...“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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..._______________________ 2. S/S: a. Sore throat b. Malaise and headache c. BUN & Creatinine _______ d. Sediment/protein/blood in urine e. Flank pain (costovertebral angle tenderness) f. BP_________ g. Facial ________ h. UO ________ i. Urine specific gravity ______ Client going into fluid volume ______________. 3. Tx: a. Get rid of the strep. Renal b. Balance activity with rest. c. I & O and daily weights d. Monitor blood pressure. e. How is fluid replacement determined? • Fluid replacement = 24 hour fluid loss + __________. f. Dietary needs: • 110 Protein? ______ Na? __________ Carbs? _______ Copyright protected. Reproduction prohibited without authorization and release by Hurst Review Services. g. Dialysis h. Diuresis begins in ___ to ___ weeks after onset. i. ___________ and protein may stay in the urine for months. j. Teach S/S of_________________________. • Malaise, headache, anorexia, nausea, vomiting, decreased output, weight gain. B. Nephrotic Syndrome: 1. Pathophysiology: It’s an inflammatory response in the ________________→ big holes form so protein starts leaking out in the urine (what do we call this? ______________)→ Now the client is hypoalbuminemic (low albumin in the blood)→ without albumin you can’t hold on to fluid in the vascular space→ so where does all the fluid in the vascular space go? ___________________→ Now the client is edematous→ since all the fluid is going out into the tissue what has happened...
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...6/11/13 NUR202 Answer the following three questions (3.30 points) The purpose of the procedure 2 nursing priorities 1 complication 1. What is a TURP? A TURP, other wise known as a transurethral resection of the prostate, is type of prostate surgery done to relieve moderate to severe urinary retention symptoms caused by an enlarged/swollen prostate. The physician essentially trims away part of the prostate to relieve the blocked urine flow. In layman’s terms (however it doesn’t sound so appealing) one could think of this as a “rotorouter” which corrects the block! RN diagnoses would be: 1. Acute pain r/t procedure aeb the patient stating he is in pain 2. Risk for TURP syndrome related to invasive procedure 3. Risk for hemorrhage related to invasive procedure Two RN priorities would include monitoring the patient for pain and preventing and monitoring for hemorrhage and TURP syndrome, which is the most serious complication of a TURP. Abnormal vascular absorption of irrigation fluid during surgery causes severe hyponatremia and hypervolemia. So the RN must assess for: dramatic increase in BP, bounding pulses, bradycardia, tachypnea, and altered mental status. The RN must also monitor for bleeding related to the invasive procedure since hemorrhage is the most common complication. To monitor for hemorrhage the RN can assess vital signs (mostly pulse, bp) every four hours, assess urinary output for color, consistency, and amount, and remind the patient...
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...Dialysis case study A 66-year-old black male was seen by his primary provider for complaints of fatigue, anorexia, swelling of hands, face, and ankles, muscles cramps, and increased difficulty breathing. He has a 3-year history of poorly controlled hypertension related to non-adherence to the medical regimen. His B/P routinely runs in the range 155-165/92-102. His B/P today was 170/105. The client does not like to take pills and feels that they are not necessary. He also has been reluctant to modify his diet and likes to eat fried foods. He does not think his eating habits are causing any problems. Because of these symptoms, the client was admitted to the hospital for treatment and further evaluation. His lab values and renal studies confirmed the diagnosis of end stage kidney disease. Because of the severity of his problems, he was started on hemodialysis. What is the likely cause of his kidney failure? Explain your answers His kidney failure is caused by uncontrolled blood pressure and lack of treatment compliance. When you have uncontrolled high blood pressure it affects the kidneys because the blood vessels narrow and stiffen causing the nephrons in the kidney to work harder. Eventually if hypertension is left untreated it can lead to end stage renal disease because the nephrons in the kidney are no longer able to filter out the toxins such as nitrogen waste which builds up in the blood. They also are unable to maintain fluid or electrolyte balance. Eventually...
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...Fluid Management in Peritoneal Dialysis Ali K. Abu-Alfa, MD, FASN Associate Professor of Medicine Director, Peritoneal Dialysis Program Associate Director for outpatient Dialysis Director of Clinical Trials Yale School of Medicine New Haven, Connecticut http://kidney.yale.edu Educational Objectives Review physiology of ultrafiltration and impact of membrane transport characteristics. Discuss fluid balance in PD with focus on clinical needs, goals and effect on outcomes. Identify areas of interventions for optimization of fluid removal. Identify patients at risk for fluid retention. Review role of alternative osmotic agents: Icodextrin. Review ISPD guidelines and clinical algorithms for fluid management in PD. Physiology of Ultrafiltration Trans-capillary fluid movement: Osmotic gradient (first and foremost). Hydrostatic pressure (much less so). Membrane function / surface area. Lymphatic re-absorption. Physiology of Ultrafiltration: Structure of the Peritoneal Membrane Physiology of Ultrafiltration: Water, Glucose and Sodium Movements Na H2O Capillary Peritoneal Space Glucose Aquaporin mediated: 50% Intercellular: 50% Glucose transporter mediated: minimal Intercellular: >90% Physiology of Ultrafiltration: Sodium Sieving with 3.86% Dextrose Dialysate LaMilia et al, Nephrol Dial Transplant (2004) 19: 1849-1855 Physiology of Ultrafiltration: Effect of Sodium Sieving on Na Removal 250 200 150 100 50 0 Na removal CAPD APD Icodextrin ...
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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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...interaction 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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...Hemodialysis and 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...
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...with End Stage Renal Disease many have only a few choices when it comes to renal replacement modalities. According to Chapman, M., Fink, N., Finkelstein, F., Marsh, J., Meyer, K., Powe, N., Wu, A. (2004), every year in the United States, nearly 90,000 patients with chronic kidney disease progress to ESRD and begin renal replacement therapy. Most patients optimally would prefer a kidney transplant, but many may not have the ability to find a donor and must get on a transplant list. So while they wait for a suitable kidney donor their only option is dialysis. End Stage Renal Disease patients have two choices of dialysis, either hemodialysis or peritoneal dialysis. Chronic dialysis can impose a considerable burden on patients and their families, with regards to health care and their quality of life. Many statistical studies have been done to compare the qualities of life with ESRD patients who are on hemodialysis and peritoneal dialysis. According to Lausevic, M., Nesic, V., Stojanovic, M., Stefanovic, V. (2006), health-related quality of life is a multidimensional concept that includes physical functioning, social functioning, mental health, and general health perceptions. This paper will discuss certain nursing issues, with regard to ESRD patients and their choice of renal replacement modalities, and review the literature from which this information was collected, and the statistical methods used and how the data was analyzed. Nursing Issues The choice of renal replacement modalities...
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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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...treated quicker than they could 30 years ago. One piece of technology that I have always wanted to know more about is the dialysis machine. Though I work in a hospital, my job is medical administration so I never have see for my own eyes how this type of technology works. A couple of years ago my mother went in for a routine checkup. A few days after her checkup, she was notified that both her kidneys were deteriorating and that she had about a year to live, if she did not have a kidney transplant. The entire family was in shock, disbelief, how could this happen to us. We did not sit around long feeling sorry for ourselves. Once the dust cleared my two sisters and I began doing research on what we could do to help our mother. It did not matter that I was in Korea, or my older sister was in Oregon and the other in California. We all pulled together and did our homework and shared what each had found. To make a long story short, my mother did have a transplant; the donor was my younger sister. Today both my mother and sister are leading healthy lives. Though my mother needed dialysis it was something that we all looked into before the transplant. Dialysis is a treatment that mimics some of the functions that healthy kidneys perform. This process is needed when our own kidneys can no longer take care of the body’s needs. People receive dialysis treatment because 85 to 90 percent of their kidneys have lost function; this is known as end-stage kidney failure. Doctor’s...
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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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...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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...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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...hemodialysis and peritoneal dialysis and will utilize this knowledge with a positive attitude. Specific Objectives The group will able to; * Define dialysis * Describe the history of dialysis * Explain the principles of dialysis * Enumerate the indication of dialysis * Explain details about hemodialysis * Describe details about peritoneal dialysis * List down the Psychosocial Issues In ESRD Patients * Dietary Management Dialysis Patient * Nursing Responsibilities Introduction The introduction of dialysis as a lifesaving treatment for kidney failure was not the result for any large scale research programme, rather it emerged from the activities of a new pioneering individuals who were able to utilize ideas, materials, and methods from a range of developing technologies. Hemodialysis as a routine treatment for renal failure was introduced in the late 1970s. The recognition for the need for immunosuppression in the transplantation and the lack of availability of transplant in the 1960s enabled it to become the preferred treatment for many patients. Definition Dialysis is the movement of fluid and molecules across a semipermeable membrane from one compartment to another. Clinically dialysis is a technique in which substances move from the blood through a semipermeable membrane and in to a dialysis solution called dialysate. Historical Evolution in the Field Of Dialysis * It was the romans first used a form of dialysis therapy by using...
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