The Complex Needs Of The Dialysis Dependent Patient

This author’s personal perceptions concerning patients facing a lingering terminal illness, have been shaped by over 20 years of critical care nursing experience. Facing death and illness on a daily basis requires self-examination and a high degree of comfort with one’s own mortality, limits and values. Constant exposure to the fragility of life forces respect for the whole person and the people who love them. A general approach to patients who are actively dying is to allow them to define what they want and need during this time. The nurse’s role

My nursing philosophy is influenced by ten years as a critical care nurse while caring for patients and their families during vulnerable and difficult points in their lives. In critical care, patients vary on the wellness-illness spectrum. A young trauma victim with no health history, now has a life altering diagnosis of spinal cord injury. A chronically ill patient requires dialysis and limb amputation due to complications from diabetes and hypertension. I try to assess each patient’s situation independently to decide the best approach during my care. Nurses can easily become focused on the mechanics of the Intensive Care Unit and forget a human is connected to the machines and medications.

Caring Hospice is a company that will provide nursing care to patients that are terminally ill. The ultimate goal is to insure the patient is kept as comfortable as possible while maintaining dignity during the dying process. This company will send registered nurses to the patient’s home for routine physical assessments, medication teaching and administration, education about terminal diseases and the dying process. The nursing staff will also create and maintain appropriate plans of care for the multi-disciplinary team to provide holistic care to the patient.

Vivian Bearing did not show a lot of kindness or compassion to her own students as she did not think that it was important. Now as her death is approaching she comes to realize that is what she has been missing. Her nurse Susie patiently explains the treatment plan to Vivian in terms that she can understand; including the DNR (do not resuscitate) and that it was her decision, Susie allowed Vivian some control over her life by giving her this choice while she fought for her dignity. As her nurse strives to provide her with compassion and empathy this is important to Vivian in her final days as compassion is connected to our human spirit; as she was approaching death (Frost, 1999, p127). Patients often experience quicker healing rates when they receive compassion as opposed to those who do not (Dossey, 2007). Susie told Vivian when she was semi conscious that they were putting a catheter in; even though Doctor Jason said :why are you bothering?” Some people, such as nurse Susie, will go out of their way to make others comfortable and put the patients need before there own, we just have to be mindful of emotional burnout if our own needs are not being met (Brehony, 1999, p

Cetiner is the primary nurse for four dialysis patients. She tends to all of their complex needs as she strives to improve their outcomes. She delivers care in a manner that preserves patient autonomy, dignity and rights. This is evidenced by all four patients exceeding unit/network benchmarks in adequacy, access and anemia management. She became an advocate for a Veteran who lives in a nursing home and has no family, resulting in improvement of care. She diligently worked with one Veteran to avoid multiple hospital admission for fluid overload. She developed a treatment program along with the Medical Director to manage the patient’s fluid both during and after the hemodialysis treatment. She has provided much support to one of the Veterans with many socioeconomic issues ultimately affecting his treatment. Because of her due diligence with his non- compliance he now stays for his entire treatment on a regular basis

1.1 Caring for patients at the end of life is a challenging task that requires not only the consideration of the patient as a whole but also an understanding of the family, social, legal, economic, and institutional circumstances that surround patient care.

Caring for patients at the end of life is a challenging task that requires not only the consideration of the individual as a whole but also an understanding of the

Nurses: Assist the patients and families to cope with the end-of-life process such as assessing and

What was once believed to be a form of neglect has resulted in a change in practice with the idea that doing less is more. Culture is an important factor in how care is rendered and thus, the limitations of palliative and hospice care lie within the desires of the family and patients. A thorough understanding of our surrounding demographics helps to ensure a seamless approach to providing care without bias or imposition of ones beliefs. However, just as with all things, providing care for the sick and comforting the dying should be rendered in moderation as to prevent the effects of burn out. Likewise, the same effects occur in the caregivers who sacrifice their responsibilities in order to care for their love ones. Finally, and with some closing thoughts, the writer wishes to express with gratitude the benefit of having taken this course to better understand oneself and others in the realm of healthcare. The lessons learned throughout have expanded this writer's knowledge and understanding of the human desire to make a connection through communication, emotion, compassion, and spiritually - the platform from which this writer wishes to continue seeking further knowledge and

Lily had only recently began dialysis treatment, and her unwillingness to proceed with treatment would have resulted in her care becoming palliative, something the healthcare professional did not think was suitable at this point in her illness trajectory. Tait (2012) points out that a critically ill patient experiences not only physiological trauma, but also psychological trauma. This psychological trauma that can be experienced after critical care has been addressed by the National Outreach Forum (2003) who suggested that services should be developed to address the implications of critical illness. Samuelson (2011) suggests that any negative emotions associated with critical care can be counterbalanced with memories that reinforce safety, control and trust. This is a useful point to consider in Lily case, who fortunately had the time to talk through her worries concerning continual dialysis treatment with the staff on the ward, who were able to convince her she was in the safest possible hands and that continuing her dialysis treatment would be the best option.

As a dialysis nurse I am tasked with providing pre and post treatment assessments for each patient and through these assessments I identify if there are any patient problems that must be managed. These problems can include access issues, such as clotting or infection, fluid related problems and many others. If a patient is short of breath or complains of chest pain prior to

Mr. Armstrong has a history of renal insufficiency and uncontrolled hypertension, along with symptoms of fatigue, pedal edema, and occasional shortness of breath. He does not have a history of trauma or obstruction to his kidneys, but his creatinine and BUN levels are currently at 3.5 mg/dl and 40 mg/dl. Normal creatinine concentration values are 0.7 to 1.2 mg/dl and normal BUN values are 10 to 20 mg/dl; this reveals that Mr. Armstrong’s kidneys are not removing wastes properly (McCance, Huether, Brashers, & Rote, 2014).  Mr. Armstrong’s history of renal insufficiency and uncontrolled hypertension is commonly found in patients diagnosed with intrarenal (intrinsic) acute renal failure. Intrarenal acute renal failure can be categorized as

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

At the end of our 2 weeks of data gathering and completing the study, the group aims to accomplish the following:

In healthcare, there is a functional and purposeful relationship that exists between the nurse, the doctor and the other interdisciplinary team. This relationship established by the healthcare team comes with a responsibility aimed at achieving a goal, which is to assist the patient to be able to gain independence and progress after hospitalization or rehabilitation. What is paramount to the healthcare team is focusing on the basic human needs of the patient gearing towards health which is a building block of health and wellness. With this being said, the writer chooses Virginia Henderson’s theory of needs because it gives an insight or guides the nurse for what to look for in caring for our patient’s needs with her 14 components of nursing care which still apply to modern nursing care and practice up till present day . As Licensed Practical Nurse (LPN) working in the Transitional Care Unit (TCU), her theory is made visible through my patient’s recovery process experienced every single day. “Henderson 's principles and practice of nursing fall under the category of grand theory that can be applied to many types of nursing” (Nicely & DeLario, 2011).