NCM-103

Hemodialysis, Peritoneal Dialysis, Kidney Surgery

Submitted by: Jesthony L. Cordero

Submitted to: Mr. Ivo Pardillo, MN

HEMODIALYSIS
-is used for patients who are acutely ill and require short-term dialysis and for patients with advanced CKD and ESRD who require long-term or permanent renal replacement therapy. Hemodialysis prevents death but does not cure renal disease and does not compensate for the loss of endocrine or metabolic activities of the kidneys. -the objectives of hemodialysis are to extract toxic nitrogenous substances from the blood and to remove excess water. In ultrafiltration, water moves under high pressure to an area of lower pressure. *Complications* With the initiation of dialysis, disturbances of lipid metabolism (hypertriglyceridemia) are accentuated and contribute to cardiovascular complications. Coronary heart disease Heart failure Angina Peripheral vascular insufficiency Stroke Anemia Gastric ulcer Nausea & Vomiting Worsening calcium metabolism Renal osteodystrophy

Nursing Management support, assess, and educate the patient patient requires constant monitoring maintenance of the vascular access device Promoting Pharmacologic Therapy medications that are water soluble are readily removed during hemodialysis treatment and those that are fat soluble or adhere to other substances are not dialyzed out very well. patient must know when and when not to take the medication. For example, if an antihypertensive agent is taken on a dialysis day, hypotension may occur during dialysis, causing dangerously low blood pressure. Promoting Nutritional and Fluid Therapy diet is important for patient maintain good nutritional status through adequate protein, calorie, vitamin, and mineral intake protein intake is restricted Home Hemodialysis - Home hemodialysis requires a highly motivated patient who is willing to take responsibility for the procedure and is able to adjust each treatment to meet the bodys changing needs. It also requires the commitment and cooperation of a caregiver to assist the patient.

The patient undergoing home hemodialysis and the caregiver assisting that patient must be trained to prepare, operate, and disassemble the dialysis machine; maintain and clean the equipment; administer medications into the machine lines; and handle emergency problems.

PERITONEAL DIALYSIS
- The goals of peritoneal dialysis are to remove toxic substances and metabolic wastes and to reestablish normal fluid and electrolyte balance. This may be the treatment of choice for patients with renal failure who are unable or unwilling to undergo hemodialysis or renal transplantation. Preparing the patient The nurses preparation of the patient and family depends on the patients: Physical and psychological status, Understanding of and familiarity with the procedure Level of alertness Previous experience with dialysis The nurse explains the procedure and must obtain signed consent, baseline vital signs and serum electrolyte levels are recorded. Preparing the equipment Before medications are added, the dialysate is warmed to body temperature to prevent patient discomfort and abdominal pain and to dilate the vessels of the peritoneum to increase urea clearance Immediately before initiating dialysis, using aseptic technique, the nurse assembles the administration set and tubing. Inserting the Catheter Ideally, the peritoneal catheter is inserted in the operating room or radiology suite to maintain surgical asepsis and minimize the risk of contamination. However, in some circumstances, the physician may insert the rigid stylet catheter at the bedside using strict asepsis. Complications Acute Complications Peritonitis - the first sign of peritonitis is cloudy dialysate drainage fluid. Diffuse abdominal pain and rebound tenderness occur much later. Hypotension and other signs of shock may also occur with advancing infection. Leakage -leakage of dialysate through the catheter site may occur immediately after the catheter is inserted. Usually, the leak stops spontaneously if dialysis is withheld for several days.

Bleeding -bleeding is also common during the first few exchanges after a new catheter insertion because some blood enters the abdominal cavity following insertion. Long-Term Complications Approaches Peritoneal Dialysis can be performed using several different approaches: - Acute intermittent peritoneal dialysis - Continuous ambulatory peritoneal dialysis (CAPD) - Continuous cyclic peritoneal dialysis (CCPD) Nursing Management of the hospitalized patient on dialysis Protecting Vascular Access Taking precautions during intravenous therapy monitoring symptoms of uremia detecting cardiac and respiratory complications controlling electrolyte levels and diet managing discomfort and pain monitoring blood pressure preventing infection caring for the catheter site administering medications provide psychological support

KIDNEY SURGERY
-a patient may undergo surgery to remove obstructions that affect the kidney, to insert a tube for draining the kidney, or to remove the kidney involved in unilateral kidney disease, renal carcinoma, or kidney transplantation. Patient positioning and incisional approaches: (a) Flank approach (b) Lumbar approach (c) Thoracoabdominal approach Nursing management administer analgesic agent as prescribed. assist patient to change positions frequently assist with and encourage early ambulation