dry weight assessment in hemo dialysis patients tirupathi- 2013
TRANSCRIPT
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Dry Weight Assesment-2013
Dr.Siva Kumar, Avitum, 12th December 2013
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• Dry Weight Assessment Started : 14th September 2013.
• Pilot Project
• Better Results Expected
• We had to select better patients in whom probing of DW is easy
• Phases of Activity :
Phase I : Shortlisting the Patients
Phase II : Execution of Project
Phase III : Analyzing the results
• Project members in center : Dr. Siva Kumar, Dr. Bhargav, C. Pradeep Reddy &
Mahesh Babu.
Introduction
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To Begin with…
• DW is the lowest weight at which patient does not develop intra dialytic hypotension & cramps
• Probing of DW is a trial & error method
• Coordination & Cooperation of the Patients plays a vital role in this programme
Example: Mr. X IDWG: 4kg Set UF : 4.5 kg Check for : Hypotension & cramps
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So for better Participants… We formulated certain criteria
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Based on the discussed criteria below listed patients were shortlisted
M. Devika A. Hari K. Gurrappa
E. Prabhakar G. Nagabhushanam Raju S. Usha Rani
Phase I: Shortlisting the Patients
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Phase II: Execution of Programme
• Counseling on benefits of maintaining DW
• Diet Counseling
• AV Fistula Care and exercise
• Physical Exercises and hot water bath
• Extra Dialysis Sessions & increasing the Dialysis Duration
• Counseling the Patient attenders
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Counseling regarding benefits of maintaining DW
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Diet Counseling
1. Salt Restriction
2. Fluid Restriction & Thirst Controlling Measures
3. Low Phosphorous Food
4. Low Potassium
5. Protein Rich Food
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Salt Restriction
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High Salt Intake can lead to…
High BP Edema Cardio Vascular Diseases
Fatigue Insomnia ~ Sleeplessness
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Fluid Restriction
Patients are always advised for taking water not more than…
Logic in the formula: Metabolic water in the body produced= 400mlWater lost through Respiration = 400mlWater lost through sweating = 400ml
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Thirst Controlling Measures
Hard Candies Ice Cubes Gargling of water
Avoid exposure to hot & humid climate
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Low Phosphorus Food
High Phosphorous diet can lead to…
• Bone & Teeth problems
• Hardening of Arteries
• Bone Pain
• Itching
• Decreased Calcium levels
Controlled intake of…
• Milk
• Cheese
• Yoghurt
• Ice-creams
• Dried beans
• Beer
• Colas
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Low Potassium Intake
Complications of High K+…
• Numbness
• Irregular heartbeat
• Paraesthesias
• Heart Failure
• Sudden Death
Complications of Low K+
• Cramps • Hypokalemic Periodic Paralysis• Tetany• Flaccid Paralysis
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Advice given…
• Avoid K+ rich fruits & vegetables
• Soaking & draining of Vegetables before cookling
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Protien Rich Food
• Repeated Dialysis leads to loss of protien • Loss of protien can lead to PEM and loss of immunity• Loss of immunity leads to infection
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AV Fistula Care & Excercises
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Counseling Patient on AVF Exercise
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AV Fistula Care Advices…
• Tight fitting garments
• Jewellery
• Weight Carrying
• BP Recordings
• Blood sample Collection
• Sleep position
• The better is your fistula functioning the more is the efficiency of Dialysis
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Physical Exercises
Walking (2 miles/day) Cycling (5 miles/ day) Climbing Stairs 15min
Gardening (45min/day) Swimming & Water Aerobics (30 min)
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When to avoid the excercises…
Chest Pain Irregular or Raphid heartbeat Leg cramps
Dizzy & light headed Fever & Joint problems
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Hot water bath
2-3 times of Hot water bath/day on Non-Dialysis Days…
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1. Extra Dialysis Sessions & increasing the Dialysis Duration We have provided the extra slots for the shortlisted patients and prolonged Dialysis durations at times whenever required.
2. Counseling the Patient Attenders
• Moral Support• Maintaining Diet principles• Ensure the patient performs the advised AVF Exercise
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Monitoring of Patient at the center
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M. Devika( Detoriating) A. Hari (Reached DW) Gurrappa (Constant) Observation
Prabhakar (Detoriating) Nagabhushanam (Constant) S. Usha Rani (Improved)
Phase III : Analysis
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Challenges Non Adherence to Counseling Very Low Urine Output
C H
R O N I
C
P A T I E
N TDepression Number of Anti- Hypertensive drugs
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Co-Morbidities
CHF Obesity
Diabetes
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Travel Expenses
Poverty
Rich Protein Food
Supplementary Medication
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Un Education No Co-Operation From Attenders
Absenteeism Having Food & water during Dialysis
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Attending Functions/ Parties
Poor AV Fistula Care Free Treatment
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Weighing Machine Errors BP Recording Errors
Not Achieving the UF Goal
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Proposal
Probing of DW assessment is possible in newly diagnosed CKD patients.
• Health Conscious
• No Depression
• More Co-Operation form Patient Attenders
• Less Co-Morbidities
• Better Urine Output
• Less number of Anti-Hypertensive Usage
• Adherence to Counseling
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WE HAVE THAT COURAGE…. WE’LL TAKE FORWARD THIS….!!!
“Success is not Final… Failure is not Fatal…
Finally Courage to Continue is what Matters”…!!!
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THANK YOU…
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