ࡱ> `0bjbj ALLLLLLLV ----tv-T~T2-----2&2 2SSSSSSS$UhXR#TL2g2^222#TLL--8TI8I8I82BL-L-SI82SI8I8QLLS-- #qj-A4=RSNT0~TUR8jX5DjX0SjXLSp22I822222#T#T'8"222~T2222+d+`^RLLLLLL  Introduction Dialysis is used to remove fluid and waste products from the body when the kidneys cannot do so, it may also be used to treat patient with edema that does not respond to treatment, hepatic coma, hyperkalemia, hypercalcemia, hypertension, uremia. hemodialysis Definition: Hemodialysis is procedure in which a machine filters harmful waste and excess salt and fluid from the blood. a needle is inserted into the arm through aspecial access point . The blood is then directs through the needle to a machine called a dialyzer. Indication: * Uncontrolled hypertension. * Neurological problems. * Pericarditis. * Fluid overload. Complication: * Muscle cramps. * hemorrhage. * Air embolus. * Hypertension. * Anemia. * Cardiac dysrhythmias. * Disequilibrium syndrome. Signs and symptoms:- Fever * *Redness *Tenderness around the fistula *Painful muscle *Nausea and vomiting *Headache. Underlying principle of hemodialysis: Equipment: 1. Dialysis Machine The dialysis machine is about the size of a dishwasher. This machine has three main jobs: * pump blood and watch flow for safety * clean wastes from blood * watch your blood pressure and the rate of fluid removal from your body  2. Dialyzer The dialyzer is a large canister containing thousands of small fibers through which your blood is passed. Reuse. Your dialysis center may use the same dialyzer more than once for your treatments. 3. Dialysis Solution Dialysis solution, also known as dialysate, is the fluid in the dialyzer that helps remove wastes and extra fluid from your blood 4. Needles Access point: * They are three types of access point: 1) Temporary access: the surgeon may insert a plastic tube (catheter) into a large vein in the neck or near the groin. Risk of infection, clotting in the catheter. 2) Arteriovenous (AV) fistula: surgically created AV fistula a connection between an artery and vein (forearm). An AV fistula is less likely than other type of access point to from clots or infected.  3) Arteriovenous (AV) graft: if the blood vessels are too small to from an AV fistula, the surgeon may instead connect an artery and vein with synthetic tube. An AV graft more likely to from clots and infection.  Patient management: Anti-itching medications Common choices: Diphenhydramine (Benadryl), hydroxyzine (Atarax, Vistaril). Why you need them: To control or reduce the itching that may occur due to dry skin or a high phosphorus level. Blood thinners Common choices: Heparin sodium (Heparin), warfarin (Coumadin). Why you need them: To control your blood pressure. Erythropoietin Common choices: Epoetin alfa (Epogen, Procrit), darbepoetin (Aranesp). Why you need it: To stimulate your bone marrow to produce new red blood cells, which helps prevent anemia. Phosphate binders Common choices: Calcium acetate (PhosLo), sevelamer (Renagel). Vitamin D supplements Common choices: Paricalcitol (Zemplar), calcitriol (Calcijex, Rocaltrol), doxercalciferol (Hectorol). Why you need them: To improve your body's ability to absorb calcium and manage levels of parathyroid hormone. Why you need them: To prevent the buildup of phosphorus in your blood. Dietary management * Eat high protein food (meat, fish, eggs). * Low high salt, potassium, phosphors food (milk, cheese) * Low calorie intake (bread, drains). * Eat fresh vegetables contain no salt. * Eat fresh fruits less potassium. Role of nurse: * Predialysis: Cheek weight. V/S ( T , BP , P ) . Cheek dialysis machine and prepare the patient ( simple position ) Access the machine sterile ( disinfection programme ) . Insert a fistula in artery and vein (neck , arm , subclavian ) . Dialyzer (filter the blood). N/S 1000 cc IV over 4 hrs. * Intradialysis: Explain the procedure. V/S Give the patient medication (heparin, N/S) Access complication and Signe and symptoms. * Postdialysis: Cheek weight. V/S Give the patient eprex Assessment : Subjective data: PT said " suddenly decreased urin output, I can't move because my body is full fluid, and I feel headache, decreased with rest, vomiting. Diagnosis : Excess fluid volume R/T decreased urin output A.M.B patient verb. Imbalanced nutrition less than body requirement R/T nausea and vomiting A.M.B patient verb. Activity intolerance R/T fatigue A.M.B patient verb. Planning : Goal : maintenance of ideal body weight without excess fluid - objective patient will be able to limit fluid intake and diuretic Goal : maintenance of adequate nutritional intake . - objective patient will be able to increased dietary intake . Goal : participation in activity within tolerance . - objective patient will be able to alterneting activity with rest . Implementation : Teach the patient to limit fluid intake to prescribed volume . - give the diutic medication . - teach the patient to increased dietary intake . Encourage patient to rest after dialysis treatment . Evaluation : - patient verb to limit fluid intake . - patient facial expression verb . - patient verb he can easy move . Documentation : - note the data and time of hemodialysis. - describe the reason for the hemodialysis and significant finding . 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