1. The client/caregiver can define hemodialysis.
    1. It is a process that mimics the functions of the kidney, removing wastes and other impurities and excessive fluid from the body.
    2. The blood is removed from the body and put into a dialyzer to filter it and is then returned to the body.
    3. The procedure usually lasts approximately 3 to 6 hours and is usually required three times per week.
  2. The client/caregiver can list various types of vascular access for hemodialysis.
    1. An external shunt may be placed in the wrist or forearm to connect an adjacent artery and vein.
    2. An internal fistula may be placed in the wrist or forearm to connect an adjacent artery and vein.
    3. An artificial graft is an additional segment added to a client’s own vessel to connect the artery and vein.
    4. For temporary hemodialysis, a catheter may be inserted into the subclavian vein at the shoulder or into the femoral vein at the groin.
  3. The client/caregiver can list measures to follow when receiving dialysis.
    1. Follow the diet as prescribed, usually low protein, low sodium, high carbohydrate, high fat, and low potassium.
    2. Restrict fluid as prescribed.
    3. Weigh as recommended.
    4. Avoid infection.
    5. Obtain adequate rest and exercise.
    6. Take medications as prescribed.
    7. Wear Medic Alert bracelet.
    8. Keep follow-up appointments with physician and dialysis.
    9. Report any light-headedness, dizziness, nausea and vomiting, sweating, headache, weakness, lethargy, muscle weakness or cramps, and irregular pulses.
  4. The client/caregiver can adequately care for the access blood route.
    1. Never allow anyone to take blood pressure, draw blood, or give injections on the arm being used for dialysis.
    2. Avoid trauma to the site.
    3. Avoid constrictive clothing on the affected arm.
    4. Avoid heavy lifting.
    5. Cleanse cannula as instructed and apply a dry, sterile dressing.
    6. Palpate the site for a vibration (thrill), which indicates blood circulation or listen with a stethoscope for a rushing sound (bruit).
    7. Report any swelling or pain over the site or absence of thrill or bruit to physician.
    8. Report any signs of infection (i.e., redness, tenderness, and warmth).
    9. Report any signs of lack of circulation, i.e., numbness, tingling, or coolness in extremities.
    10. Report any bleeding.
  5. The client/caregiver is aware of possible complications.
    1. Infection
    2. High or low blood pressure
    3. Heart arrhythmias
    4. Hemorrhage and anemia
    5. Air embolus
    6. Restless leg syndrome
    7. Hepatitis B
    8. Muscle cramps
    9. Hypovolemia and shock
    10. Disequilibrium syndrome

Resources

American Association of Kidney Patientswww.aakp.org
American Kidney Fundwww.kidneyfund.org
National Kidney Foundationwww.kidney.org
Dietitian
Support groups
Counseling

References

Ackley, B. J., & Ladwig, G. B. (2006). Nursing diagnosis handbook: A guide to planning care. St. Louis: Mosby Inc.Canobbio, M. M. (2006). Mosby’s handbook of patient teaching. St. Louis: Mosby Inc.Perry, A., & Potter, P. (2006). Clinical nursing skills & technique. St. Louis: Mosby Inc.Timby, B. K., & Smith, N. C. (2003). Introductory medical-surgical nursing (8th ed.). Philadelphia: J. B. Lippincott

Credits

Client Teaching Guides for Home Health Care, 2nd ed.© 2008 Jones and Bartlett Publishers, Inc.www.jbpub.com

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