Dialysis Case Study

A few service models are generally accepted as an outpatient dialysis service line. Healthcare organizations have to decide which mode of dialysis they deem most effective in serving their patients: 1) Outsourcing their dialysis service line to a specialized service provider such as Fresenius or Davita, 2) instituting a home dialysis service 3) Implementing a hospital stand alone outpatient dialysis center 4) Free standing dialysis clinic. In addition, organizations need to establish protocols on the two-dialysis treatments, hemodialysis or peritoneal dialysis, and reach a consensus which to provide.

* 8. What was the mean severity for renal disease for the research subjects? What was the dispersion or variability of the renal disease severity scores? Did the severity scores vary significantly between the control and the experimental groups? Is this important? Provide a rationale for your answer.

Dr. Jones examined a patient in his office who needed dialysis access procedure on her arms. Prior to Dr. Jones review, Ms. Smith the med tech/secretary examined the patient and documented that the patient blood pressure in both arms were equal. After Dr. Jones examined the patient to compare it with Ms. Smith evaluation he noticed discrepancy in the physical exams. The patient radial pulse in the left arm felt diminished compared to the right. The systolic blood pressure in the left arm was 60mm/hg less than the right, therefore the left hand is most suitable for an access procedure because the patient was right handed. Dr. Jones followed up with the patient and discovered that blood pressure readings were performed only on the right arm. Thus, he confronted the employees about the medical data and she admitted that she falsified the information because she was busy. If Dr. Jones relied on this data he would have conducted an access procedure in the left arm. Dr. Jones applying access procedure to

The wait times of dialysis patients before and after hemodialysis treatments have been an area of concern. In a typical morning at an outpatient dialysis clinic, all the patients for the first shift will begin to gather in a waiting room just prior to a specific time. I will use the start time of 7:00 a.m. for example. The nurses and patient care staff will arrive a considerable amount of time earlier to prepare for the oncoming shift of patients. At 7:00 a.m., the nurse in charge will begin calling each patient in one at a time. An assessment is done. The patient is weighed. His/her lungs are listened to. Many specific questions are asked. A treatment goal is determined based on protocols. Then, the assessment data is entered into a networked computer system, which is retrieved at a specific station for a particular patient. This process continues until every station in the clinic is full. Typically, a clinic will hold anywhere from 12 to 30 stations. For this example, I will use a 20-station clinic.

For this study, emergency medical professionals are randomly choosing which patients they will perform their studies on. One example is medical workers are using a hypertonic solution

Congress mandated QIP, as part of the dialysis bundle reform, which will result in payment decrease to providers who do not meet certain quality metrics. These quality measurements could avert the possibilities of harmful incentive effects (Gupta, C., Chertow, Linthicum, Van Nuys, Belozeroff, Quarles, & Lakdawalla, 2014). The CMS is working to develop a comprehensive quality monitoring initiatives to avoid problems associated with incentives to stint on care. This type of approach could be a significant tool for avoiding and solving the issues of incentives versus quality care (United States Government Accountability Office, 2011). This SE MI clinic is currently struggling to meet Dialysis Quality Indicators (DQI) doing poorly in bone demineralization and access managements, and could mean potential reductions on their bundled payments. The company would have to be more efficient in other budget measures including labor productivity and trimming of supply cost. Cost-containment measures such as staffing shortages can significantly affect quality care (Thomas-Hawkins, Denno, Currier, & Wick,

We used clinical and biochemical data derived from the DaVita database. The study population (N=420,255) included subjects undergoing hemodialysis in DaVita facilities across the US during the period of 2004 to 2011.

In the history of a chronic kidney disease patient, I found that both of his parents have passed away. While his mother and father did get a divorce after he graduated high school, their separation made them stronger, and better parents. My patient has two sisters, both older, the middle one with mental illnesses of schizophrenia and paranoia. This creates a dysfunctional communication pattern within the sibling structure, the middle sister is difficult to communicate with, due to the feeling of abandonment. He was never married, but 16 years ago, found out that he had a daughter with an old girlfriend. She is now 32 years old. Now, he also has a granddaughter. Due to his disability and lack of mobility, he is only able to keep in touch with them through the internet and phone.

Receiving hemodialysis in the in-patient or outpatient setting is uncomfortable and non-pleasurable. Thankfully, “the movement of medical care out of institutional settings into patients’ homes has increased in most industrialized countries as part of the general emergence of self- care options in the

Unfortunately, if given the duty to select patients for dialysis on hourly basis, I would give preference to young children and individuals who require less time. In that case selecting patients A, C, E and F would be given priority which account to consumption of 23 hours. Lastly, I would give preference to the patient J who requires 6 hours of dialysis and is waiting kidney donation from his brother.

Final Question: In patients with non-dialysis-dependent (NDD) Chronic Kidney Disease (CKD) who have iron-deficiency anemia, how efficacious is intravenous (IV) ferric carboxymaltose in increasing hemoglobin levels and reducing treatment-related adverse events compared to IV iron sucrose?

Western Dialysis Clinic is an independent, non-profit full service rental dialysis clinic. The clinic currently provides two types of treatments, which include Hemodialysis (HD) and Peritoneal (PD).

Patients with end-stage kidney disease can have complex co-morbidities. The choice between dialysis and conservative management is difficult for nephrologist. Palliative care is the need of hour for individuals with end-stage kidney disease. It can provide support with symptom management, advance care planning, psychological and spiritual support and bereavement care. Optimal care may be provided to the patient through collaboration between renal and palliative care professionals. Palliative care gives patient-centred care. Multidisciplinary input is the key for complex care needs of these patients. There is growing awareness about the benefit of combining palliative care with needs of those with end-stage kidney disease. Studies have shown

Acute renal failure is defined as a substantial deficiency in renal function (Huether, 2017, p. 760). Dirkes (2016) article explains:

Patients who are diagnosed with acute renal failure go through difficult times dealing with the disease. Their families too experience psychological difficulties, not knowing the degree of suffering their loved ones are going through. Therefore, in order to provide the best of care for the patient, nurses need to be knowledgeable about the problem, and find the best professional way to educate the patient and family so that the patient does not end up into the hospital for re-admission. Family members can best relate to the situation and understand what their loved ones are going through if they are included into the care of the patients. You get a better outcome when you treat patients as a whole. It is critical for nurses and other health care workers to provide patients and their family members with the necessary information in order for them to make informed decisions.