Haemodialysis

Haemodialysis

Renal physiology
1. Blood and nerve supply
2. nephron
3. urine formation
  1. Glomerular filtration
  2. Tubular reabsorption
  3. Tubular secretion
4. renal clearance
Pathology of renal failure
1. normal blood composition disrupted
2. loss of nephron functions
3. Azotemia -- accummlation of waste products of protein metabolism
4. Retention of nitrogenous products
Principles of haemodialysis
1. metabolic waste and toxins are filterd
2. Used to manage the uremia, fluid overload, and electrolyte imbalances
3. toxins diffused through membrane
4. clean blood returned to patient's venous circulation
5. Each dialyzer has its own specific characteristics
psychosocial
1. change of role in the family and community
2. loss of spontaneity
3. loss of personal freedom
4. loss of social connectedness
5. Loss of sense of self
machine monitoring continous
1. arterial and venous pressures
2. blood flow rate
3. transmembrane pressure (TMP)
4. ultrafiltrate
5. dialysate monitoring
  1. Temperature
  2. flow
  3. conductivity
6. IV saline infusion
7. Heparin infusion pump
8. Blood Pump
Patient monitoring
1. observe and document
2. physiological state
3. response to dialysis
4. patient assessment
  1. hourly vital signs, more frequent for unstable patients
  2. physical assessment
  3. Weighed before and after treatment
  4. oedema
  5. Speech
  6. Thought processes
5. pain
Role of the Nurse
1. Qualities of the nurse
  1. interact effectively with patient and health team
  2. Interest and skills in patient teaching
  3. Problem solving skills
  4. self confidence
  5. patience
  6. resillience
  7. Caring, compassion, sensitivity.
  8. Ability to cop with stress
2. Education for the nurse
  1. In service
  2. On the job training
  3. Formal training through educational or professional organisations
3. Function of the nurse
  1. Meet practice requirements
  2. Patient and family educaiton
  3. Support self care
  4. Ongoing asessment
  5. Must be present during treatment
Clinical signs of chronic kidney disease
1. hypertension
  1. Normal BP range for adults <120 / <80
2. Brittle hair, nails and skin
3. Reduced white blood cell count
  1. Infection second most common cause of death
4. Poor appetite and/or nausea
5. smell of urine or ammonia on the breath
6. GI bleed, diarrhea or constipation
7. anemia
8. Loss of bone density and strength
9. Fatigue, slow mental processes, anxiety, depression, and agitation
10. left ventricular dysfunction
11. Pulmonary edema
12. cessation of menstruation, infertility
13. abnormal metabolism of glucose, lipids, and protein
14. Decrease in the GFR
  1. Norm GFR 125 mL/min
Acute kidney injury
1. Three levels of renal dysfunction AKIN 1,2,3
2. dialysis can be a treatment
  1. indcations
    1. uremia
    2. hyperkalemia
    3. acidosis
    4. fluid overload
    5. exposure to nephrotoxic agent
    6. Hypovolaemia
3. rapid deterioration of renal function
  1. signs and symptoms
    1. urine output > 400ml/day
    2. increase in blood urea nitrogen
    3. creatinine, hyperkalemia, and acidosis

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	Created by myjish over 10 years ago