Peritoneal dialysis is an alternative to hemodialysis that allows patients with kidney disease the ability to be flexible and maintain a high quality of life, while receiving dialysis. Continuous ambulatory peritoneal dialysis (CAPD), intermittent peritoneal dialysis (IPD), and continuous cycling peritoneal dialysis (CCPD) are some of the options available to these patients and although they are all different they operate on the same premise. A permanent, indwelling catheter will be inserted into the peritoneum and using aseptic technique, the indwelling catheter is hooked up to a large bag of dialysate. The fluid is then infused into the peritoneal cavity either by machine or by gravity. Through diffusion and osmosis extra fluid and waste products enter the dialysate fluid and are removed from the body when the fluid is drained. The process involves a specific fill, dwell and drain time which altogether equals one exchange. The choice of fluid type, treatment, and exchange time are based on the specific needs of the patient (Lippincott, Williams and Wilkins, 2014). In order to be able to utilize this type of dialysis a patient must not have extensive abdominal adhesions, or multiple abdominal surgeries, and they must not have a cognitive deficit that would impair their ability to carry out the set procedures necessary to safely perform the treatment (Mendelssohn, et al., 2009). There are many benefits to this method of dialysis, but there are also several serious risks involved such as peritonitis, severe protein loss, fluid volume overload, catheter site infections and abdominal hernias. A patient may not be able to completely avoid complications, but they can significantly reduce their risk with proper education and utilization...
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...13). Best available evidence for peritoneal dialysis catheter exit-site care. Nephrology Nursing Journal, 63-68.
Lippincott, Williams and Wilkins. (2013). Professional Guide to Diseases. Ambler, PA: Wolters Kluwer Health.
Lippincott, Williams and Wilkins. (2014). Lippincott Manual of Nursing Practice. Ambler, PA: Wolters Kluwer Health.
Mendelssohn, D. C., Mujais, S. K., Soroka, S. D., Brouillette, J., Takano, T., Barre, P. E., . . . Finkelstein, F. O. (2009, August 28). A prospective evaluation of renal replacement therapy modality eligibility. Nephrology Dialysis Transplantation, 555-561. doi:10.1093/ndt/gfn484
Savas, O., Yucel, L., Guvenc, S., Ekiz, S., & Kazancioglu, R. (2009, September). Assessing and training patients on peritoneal dialysis in their own homes can influence better practice. Journal of Renal Care, 35(3), 141-146. doi:http://splashurl.com/peeoxey
Mcgrogan, A., Franssen, C. F. and De Vries, C. S. 2011. The incidence of primary glomerulonephritis worldwide: a systematic review of the literature. Nephrology Dialysis Transplantation, 26 (2), pp. 414-430.
2013). Inappropriate use of urinary catheter in patients as stated by the CDC includes patients with incontinence, obtaining urine for culture, or other diagnostic tests when the patient can voluntarily void, and prolonged use after surgery without proper indications. Strategies used focused on initiating restrictions on catheter placement. Development of protocols that restrict catheter placement can serve as a constant reminder for providers about the correct use of catheters and provide alternatives to indwelling catheter use (Meddings et al. 2013). Alternatives to indwelling catheter includes condom catheter, or intermittent straight catheterization. One of the protocols used in this study are urinary retention protocols. This protocol integrates the use of a portable bladder ultrasound to verify urinary retention prior to catheterization. In addition, it recommends using intermittent catheterization to solve temporary issues rather than using indwelling catheters. Indwelling catheters are usually in for a longer period. As a result of that, patients are more at risk of developing infections. Use of portable bladder ultrasound will help to prevent unnecessary use of indwelling catheters; therefore, preventing
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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.
Taylor, C. (2011). Introduction to Nursing. Fundamentals of nursing: the art and science of nursing care (7th ed.). Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.
K. Lynn Wieck, RN, PhD, FAAN, is the Jacqueline M. Braithwaite Professor, College of Nursing, The University of Texas at Tyler, Tyler, TX, and CEO, Management Solutions for Healthcare, Houston, TX; Jean Dois, RN, PhD, NEA-BC, FACHE, is the System Director for Quality and Nursing, CHRISTUS Health System, Houston, TX; and Peggy Landrum, RN, PhD, is Clinical Professor, College of Nursing, Texas Woman 's University, Houston,
It has also developed numerous courses that are intended to provide information and tools that may be needed to approach both significant nursing care and patient care issues. Given the scale of the population suffering with chronic kidney disease and the diversity of backgrounds in which patients are found, this curriculum may be of benefit to nurses caring for nephrology patients in many settings (ANNA, 2015). It supports, promotes among its members, and sponsors nursing research intended to develop evidence-based practice and to advance nursing science (ANNA, 2015). It strives to provide nurses with leadership opportunities, and encourages nurses to seize opportunities to advance and refine their leadership abilities (ANNA, 2015).
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.
(3)Bellomo,R.,Cass,A.,Cole,L.,Finer,S.,Gallagher,M.,Lo,S.,McAthur,C.,McGuinness,S.,Myburgham J.,Norton,R.,Scheinkestel,C.,& Su,S. for renal study investigators(2009).Intensity of continuous renal-replacement therapy in critically ill patients. The New England Journal of Medicine, 361(17), 1627-1638.
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Spark Ralph, S. & Taylor, C. M. (2011). Nursing diagnosis reference manual (8th ed.). Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.
As the kidneys regulate the quantity of fluid which leaves the body, patients who suffer from kidney disease progression, may be not be able to regularize fluid removal from their body. Due to this scenario, their physician or specialist may ask them to reduce their intake of fluid. Lowering daily fluid intake for the renal diet involves: not drinking to socialize or from habit, only having a drink when thirsty, and sucking on a wedge of lemon or chips of ice. It also entails taking measures for monitoring the quantity of fluid that is drunk. This is done by measuring a regularly used glass or cup to measure the quantity of fluid it holds, as well as placing the recommended daily quantity of water into a specific container, and then only taking the fluid that is consumed from this. This insures that the recommended amount is not exceeded (Medical
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
Potter, P. A., & Perry, A. G. (2009). Fundamentals of nursing (Seventh ed.). St. Louis, Mo.: Mosby Elsevier.