have chronic disease and over 400,000 persons have ESRD and require dialytic or transplantation therapy. In the Philippines, annually we have about 6,ooo patients started on dialysis most of which are caused by diabetis mellitus. Complications of this condition have also made this the 9th cause of death in our country. This is how important this disease entity has become over the last decade. Each of us has 2 kidneys, one on each side of our flanks. Chronic kidney disease is a permanent damage to both kidneys that persists for at least 3 months. If the kidney damage is temporary and has occurred less than 3 months, this is referred to as acute kidney or renal failure. Acuteness does not refer to the severity of the condition, but to a recent and temporary event, therefore, almost always reversible. Chronicity implies long-term event that is permanent and irreversible. This is probably why most patients fear to hear that they have kidney disease and would need dialysis. CKD has five (5) stages based on the kidney function as estimated by the glomerular filtration rate (GFR).The best overall measure of kidney function is the GFR and the preferred method for its estimation is the GFR by the Modification of Diet in Renal Disease (MDRD) calculation. In our setting, we use alternatives like the Blood Urea Nitrogen...
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...Clara Skepple Miranda Wilby, Sarah Cavanagh Thursday, March 3 2016 Observing Diffusion and Osmosis INTRODUCTION: Related Theory: The cell membrane is the outermost boundary of the cell, made up of proteins and lipids. This membrane holds the cell together and establishes the movement of materials that go into and out of the cell. This is a selectively permeable membrane: a barrier that allows some molecules to pass through, but prevents other molecules from penetrating (1). Passive transport is the movement of materials across a cell membrane without the use of energy from the cell. One type of passive transport is diffusion. Diffusion involves the movement of molecules from an area with a higher concentration to one with a lower concentration (1). Diffusion is affected by many things; temperature, concentration and pressure. It disperses until molecules are equally distributed within a space. Osmosis is diffusion of water through a selectively permeable membrane. Water will diffuse from the place with higher concentration to the place with a lower concentration. Water goes through the concentration gradient. Which is when molecules without energy diffuse from the place with higher concentration to the one with lower (1). The ability to diffuse through water all depends on the size of the molecule as well. For example, starch is a large molecule therefor it should not fit through the cells membrane. Starch is a polysaccharide because it is comprised of lots of sugars. Individually...
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