Haemodialysis

Haemodialysis

1. Renal physiology

   • Blood and nerve supply
   • nephron
   • urine formation
     • Glomerular filtration
     • Tubular reabsorption
     • Tubular secretion
   • renal clearance

2. Pathology of renal failure

   • normal blood composition disrupted
   • loss of nephron functions
   • Azotemia -- accummlation of waste products of protein metabolism
   • Retention of nitrogenous products

3. Principles of haemodialysis

   • metabolic waste and toxins are filterd
   • Used to manage the uremia, fluid overload, and electrolyte imbalances
   • toxins diffused through membrane
   • clean blood returned to patient's venous circulation
   • Each dialyzer has its own specific characteristics

4. psychosocial

   • change of role in the family and community
   • loss of spontaneity
   • loss of personal freedom
   • loss of social connectedness
   • Loss of sense of self

5. machine monitoring continous

   • arterial and venous pressures
   • blood flow rate
   • transmembrane pressure (TMP)
   • ultrafiltrate
   • dialysate monitoring
     • Temperature
     • flow
     • conductivity
   • IV saline infusion
   • Heparin infusion pump
   • Blood Pump

6. Patient monitoring

   • observe and document
   • physiological state
   • response to dialysis
   • patient assessment
     • hourly vital signs, more frequent for unstable patients
     • physical assessment
     • Weighed before and after treatment
     • oedema
     • Speech
     • Thought processes
   • pain

7. Role of the Nurse

   • Qualities of the nurse
     • interact effectively with patient and health team
     • Interest and skills in patient teaching
     • Problem solving skills
     • self confidence
     • patience
     • resillience
     • Caring, compassion, sensitivity.
     • Ability to cop with stress
   • Education for the nurse
     • In service
     • On the job training
     • Formal training through educational or professional organisations
   • Function of the nurse
     • Meet practice requirements
     • Patient and family educaiton
     • Support self care
     • Ongoing asessment
     • Must be present during treatment

8. Clinical signs of chronic kidney disease

   • hypertension
     • Normal BP range for adults <120 / <80
   • Brittle hair, nails and skin
   • Reduced white blood cell count
     • Infection second most common cause of death
   • Poor appetite and/or nausea
   • smell of urine or ammonia on the breath
   • GI bleed, diarrhea or constipation
   • anemia
   • Loss of bone density and strength
   • Fatigue, slow mental processes, anxiety, depression, and agitation
   • left ventricular dysfunction
   • Pulmonary edema
   • cessation of menstruation, infertility
   • abnormal metabolism of glucose, lipids, and protein
   • Decrease in the GFR
     • Norm GFR 125 mL/min

9. Acute kidney injury

   • Three levels of renal dysfunction AKIN 1,2,3
   • dialysis can be a treatment
     • indcations
       • uremia
       • hyperkalemia
       • acidosis
       • fluid overload
       • exposure to nephrotoxic agent
       • Hypovolaemia
   • rapid deterioration of renal function
     • signs and symptoms
       • urine output > 400ml/day
       • increase in blood urea nitrogen
       • creatinine, hyperkalemia, and acidosis