Acute Adequacy Case

541). Interventions should be rendered continuously, promptly and appropriately as it can cause life-threatening complications (Holt 2009, p. 26). Apparently, the patient is stable, but continuous assessment and management should be done to avoid recurrences of untoward signs andsymptoms and prevent potential complications. Firstly, continuous assessment and vital signs should be done and these include blood pressure, cardiac rate, respiration, venous distention and skin turgor to assess possible occurrence of fluid overload as a result of rapid administration of large fluid that is often needed to treat the patient with DKA (Smeltzer & Bare 2004 p. 1185). Aside from this, documentation of fluid intake and output should be monitored and documented to assess for circulatory overload and renal function (Holt 2009, p. 61). Significantly, it is integral in the provision of continuous care that nurses reassess the factors that may have contribute or led to DKA, and educate the patient and his family about strategies to prevent its recurrences (Smeltzer & Bare 2004 p. 1186; Lemone, Burke & Bauldoff 2011, p. 551).

There were no significant differences between either of these labs or the blood volume processed before or after Ateplase push or dwell administration (Vercaigne, Zacharias, & Bernstein, 2012). Push administration injects a small amount of Ateplase into circulation, while the dwell method doesn’t. Often time patient catheters are dwelled with Ateplase in between treatments, as the dwell method requires at least two hours (Vercaigne, Zacharias, & Bernstein, 2012). Hemodialysis units operate on a stringent schedule per shift that decreases flexibility of time. As a result of this the push method is most widely ordered. Within this author’s clinic, once the push method is unsuccessful after two attempts the dwell method is then implemented. In conclusion, the push method was found to have the best immediate and long term results within this study. The authors identified that the sample size was inadequate, which ultimately decreased the validity of this finding (Vercaigne, Zacharias, &

The usual way was to log onto a computer (if not in use); look for the patient and quickly skim the patient’s history, resulting in wasted time. The result was a flow sheet that was easily accessible, located in front of the patient's bedside chart. The flow sheet included pertinent information from the patient’s last two hemodialysis treatments. We received positive feedback from the staff, and the flow sheet was adopted in the unit. After one year, the project was reviewed and continued to receive positive

Patients will go through one of two forms of this treatment continuous renal replacement therapy (CRRT) or slow low efficiency dialysis (SLED). SLED being the faster method as it cuts the session time in half from the average time in CRRT of 6 to 12 hours a session down to 3-4 hours. But each method has its own advantages and disadvantages. SLED being cheaper and faster method that is gaining more favor in recent times. CRRT is used to treat critically ill patients with acute kidney injury and being more user friendly while having better fluid removal. (Longo, D. . Harrison's principles of internal medicine.: McGraw-Hill. Ch 281) Through dialysis thousands of patients with chronic kidney disease lives have been saved and extended through these treatments.

In dialysis, blood is circulated through an extracorporeal circuit for long periods of time. During this process the blood can begin to develop clot formations throughout the CVC, extracorporeal circuit, and the dialyzer itself; which causes multiple complications for the dialysis patient. In order to minimize or eliminate the

Hemodialysis is swift fluid, urea and creatinine removal, effective potassium removal, protein loss is reduced, serum triglycerides is reduced, requires vascular access such as AVFs, AVGs and temporary and permanent catheters. Requires to be done three times a week. Two needles are placed, one in the artery and one in the vein. GFR is not the primary concern; symptoms are. Hemodialysis pushes the patient blood from the body through a dialyzer and back into circulation. It is the most effective dialysis treatment in clearing nitrogenous waste from the

In Kidney failure cases urea, creatine, uric acids and electrolytes move from the blood to the dialysate with the net effect of lowering their concentration in the blood. RBC s WBC s and plasma proteins are too large to diffuse through the pores of the membrane. Hemodialysis patient are exposed to 120 to 130 L of water during each dialysis treatment. Small molecular weight substances can pass from the dialysate in to patient’s blood. So the purity of water used for dialysis is monitored and controlled.

I began with the resident’s diabetic problem. It is a fact that diabetes is a complex condition affecting many of the patient’s body systems. So, the potential to damage the urinary system involving the kidneys, ureters, bladder, and urethra renal function is highly possible. Also, the immune system of the patient is already compromised and makes it even easier for this patient to acquire UTI. With the problem in the urinary system, it then caused the decreased of urine output for about 4 days which resulted into catheterisation. So then, the manifestation of hypoglycaemia was the effect of these mentioned reasons. As a support to my rational thinking, an evidence based researched stated that from a 94 patients who had renal insufficiency (46 had diabetes mellitus), an episodes of hypoglycaemia occurred for about 137 times in a duration of six months. Furthermore, one of the major related cause of hypoglycaemia is infection. (N Engl J Med 1986;

He is diagnosed with CKD Stage 5 secondary to Chronic Glomerulonephritis and is also diabetic. He is undergoing hemodialysis treatment for the last 2 years. He currently has an AVG right with poor bruit and thrill with access recirculation of 26%. He also had 2 failed AVF access on the left arm. He passes minimal urine of less than 60 ml per day. He has interdialytic fluid gains of more than 5%, and rarely reaches target IW post dialysis, his diabetic management is HbA1c >10%. The patient’s diet during dialysis includes intake of soda and 6 slices of pizza. He does not get enough sleep and rest at night as he plays computer games or has a late night photo shoot. Patient X usually complains of shortness of breath during dialysis. Furthermore, the patient was prescribed with Fresenius F80 dialyzer, with a blood flow rate of 250 ml/min and a dialysate flow of 500ml/min, thrice a week 4

The patient had brain hypophysectomy and developed diabetes insipidus (DI). The nurse is monitoring his I/O hourly and have labs for renal function and blood every 4 hours. The electrolytes were also analyzed every 4 hours. Patient urine output was up to 1,500 to 2,000 ml/h the last day and was reduced to 300-500 ml per hour in the last 12 hours. In the morning, the patient drank 3 cups of water and suddenly his urine output was increased remarkably. I saw the urine collection device was almost full within 15 minutes.

The writer will examine the prevalence of diabetes among the patients with end-stage renal disease (ESRD), potential benefits, and harm during management of underlying cause, and analysis of glycemic index hemoglobin A1c (HgbA1c) in managing diabetic ESRD patients. Diabetes is one of the frequent reasons and common persistent complications of ESRD (Kovesdy, Park, & Kalantar-Zadeh, 2010). According to the United States Renal Data System (USRDS), diabetes is the primary cause leading to ESRD. Among 20.8 million diabetic population, approximately 232,984 were affected by ESRD that accounted for increase in Medicare budget from 5.4% to 6.3% at the end of 2011 (United States Renal Data System [USRDS], 2013). Not everyone with diabetes develop ESRD, thus strictly controlling blood sugar level lower the chances of getting kidney disease (Mehrotra, Kalantar-Zadeh, & Alder, 2011).

Chronic kidney disease (CKD) is an irreversible condition that progresses causing kidney dysfunction and then to kidney failure. It is classified by a GFR of <60mL/min for longer than 3 months. There are five stages of CKD: Stage 1 has kidney damage but has a GFR ≥ 90. Stage 2 has mild damage and a GFR of 60-89. Stage 3 has moderate damage and a GFR of 30-59. Stage 4 has severe damage and a GFR of 15-29. Stage 5 is also known as end stage renal disease (ESRD), this is kidney failure with a GFR of ≤ 15 and theses patients are typically on dialysis or in need of an immediate transplant. The leading cause of CKD is diabetes. Hypertension is also a major cause. Since most DM patients have HTN,

Infection control measures must followed if the patient has a central venous catheter. If there is a break infection control the patient is at a higher risk of contracting a blood stream infection. Heparin is to be drawn by the Registered Nurse, and can be administered by the Certified Hemodialysis Technician, which varies by state. Within this author’s region, Registered Nurses are solely responsible to prepare Heparin for administration. This change was implemented due to increase incident reporting related to Heparin administration. Afterward, the dialysis machine must be circulated, which further purifies the water, and then the patient is able to be connected to the hemodialysis lines. A licensed nurse must then assess the patient and the patient’s hemodialysis prescription prior to treatment

The mortality rate of AKI is very high (up to 80% mortality in critically ill children and adults).The incidence rate of AKI has increased in hospitalized patients gradually from 4.9% in 1983 [1] to 20% in 2012 [2].There are more than 35 definitions of AKI [3] which makes the incidence rate varies greatly due to the lack of a standard and Definition. The Acute Dialysis Quality Initiative (ADQI) published (RIFLE) criteria (Risk, Injury, Failure, Loss, End-Stag) in 2004 (table1).

Unlike the previous study, factors such as age, female gender, diabetes, catheter insertions before dialysis and lack of maturation process were seen as possible factors that accounted for the failure of Vascular Access.