Comprehensive Overview of Nursing Care for Dialysis Patients

 
N
u
r
s
i
n
g
 
C
a
r
e
 
o
f
 
P
a
t
i
e
n
t
 
o
n
 
D
i
a
l
y
s
i
s
 
 
Dr. M.L.Patel
Additional Professor
Department of Medicine
KGMU Lucknow
 
N
u
r
s
i
n
g
 
C
a
r
e
 
o
f
 
P
a
t
i
e
n
t
 
o
n
 
D
i
a
l
y
s
i
s
 
Protocols
 
 
In each
 
unit in
 
regard
 
to
 
machines
,
Procedure
 
& patient
 
care
Sanitizing
 
machines
 
PD 
cath
 
care/dressing
 
/treatment
 
Flushing
 
new
 
PD
 
catheter
 
PET
 
Peritonitis
 
care
 
Investigation
 protocol
 
Vaccination
Records
 
/Treatment
 
flow
 
sheets
 
H
e
m
o
d
i
a
l
y
s
i
s
 
r
e
q
u
i
r
e
s
 
5
 
t
h
i
n
g
s
 
1.
Access
 
to
 
patient
 
’s
 
circulation
 
(usually
 
via fistula)
2.
 
Access
 
to
 
a dialysis machine
 
and
 
dialyzer
 
with a semipermeable
membrane
3.
 
The appropriate
 
solution
 
(dialysate
 
bath)
4. Time: 12
 
hours
 
each week, divided
 
in 3 equal segments
5. Place:
 
home (if feasible) or a
 
dialysis
 
centre
 
 
 
H
e
m
o
d
i
a
l
y
s
i
s
-
 
P
r
o
c
e
d
u
r
e
 
1
.
 
Patient
 
’s
 
circulation is accessed
2. Unless
 
contraindicated,
 
heparin
 
is
 
administer
ed
3. Dialysis
 
solution
 
surrounds the membranes
 
andflows
 
in the opposite direction.
 4. Dialysis
 
solution
 
is:
a.
Highly purified
 
water
b.
 
Na,K,
 
Ca, 
Mg,
 
Cl,
 
& 
Dextrose
c.
 
Either bicarbonate or
 acetate,
 
to
 
maintain proper Ph.
6. Via
 
the
 
process
 
of diffusion,
 
wastes
 
are
 
removed
  
in the
 
form
 
of solutes
 
(metabolic
wastes,
 acid-base components and
 
electrolytes)
 
 
 
 
 
7.
 
Solute
 
wastes
 can
 
be
 
discarded
8. 
Ultrafiltration
 
removes
 
excess
 
water
 
from
 
the blood
9. After cleansing,
 
the
 
blood
 
returns 
to
 
the client via
 
the access
 
 
C
o
m
p
l
i
c
a
t
i
o
n
s
 
r
e
l
a
t
e
d
 
t
o
 
v
a
s
c
u
l
a
r
A
c
c
e
s
s
 
d
u
r
i
n
g
 
H
e
m
o
d
i
a
l
y
s
i
s
 
1.
Infection
2.
 
Catheter
 clotting
3. 
Central
 venous thrombosis
4. Stenosis
 
or thrombosis
5. Ischemia
 
of the 
affected
 limb
6. Development of an
 
aneurysm
 
 
 
P
r
e
-
d
i
a
l
y
s
i
s
 
c
a
r
e
 
Assess for-
Weight:
 
Determines
 
amount
 
of fluid
 
to
 
be 
removed
 during
 
dialysis
Vital Sign
:
 
BP 
for
 
hypo
 
and
 
hypertension; 
temperature 
for
 
sepsis;
 
respiration 
for
 fluid
Overload
Potassium level
:
 
Determines potassium
 level 
in dialysate
 
(in the
 
chronic
 
setting,
 
this is
done monthly
 
unless
 
the patient
 
is 
symptomatic
Hold
 
drugs
 
that pass
 
through
 
the
 
dialysis membrane,
 
such
 
as piperacillin,
 
folic
 
acid, and
other water-soluble
 
vitamins.
 
Hold
 
antihypertensive
 
drugs,
 
especially
 
if 
systolic
 pressure
 
is below 100, per physician
order
 
 
 
 
 
 
Check 
access
 site
 
Assess
 
fistula
 
or 
graft
 
for
 
infection
 
Assess
 
circulation
 
in 
distal 
portion
 
of
extremity
 
Auscultate
 
for
 
bruit
 
Palpate
 
for
 
thrill
 
No IV or blood
 
draws
 in that
 
arm
 
No BP in arm
 
During Dialysis
 
Watch
 
for
 
Hypotension
 
Muscle
 
cramps
 
Nausea and vomiting
 
Headache
Itching
Less
 
commonly:
 
disequilibrium
 
syndrome, 
hypersensitivity
 
reaction, arrhythmia, cardiac
tamponade, seizures,
 
air embolism
 
 
 
POST DIALYSIS CARE
 
Monitor BP; report 
hypotension
 
or
 
hypertension
 
Watch
 
for
 
bleeding
 
Check 
weight
 
and 
compare
 (weight loss should
be close 
to
 fluid 
removal
 
goal 
set
 
during
treatment)
 
Document
 
unusual findings
 
Assess access
 site
 
for
 
bruit, thrill,
 
exudate,
 signsof infection, bleeding
 
Give
 
missed meds, if 
indicated
 
 
NURSHING INTERVENTION IN DIALYSIS
 
1.
Explain
 
procedure
 
to
 
client
2.
 
Cannulating
 
& connecting
 
to
 
HD
 
machine
3. Monitor hemodynamic
 
status
 
continuously
4. Monitor acid-base
 
balance
5. Monitor electrolytes
6. Insure
 
sterility
 
of 
system
7. Maintain
 
a closed
 
system
8. Diet Restriction- 
Protein
 
intake, 
 Sodium
 
intake, 
Potassium
 
intake, 
 
Fluid
 
intake
9. 
Reinforce
 
adjustment 
to
 
prescribed medications that 
may
 
be 
affected
 
by
 
the process
 
of
hemodialysis
 
 
 
 
 
 
 
NURSHING INTERVENTION IN DIALYSIS
 
10. Monitor 
for
 
complications 
of
dialysis
 
related
 
to:
Arteriosclerotic
 
cardiovascular
disease
Congestive
 
heart
 failure,
Stroke
,
Infection,
 
 
 
 
 
 
 
 
 
 
 
Gastric ulcers
,
  
Hypertension,
Calcium deficiencies,
Anemia and 
fatigue,
Depression,
sexual
 
dysfunction,
suicide risk
 
D
I
E
T
 
D
I
A
L
Y
S
I
S
 
PD
 
get
 calories 
from
 
Dextrose 
in the fluid
 
–PD patients 
may
 
eat
fewer
 
CHO
 
than
 
hemodialysis patients
Protein-
 
HD
 
loses 10-12 gms of Aminoacids and PD 5-15gms
 
of
protein
 
per 
treatment
Also compensate infection inflammation
 
anemia
 
-->so consume
HBV
 
protein
 (1gm/Kg/day)
Na – Salt 2gm/day—salt induce 
thirst
 
High B
 
P,
 
and HF
K-
 
2mg/day K is 
more
 
efficiently
 
removed
 
in PD(daily treatment)
 
 
 
 
 
 
 
 
Phosphorous
 
cause
 
severe
 bone
 
and
 
heart problems
 
, itching
 
and
tissue
 
calcifications (800-1000mg/Day)
 
Ta
 
ke
 
phosphate
 
binders
 
Ca should
 
be
 more
 
than
 
2000mg
 
/day.
 
Ca is pulled out 
by
dialysis
 
lead 
to
 
serious
 
health
 
problems
Fluid-
 
if they
 
consume
 
more fluid
use 
concentrated
 
dialysate
 
if
no
 
urine
 
out
 
put –consume
 
<than
 
1000ml
 
/day
 .
Consume
 
20-25
 
g fiber
 
 
 
 
1.2
 
g of protein/kg
 
body
 
weight/day
 
for 
hemodialysis
 
patients
 
1.3 g of protein/kg
 
body
 
weight/day
 
for 
peritoneal dialysis
 
patients
 
35 
kcal/kg
 body
 
weight
 
for
 
patient less than
 
60 
years
 
of age
 
30
 
to
 
35 
kcal/kg
 body
 
weight 
For
 
patients 60 
years
 or older
Thank 
yo
 
u
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Detailed information about providing nursing care for patients on dialysis, including protocols for machine use, patient care, and investigation, as well as essential aspects of hemodialysis procedures. The content covers access requirements, dialysis machine setup, procedure steps, waste removal, ultrafiltration, and potential complications during hemodialysis. Pre-dialysis care recommendations are also outlined to ensure patient safety and optimal treatment outcomes.


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  1. Nursing Nursing Care Care of of Patient on Dialysis Patient on Dialysis Dr. M.L.Patel Additional Professor Department of Medicine KGMU Lucknow

  2. Nursing Nursing Care Care of of Patient on Dialysis Patient on Dialysis Protocols In each unit in regard to machines,Procedure & patient care Sanitizing machines PD cath care/dressing /treatment Flushing new PD catheter PET Peritonitis care Investigation protocol Vaccination Records /Treatment flow sheets

  3. Hemodialysis Hemodialysis requires requires 5 5 things things 1. Access to patient s circulation (usually via fistula) 2. Access to a dialysis machine and dialyzer with a semipermeable membrane 3. The appropriate solution (dialysate bath) 4. Time: 12 hours each week, divided in 3 equal segments 5. Place: home (if feasible) or a dialysis centre

  4. Hemodialysis Hemodialysis- - Procedure Procedure 1. Patient s circulation is accessed 2. Unless contraindicated, heparin is administered 3. Dialysis solution surrounds the membranes andflows in the opposite direction. 4. Dialysis solution is: a. Highly purified water b. Na,K, Ca, Mg, Cl, & Dextrose c. Either bicarbonate or acetate, to maintain proper Ph. 6. Via the process of diffusion, wastes are removed in the form of solutes (metabolic wastes, acid-base components and electrolytes)

  5. 7. Solute wastes can be discarded 8. Ultrafiltration removes excess water from the blood 9. After cleansing, the blood returns to the client via the access

  6. Access Access during during Hemodialysis Hemodialysis 1. Infection 2. Catheter clotting 3. Central venous thrombosis 4. Stenosis or thrombosis 5. Ischemia of the affected limb 6. Development of an aneurysm

  7. Pre Pre- -dialysis dialysis care care Assess for- Weight: Determines amount of fluid to be removed during dialysis Vital Sign: BP for hypo and hypertension; temperature for sepsis; respiration for fluid Overload Potassium level: Determines potassium level in dialysate (in the chronic setting, this is done monthly unless the patient is symptomatic Hold drugs that pass through the dialysis membrane, such as piperacillin, folic acid, and other water-soluble vitamins. Hold antihypertensive drugs, especially if systolic pressure is below 100, per physician order

  8. Check access site Assess fistula or graft for infection Assess circulation in distal portion of extremity Auscultate for bruit Palpate for thrill No IV or blood draws in that arm No BP in arm

  9. During Dialysis Watch for Hypotension Muscle cramps Nausea and vomiting Headache Itching Less commonly: disequilibrium syndrome, hypersensitivity reaction, arrhythmia, cardiac tamponade, seizures, air embolism

  10. POST DIALYSIS CARE Monitor BP; report hypotension or hypertension Watch for bleeding Check weight and compare (weight loss should be close to fluid removal goal set during treatment) Document unusual findings Assess access site for bruit, thrill, exudate, signsof infection, bleeding Give missed meds, if indicated

  11. NURSHING INTERVENTION IN DIALYSIS 1. Explain procedure to client 2. Cannulating & connecting to HD machine 3. Monitor hemodynamic status continuously 4. Monitor acid-base balance 5. Monitor electrolytes 6. Insure sterility of system 7. Maintain a closed system 8. Diet Restriction- Protein intake, Sodium intake, Potassium intake, Fluid intake 9. Reinforce adjustment to prescribed medications that may be affected by the process of hemodialysis

  12. NURSHING INTERVENTION IN DIALYSIS Gastric ulcers, Hypertension, Calcium deficiencies, Anemia and fatigue, Depression, sexual dysfunction, suicide risk 10. Monitor for complications of dialysis related to: Arteriosclerotic cardiovascular disease Congestive heart failure, Stroke, Infection,

  13. DIET DIET DIALYSIS DIALYSIS PD get calories from Dextrose in the fluid PD patients may eat fewer CHO than hemodialysis patients Protein- HD loses 10-12 gms of Aminoacids and PD 5-15gms of protein per treatment Also compensate infection inflammation anemia -->so consume HBV protein (1gm/Kg/day) Na Salt 2gm/day salt induce thirst High B P, and HF K- 2mg/day K is more efficiently removed in PD(daily treatment)

  14. Phosphorous cause severe bone and heart problems , itching and tissue calcifications (800-1000mg/Day) Ta ke phosphate binders Ca should be more than 2000mg /day. Ca is pulled out by dialysis lead to serious health problems Fluid- if they consume more fluid use concentrated dialysate if no urine out put consume <than 1000ml /day . Consume 20-25 g fiber

  15. 1.2 g of protein/kg body weight/day for hemodialysis patients 1.3 g of protein/kg body weight/day for peritoneal dialysis patients 35 kcal/kg body weight for patient less than 60 years of age 30 to 35 kcal/kg body weight For patients 60 years or older

  16. Thank yo u

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