Kidney Dialysis

Ms. Mancinho continues to strive for excellence and patient care improvements in her position as staff nurse in the hemodialysis unit. She is currently the primary nurse for five of our chronic dialysis patients. All of her primary patients exceed recommended adequacy guidelines and maintain patent, infection free arterial venous fistulas/grafts. While participating in monthly interdisciplinary care plan meetings, she makes suggestions that have led to positive outcomes such as: changes in dry weights, reviews of patients medications with the nephrologist to facilitate warranted medication adjustments as needed, referrals/close coordination with other disciplines such as podiatry and wound care to prevent infection/amputation in patients with advanced vascular disease, and endocrinology for educational purposes for well controlled blood sugars. She is able to quickly assess subtle changes in her patients to then notify the charge nurse and physician for appropriate guidance in facilitating positive patient care outcomes. Through her acute assessment skills she prevented an access from clotting. Prevention of clotting leads to extended longevity of the access. She applies the nursing process to systems or processes at the team/unit/work group level to improve Veteran care. She worked with flow in the new unit which led to better patient care and staff satisfaction. She developed the time out policy: a requirement for

Recruiting new employees is one of the biggest challenges health care organizations face today. The total population of RN's available for staffing is rising at the slowest pace of the last 20 years (Keller, Siela, Twibell, 2009). Healthcare facilities across the nation are struggling to meet the staffing requirements to stay afloat and provide adequate care to patients. The question in front of many organizations is how to stand out in a competitive workforce and recruit top hires.

During the transitioning process to the new hemodialysis unit, Ms. Conlon anticipated the challenges acquired by learning to set up and use new water equipment in an acute situation. In response to this, Ms. Conlon created and implemented a reverse osmosis flow sheet to assist her colleagues with the quick set-up of the portable RO in the ICU care setting. This tool resulted in a smoother transition for her colleagues, improvement in the delivery of care to the acute dialysis patient, and a decrease in the possibility of staffing overtime.

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.

The dialysis bag is comparable to a cell membrane. They are similar in the sense they are both semi-permeable. Smaller molecules can pas through the tubing however larger ones cannot. An obvious difference would be the composition of the tubing compared to the membrane. Another difference is that although they both are semi-permeable, the tubing simply works depending on the size of the molecules, while a cell membrane depends on a multitude of things such as ions and receptors, etc.

Every day the kidney’s filter on an average of about 120 to 150 quarts of blood that produces 1 to 2 quarts of urine that has extra fluid and waste. The importance of the kidney is to keep the blood stable so the body can function properly. The fluids that are removed from the body help prevent blood cells and large molecules (proteins) from passing. Once filtered it can pass through the tubule that sends minerals back into the blood stream to remove waste (niddk.nih.gov).

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

The option that is most frequently used to treat the disease is dialysis. Dialysis takes a person blood and passes it through an artificial dialyzer which removes toxins and extra fluids from the patient’s blood. In addition to the “Core curriculum for the dialysis technician: a comprehensive review of hemodialysis” dialysis can be done in centers or at the patient’s own home, most of the time it’s done in centers three times a week for four hours.

In the human body, there are systems that provide different functions and help the body to operate more efficiently. The urinary system is one in particular designed to help the body remain free of excess that we no longer need. “The urinary tract is the drainage system used for removing wastes and extra water. The urinary tract includes two kidneys, two ureters, a bladder, and a urethra. The kidneys are a pair of “bean-shaped” organs, each about the size of a fist. The kidneys are located below the ribs, one on each side of the spine, towards the middle of the back.” (NIDDK, 2013) Every several minutes, your kidneys filter around three ounces of blood, also then removing wastes and extra water. That extra water and

My community assessment project focused on adults with chronic renal disease who are receiving peritoneal dialysis under the care of the Davita Dialysis Clinic located in Dothan, Alabama. This modality of artificial kidney replacement minimizes the disruption of the user’s daily life by allowing them to remove waste products from their bodies on daily basis during their ordinary sleeping hours. According the Centers for Disease Control and Prevention, it was estimated that as many as 10% of adults or more than 20 million people in the United States may be suffering from chronic kidney disease and in 2011 alone, 113,136 of these individuals began treatment for their end stage renal disease ("National chronic kidney disease fact sheet,

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.

Drug therapy consists of; Lasix, antihypertensives, antiemetics, H-2 blockers, erythropoietin, vitamins and electrolyte balancing agents (phosphate, calcium, V-D, Vit-B, and amino acids. Dialysis is mostly the patient’s only way of survival. Nutritional therapy is encouraging patients to avoid ↑Ca and ↑ protein foods. Fluid restriction is important since the kidneys have a difficult time excreting. If left untreated the patient would essentially die. The fluid overload combined with the toxicity of the left over wastes would shut down the body’s organs and death would occur.

Hemo dialysis is the filtration of blood to remove the toxins and it is done three times a week for three to four hours (Sullivan, 2010). This would require a person to have transportation to a dialysis clinic, and they would most likely not be able to hold a job. The second treatment option is peritoneal dialysis which consists of multiple exchanges of dialysate during the day which requires no equipment or by using a cycling machine at night (Sullivan, 2010). This can be done at persons home. If the cycling machine is used, a person is more likely to lead a normal life because the exchanges will be done at night when the person is sleeping. Both of these treatment options would require a surgery to obtain access to perform the dialysis. HD requires a vascular access. With vascular access there can become problems with infection and clotting (Sullivan, 2010). With PD a catheter is implanted into the lower abdomen. There is also the risk of infection and peritonitis with this treatment (Sullivan, 2010). PD may be more cost effective because the people on PD tend to be healthier and require less medications (Sullivan, 2013). The most ideal and cost effective treatment is transplantation (Sullivan, 2010). But even with transplantation there is the risk of rejection, so immunosuppressive medications must be taken for the duration of a person's life. According to the Organ procurement and transplantation network (2013), there are

Hemodialysis (HD) is one of several renal replacement therapies used for the treatment of end stage kidney disease (ESKD) and kidney failure. Dialysis removes excess fluids and waste products and restores chemical and electrolyte balance. HD involves passing the patient’s blood through an artificial semipermeable membrane to perform the filtering and excretion functions of the kidney. One important step before starting regular hemodialysis sessions is preparing the vascular access; ideally, a vascular access should be placed weeks or months before you start dialysis. The

Kidney failure is a public health problem, which has dramatic effects on patients' health. In some