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1- Renal anatomy
7- Medications used
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1- Parenchyma: the solid part of the kidney, where the
process of waste excretion takes place.
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¢§he kidneys are a pair of brownish-red structures .
i. Secretion of prostaglandins
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Urine is formed in the nephrone through
a complex three-step process:
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ðhen the kidneys sense a decrease in the oxygen tension in
renal blood flow, they release Erythropoitin, which simulate the
bone marrow to produce red blood cells, thereby increasing the
amount of hemoglobin available to carry oxygen .
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Specialized vessels of the kidney called the vasa recta
constantly monitor blood pressure as blood begins its
passage into the kidney.
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1. ðhen the kidney are functioning normally the volume of
electrolyte excreted per day is equal to the amount
ingested .
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M. r t M t Mt r M s i ilt r Mt
l r li is r Ms r i t t l t ti t
ri lMvs t i .
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1. Acid production results from the catabolism or
breakdown of protein.
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1. ðith high fluid intake, a large volume of dilute urine
is excreted, and with low fluid intake a small volume
of concentrated urine is excreted.
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Renal failure results when the kidneys cannot
remove the body's metabolic wastes or perform
their regulatory functions.
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F ilur
Pr r l l F ilur P st r l
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Pr r l (c us s i th bl d suppl ):
[hypovolemia(decreased blood volume), usually from
shock or dehydration and fluid loss or excessive
diuretics use.
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Renal (damage to the kidney itself):
[acute glomerulonephritis
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Post-renal (obstructive causes in
the urinary tract) due to:
[medication interfering with normal bladder
emptying (e.g. anticholinergics).
[kidney stones.
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C s sus crit ri ( IFLE) f r th di g sis f m F
r :
Äanuria
ÄDecreased appetite
ÄPersistent hiccups
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ÄChanges in mental status or mood
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ÄUrinalysis may be abnormal.
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Äðater and sodium restriction
ÄProtein restriction
Ä Nephrotoxins
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Chronic renal failure is divided into five
stages of increasing severity. Stage 5
chronic kidney failure is also referred to as
end-stage renal disease, where in there is
total or near-total loss of kidney function
and patients need dialysis or transplantation
to stay alive.
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[Headache, numbness in the feet or hands (peripheral
neuropathy), disturbed sleep, altered mental status
(encephalopathy from the accumulation of waste products
or uremic poisons), and restless legs syndrome
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ÄUrine analysis for albumin and creatinin, BUN
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Pr t i r stricti : Decreasing protein intake may slow the
progression of chronic kidney disease. A dietitian can help you
determine the appropriate amount of protein for you.
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Dialysis(from Greek, "dia", meaning
through, and "lusis", meaning loosening)
A process by which waste products are
removed from the body by diffusion
from one fluid compartment to another
across a semi permeable membrane.
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1- High level of serum potassium.
2- Fluid overload.
4- Increasing acidosis.
5- Pericarditis.
6- Severe confusion.
2- Hyperkalemia.
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Like healthy kidneys, dialysis keeps the body
in balance. Dialysis does the following:
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1- Hemodialysis.
2- Peritoneal Dialysis
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In hemodialysis, an artificial kidney
(hemodialyzer) is used to remove waste and
extra chemicals and fluid from the blood. §o get
blood into the artificial kidney, the doctor needs
to make an access (entrance) into blood vessels.
§his is done by minor surgery .
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2) Graft: An anterior venous graft that connect
artery to vein by artificial substance places usually
in the forearm, upper arm or upper side.
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§he time needed for the dialysis depends on:
-how well the kidneys work(if Mcut renal failure)
-how much fluid weight the clients gain between
treatments.
-How much waste the clients have in his body.
-How big he is(§he type of artificial kidney used).
-Usually, each hemodialysis treatment lasts about
four hours and is done three times per week.
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Ä §ypes of Peritoneal Dialysis:
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. In this type of dialysis, the blood is cleaned
inside the body. §he doctor will do surgery to place
a plastic tube called a catheter into the abdomen
(belly) to make an access. During the treatment
the peritoneal cavity is slowly filled with dialysate
through the catheter.
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1. principles involved
2. access
3. location of dialyzing membrane
4. equipment
5. length of time involved
6. indications for use
i. advantages / disadvantages
8. complications
9. general nursing care(HD and PD)
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diMl sis P rit Ml DiMl sis
.Ultrafiltration via
pressure gradient
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diMl sis P rit Ml DiMl sis
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diMl sis P rit Ml DiMl sis
In general thought to be
larger
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diMl sis P rit Ml DiMl sis
Dialysis machine
Indwelling catheter
Dialysate
Needles / §ubing to
access site Administration
§ransfer Set
Dialysate
Continuous cycler
machine
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diMl sis P rit Ml DiMl sis
In ARF:
Uncomplicated ARF
Uncomplicated ARF
² Improve Organ
System Failure
² Replace renal function
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diMl sis P rit Ml DiMl sis
[less equipment.
[Patients do not need to
have an external access
site.
§reatments done at home
for greater independence
Patients benefit from
regular contact with other
[§reatment times more
patients.
flexible.
§here is no need to have
[§here is less stress for
equipment at home.
some patients
[ Patient benefit from
continuous nursing care.
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diMl sis P rit Ml DiMl sis
During §reatment: [ Infections
² Hypotension and
arrhythmias [Slower
² Abdominal cramping
and nausea Cannot be used if
abdominal adhesions h/o
Patients must travel to a peritonitis, hernias,
center three times a morbid obesity, severe
week. COPD, Pre-existing
Vertebral disease
§here is a fixed schedule
Cannot be used if patient
Diet and fluid restriction not capable of performing
Fatigue/weaknes
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diMl sis P rit Ml DiMl sis
ðeak immune system (ESRD) ðeak immune system (ESRD)
²Sepsis
² Peritonitis
Graft Malfunction
² Exit Site Infections
² Clotting / §hrombus ² SubQ§unnel Infections
Outflow problems
Rejection of AV Graft Catheter Malfunction
Hypotension, Arrhythmias can Intraperitoneal Bleeding
occur during procedure Protein Loss
May not work for all:
Dialyzer Reactions can occur during procedure
Air Embolus
Dialyzer Reactions
Hepatitis
Muscle Cramps
² Inadequate removal of
Disquilibrium Syndrome toxins
Low back pain
Pulmonary
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Anemia
Renal Osteodystrophy
H§N
Fluid overload
Pericarditis
Hyperkalemia
Nerve damage
Infection
Heartm disease
Nursig DiMgsis Exp ct d Outc s Nursig It rv tis
§he patient will maintain adequate [Assess vital signs before and during
dialysis to establish base line
fluid balance. measurement and help detect changes
Outcome measurements criteria : in fluids status.
1) High risk for [Blood pressure with normal range [Contact the physician to clarify
fluid volume deficit withholding of drugs that may
contribute to hypovolemia , such as
r/t fluid removal [Stable heart and respiratory rate analgesics.
during dialysis and
possible blood loss [Observes for signs and symptoms of
[Absence of tachycardia, dizziness, hypovolemia such as dizziness
from access device. restlessness, nausea and vomiting. restlessness anxiety, nausea ,
vomiting and postural hypotension.
[Clotting time within normal range. [Assess patency of fistula or graft
used for dialysis by palpating or
[Acceptable weight loss without auscultating for bruit. Check patency
of external shunt by observing for
hypotension continuous blood flow through shunt.
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Nursig DiMgsis Exp ct d Outc s Nursig It rv tis
§he patient will remain free of [Measure oral temperature
infection. and other vital signs Q 1 hr
Outcome measurements criteria : or as needed.
[Observe for diaphoresis
[Oral temperature at or below 3i.2 C. and chills
[Monitor ðBC count, and
High risk for [ðBC counts within normal range. report abnormalities to the
infection r/t physician.
invasive nature of [Vital signs within normal range [Use sterile technique when
hemodaialysis . inserting and removing
[Absence of diaphoresis and chills. access needle.
[Check graft, shunt, or
[Absence of warmth, redness, fistula site for S&S of
tenderness, and swelling at graft, infection: redness, swelling,
shunt or fistula site. warmth, and tenderness.
[Maintain universal
precautions all times to
protect the patient and
nurse from spread of
infections.
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Nursig DiMgsis Exp ct d Outc s Nursig It rv tis
§he patient will remain free of [Measure vital signs.
S&S of disequilibrium syndrome. frequently to detect
Outcome measurements criteria changes.
[Monitor for confusion,
:
headache, nausea, vomiting
and restlessness.
[Vital signs within normal ranges. [Observe the patient
3) Altered closely toward end of
thought process [Orientation to person, place, dialysis session and
r/t disequilibrium and time. afterward, when
syndrome disequilibrium syndrome is
secondary to [Absence off headache, most likely to occur.
[Implement seizure
hemodialysis . restlessness, nausea and
precautions if necessary.
vomiting. Report seizure to physician
immediately.
[Absence of seizures. Keep bed in low position
with side rails up to
[Absence of S&S of injury. prevent injury.
Administer mild analgesics,
as prescribed if the patient
complains off headache.
Provide quiet, restful
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environment.
Nursig DiMgsis Exp ct d Outc s Nursig It rv tis
§he patient will express an Explain need for dialysis and its
effect on kidney function,
understanding of dialysis and blood chemistry result, and
follow up care. dietary restrictions.
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Name of §herapeutical uses Side Effect Nursing Role
Medication
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Name of medication §herapeutical uses Side Effects
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