Wait a second!
More handpicked essays just for you.
More handpicked essays just for you.
Chapter 47: Nursing Management: Acute Kidney Injury and Chronic Kidney Disease
Don’t take our word for it - see why 10 million students trust us with their essay needs.
Ms. Poulos is a Staff RN in the Hemodialysis Unit. She is currently the primary nurse for five of our chronic dialysis patients. Each of her primary patients has exceeded the quality benchmarks in the areas of adequacy, anemia management and access. As a member of the interdisciplinary team she attends monthly care plan meetings and has made suggestions that have led to positive outcomes such as: changes in dry weights, medication reviews with the nephrologist to facilitate warranted medication adjustments as needed as well as referrals/close coordination with other disciplines such as vascular, endocrine, infection prevention, social services and oncology to meet the needs of her patients. She is able to quickly assess subtle changes in her …show more content…
Poulos provided support to one of her patients during a stressful time when diagnosed with prostate cancer. She was diligent during his six week course of radiation treatment. The patient was monitored closely for any untoward symptoms that could interfere with his dialysis treatments. The fluid gains and/or losses between treatments interrupted his normal bowel function. She worked with the physicians to achieve a positive outcome for the patient. Ms. Poulos had another patient she worked closely with who had a few hospitalizations in this past year for ischemic colitis. Being a fragile older man the surgery team felt he needed to be treated conservatively. Taking care of this patient was challenging because it was difficult to keep his blood pressure elevated to prevent further ischemic issues however her diligence in caring for the patient lead to his success.
Ms. Poulos was responsible for managing the Dialysis Flu Clinic. She was responsible for giving the patients their vaccinations and tracking those that received the vaccine outside of the VA. Her tracking included: whether the patient received the high dose vs. the normal strength, any refusals, placement of vaccination and the date. The tracking was captured in CPRS to make sure the patient’s medical records remained up to
Kidney Care is comprised of U.S. dialysis and related lab services, ancillary services and strategic initiatives, including international operations and corporate administrative support. The U.S. dialysis and related lab services business is the largest line of business, which is a leading provider of kidney dialysis services in the U.S. for patients suffering from chronic kidney failure, also known as end stage renal disease (ESRD). The HCP division is a patient- and physician-focused integrated healthcare delivery and management company with over two decades of providing coordinated, outcomes-based medical care in a cost-effective manner ("DaVita Healthcare Partners 10-K Annual Report" 2015). STp(c) Segmentation, targeting, and positioning together comprise a three stage process.
When we see patients, we must remember that we are not simply treating a disease. We are caring for people with lives, hobbies, jobs, families, and friends, who are likely in a very vulnerable position. We must ensure that we use the status of physicians to benefit patients first and foremost, and do what we promised to when we entered the profession: provide care and improve quality of life, and hopefully leave the world a little better than it was
At the time of the interview Mrs. Mays suffered from high blood pressure and worried that if she doesn’t get it under control she would suffer a stroke. She also complained of painful arthritis of the spine as well as a herniated lumbar disc. To combat the spine pain she was on muscle relaxers and painkillers that made her extremely lethargic. During Ms. Mays’ lifetime she had two bouts with cancer, skin and breast cancer. She has since been cancer free but undergoes mammograms and full body scans every six months as precautions to check for irregularities. Overall she considers herself very lucky to be relatively healthy and independent at her
Malnutrition is common in haemodialysis patients due to specific characteristics of chronic renal insufficiency such as insufficient filtration ability and accelerated protein degradation. A deteriorated nutritional condition threats chronic dialysis patients lowered mobility and poor outcome include increased mortality (Carrero et al., 2013; Locatelli et al., 2002; Vannini, Antunes, Caramori, Martin, & Barretti, 2009). Thus there are several malnutrition indicators of haemodialysis patients were proposed such as SGA, GNRI and albumin level. Nevertheless, detection rate of each indicators seems to differ to each other (Pifer et al., 2002) and consideration of particular characteristics of haemodialysis patients is required for the practical apply. Hence, use of sensitive identifying assessment method and early intervention on malnourished patients are quite meaningful.
Ms. Bardsley functions as a hemodialysis liaison and leader in clinical practice with the following roles: charge nurse, preceptor, and mentor for her colleagues. She is the resource person for the Hct-Line monitoring tool. The tool is used to monitor patient’s fluid removal during treatment to avoid hypotensive episodes associated with decreased perfusion to the heart. She routinely monitors the patient outcomes which to date has resulted in 0 admissions. She recently updated the policy to make it more user friendly for the staff and to maintain staff competency.
More often than not positive patient outcomes come from these procedures, but not without challenges along the road to recovery. Recently I had a patient that underwent a bowel resection with establishment of an end colostomy for the treatment of her diverticulitis. Fortunate, the procedure went without complications from a surgeon’s point of view, but sadly this was not the case for the patient. Caring for this patient postoperatively presented great opportunity for me to practice presence. The pain and suffering my patient was experiencing had nothing to do with the mechanical aspect of her surgery, but rather the emotional craters created by discovering her colostomy bag. For the patient, a colostomy was the absolute worst case scenario. New colostomies require frequent attention from nurses; checking for viable tissue, emptying output, and watching for signs of infection. Each time I assessed the ostomy humiliation and shame consumed her spirit and body. After the second flood of these emotions, I stopped dead in my tracks, pulled up a chair and asked the patient “how are you feeling”. A constant stream of tears ran down her face as she expresses to me the fear she has in telling her significant other that she will forever have “a bad of feces” on the outside of her abdomen. My heart cried for her! I couldn’t imagine how she must feel. As a woman, she previously viewed her body as a sacred part of her that she was able to share with her partner, but she no longer felt beautiful and sexy, but rather a disgrace. Her painful emotions struck my heart like a bolt of lightning, how was I supposed to help her see the beauty of this colostomy? In the end, it was my time and patience coupled with positive affirmations that relieved her fears of the unknown. I had every opportunity to place ignorance at the frontline of my care and ignore the obvious
...cannot attend to it alone. The nurse must be able to understand and organize a multi-dimensional approach to care. During my clinical experience I was able to work with CNA’s, LPN’s and RN’s. This allowed me to learn from their experience and to deliver better care as a result. I also worked with members of my own team and we each learned from each other’s strengths and weakness.
After further multidisciplinary team meetings with the involvement of John the treatment option of automated peritoneal dialysis was implemented (NSF 2004). Once the Tenchkoff catheter had been inserted, education and training completed John was ready for discharge home.
As a NP in the urgent care field K.W. analyzes lab data during many visits. This competency focuses on skills, understandings and integrative abilities and this helps the APN with basic foundation in being able to translate results into the proper patient outcomes (National Organization of Nurse Practitioner Faculties, 2012).
Dialysis is a process by which excess waste and water is removed from the blood to maintain a balanced proportion of contents/nutrients. Dialysis is done by using different dialysis machines which are usually very costly and sensitive. The duty to maintain a constant proportion of contents in the blood is usually done by kidneys but when they are not functioning properly the procedure of dialysis used. Therefore it is a very important and beneficial process for people whose kidneys are not functioning properly or who cannot undergo a kidney transplant due to various reasons for example blood type or reactive immune system. The process of dialysis might look very simple but there is a lot more ethical complexity related to it that will be elaborated. (White & Fitzpatrick)
Chronic kidney disease (CKD) is increasingly becoming a major community and public health issue. This paper looks into CKD as both a community and public issue and proposes how concerned stakeholders and partners can be mobilized to work together toward fighting the disease.
According to Duffield, Roche, Dimitrelis, Homer, and Buchan (2015), nurse leaders play a critically important role in staff morale and retention. In consideration of this, the most effective method of sharing these findings would be an initial one-on-one presentation with the nurse manager. Posters in key areas of the facility could possibly take care of any relationship education directed to the staff. In order to disseminate the information beyond one facility, there could first be one-on-one presentations with the other facility managers. If the information proved to be helpful, a submission to one of the national nephrology journals could be a
On these occasions, I rely on my nursing assessment, evaluation, and interventions, collaborative skills, and scientific knowledge to make sound clinical judgments for the benefit of my patients. As a hemodialysis nurse, I will persevere to comply with innovation in nursing practice, EBP, research, and education. I believe growth requires generation of innovative, improved ideas and practices for the betterment of the organization and patient satisfaction. For this reason, I will embrace technological advancements; empower front line staff to embrace change and innovation; and motivate staff to be change agents on the floor with the aim to provide better quality of care for our
My first patient that I started as student nurse on one of the long Rehab Center was a seventy two year old man who had Clostridium difficile (C.diff), Dementia, Hip replacement, and Obesity. Due to the above sickness he had many complications. I can still remember his face suffering from pain. Because of his lack of ambulation and incontinence, he had developed a very serious pressure ulcer under his sacral area. I went through to the room with my instructor and the instructor introduces me for the patient as his student nurse from Towson University and will taking care of him. However the patient was not happy and he becomes a challenging patient in my first experience day. But I may learned more from that challenging patient for my future experience.
The community- level practice focus is to change the norm, attitudes, practice behavior and increase the knowledge of the entire community regarding the importance of immunization and the consequences of not being immunized (Stanhope & Lancaster, 2012). PHN primary goal is to prevent illness or a disease from occurring. Administering vaccines are a primary intervention that the PHN provides. The local public health nurses provided information packages to the public schools, senior citizen centers, daycare centers and other local businesses on the need for flu vaccines and where to go for free or affordable flu vaccines. In the packet was a contact card for the community to give back to the PHNs. This was a way for the PHNs to track the number of people who responded to the outreached message. Once a year...