clinical presentation on hemodialysis

7/29/2019 Clinical Presentation on Hemodialysis

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HEMODIALYSIS


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CLINICAL PRESENTATION ONADVANCED NURSINGPRACTICE

TOPIC : HEMODIALYSIS

PRESENTED BY: Mr. RAVI

BASARGI Msc Nsg I Year


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INTRODUCTION

Dialysis is used to remove fluid &uremic waste

products from the body when kidneys are unable

to do so

It may be used to treat patients with edema that

does not respond to other treatment

hyperkalemia ,hypercalcemia ,hypertension &

uremia

Need for dialysis may be acute or chronic

Acute dialysis may be indicated when there is

high &increasing level of serum potassium ,fluid

overload ,increasing acidosis ,pericarditis, severe

confusion ,.It is also be used to remove certain


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TYPES OF DIALYSIS

1.HEMODIALYSIS

2.PERITONEAL DIALYSIS


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HEMODIALYSIS

Hemodialysis is the most common methodof dialysis more than 280000americans

currently recieve chronic hemodialysisIt is the process of purifying the blood &removing the waste products from theblood outside the body &the purified bloodis reinfused

Hemodialysis is used for patients who areacutely ill & require short term dialysis (daysto weeks)for patients with ESRD who requirelong term or permanent therapy


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For patients with chronic renal failurehemodialysis prevents death ,it does not curerenal disease &does not compensate for theloss of endocrine or metabolic activity ofkidneys

Treatment usually occurs 3 times a week for 3to 4 hrs /treatment

Patients receive chronic or maintenancedialysis when they require dialysis therapy forsurvival &control uremic symptoms


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OBJECTIVES

TO extract toxic nitrogenous substancesfrom the blood &to remove excess water

In hemodialysis the blood laden withtoxins & nitrogenous wastes is divertedfrom the patient to a machine a dialyzerwhere toxins are removed & blood is

returned to the patient


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PRINCIPLES

Diffusion

Osmosis

Ultrafiltraton


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DIFFUSION

The toxins &waste in the blood are removed bydiffusion that is they move from an area ofhigher concentration in blood to an area of

lower concentration dialysateThe dialysate is a solution made up of all the importantelectrolytes in their ideal extracellular concentration

The electrolyte level in the patients blood can bebrought under control by properly adjusting the dialysatebath

The semipermeable membrane impends the diffusion oflarge molecules such as RBCs & proteins


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ULTRAFILTRATION

Water moves under high pressure to to an area low pressure

This process is much more efficient than osmosis at water

removal &is accomplished by applying negative pressure or asunctioning force to the dialysis membrane because patientswith renal disease usually can not excrete water this force isnecessary to remove fluid to achieve fluid balance

The anticoagulant heparin is administered to keep bloodfrom clotting in dialysis circuit cleansed blood is returned to

the body by the end of the dialysis treatment ,many wasteproducts have been restored to normal


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TYPES OF DIALYSERS

1. HOLLOW FIBER

2. PARALLEL FLOW PLATE3. THE COIL


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1. HOLLOW FIBER DIALYSER


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3.COIL DIALYSER


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COMPOSITION OF DIALYSATE

FLUID

sodium 140.0

potassium 1.0

calcium 1.25

bicarbonate 34.0

magnesium 0.5chloride 107.5

glucose 5.5

E i


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Equipment

For preparing the hemodialysis

machineFor hemodialysis with a double-lumencatheter:

For hemodialysis with an AV fistula

For hemodialysis with an AV shunt

For discontinuing hemodialysis with adouble-lumen catheter

For discontinuing hemodialysis with anAV fistula

For discontinuing hemodialysis with anAV shunt


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HEMODIALYSIS ACCESS SITES


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1.SUBCLAVIAN VEIN CATHETERISATION


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2.FEMORAL VEIN CATHETERISATION


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3.ARTERIO VENOUS FISTULA


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4.ARTERIOVENOUS SHUNT


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5.ARTERIO VENOUS GRAFT


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PREPARATION OF EQUIPMENTS


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WORKING OF HEMODIALYSIS


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IMPLEMENTATION

Check vital signs

Give comfortable position

Use standard precaution


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1.Beginning hemodialysis with a

double-lumen catheter


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2.Beginning hemodialysis with an AV

fistula


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3Beginning hemodialysis with an AV

shunt


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4. Discontinuing hemodialysis with a

double-lumen catheter


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5. Discontinuing hemodialysis with an

AV fistula


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6.Discontinuing hemodialysis with an

AV shunt


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Special considerations


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Home care


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COMPLICATIONS

FEVER

DIALYSIS DISEQUILIBRIUMS

SYNDROMES

HYPOVOLEMIA

HYPERNETREMIA

HYPERGLYCEMIA


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DOCUMENTATION

Record the time treatment began and anyproblems with it. Note the patient's vital

signs and weight before and duringtreatment. Note the time blood sampleswere taken for testing, the test results, andtreatment for complications. Record the

time the treatment was completed and thepatient's response to it.


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clinical presentation on hemodialysis

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