Medical Essay on Renal Failure

A dialysis center offers both inpatient and outpatient services to patients experiencing sudden and a gradual loss of kidney function. Such patients may be suffering from acute kidney injury, end-stage renal disease or chronic renal disease. Renal replacement therapy is implicated for a patient with stage five-kidney disease and can include procedures such as kidney transplant, peritoneal dialysis, and hemodialysis (Kiousi & Grapsa, 2015). Moreover, renal replacement therapy is indicated for patients requiring toxin removal, or those with acid-base and electrolyte imbalance. The various types of hemodialysis include: the conventional type where patient makes 2-3 visits the dialysis center; daily dialysis whereby the patient perform the procedure at home on a daily basis; nocturnal hemodialysis where the procedure is done as the patient is asleep either at home or in the care center. For a hemodialysis procedure, the patient is required to have 2-3 dialysis sessions in a week. The sessions can last 2-4 hours, but the nature or extent of injury to the kidneys will determine the speed of the procedure.

Once in the dialysis center, the patient checks in at the reception desk and waits for their turn. The attending nurse directs the patient to their room that houses their dialysis machine. The room is either a private room, devoid of other occupants or a large room with multiple patients. The attending nurse first performs a thorough physical examination on the patient to ascertain the presence of renal disease complication. In the presence of such complications, such as edema due to heart failure, nurses are required to report the incidence to the physician for further management plans. The absence of complications gives the green light to renal replacement therapy initiation.

Before initiating the procedure, the attending nurses and technicians wash their hands with detergent soap and running water. In between procedures, they would use alcohol-based hand gels to sanitize their hands. This activity is aimed at reducing the multiple causes of infection in the patient. It is evident that a patient receiving dialysis has a weakened immune system and is susceptible to a variety of infections such as hospital-acquired pneumonia and enteric bacterial infections. After this, the nurse measures the patients weight and vital signs that includes pulse rate, heart rate, respiratory rate, temperature and the blood pressure. The patient is then allowed to sit and lie back on the seat, beside the dialyzer.

Next, the nurse cleans the site for vascular access with a methylated cotton swab. Vascular access is established via a cannula and a set of tubes connected to the hemodialysis machine. The machine pumps blood from the patient to a dialyzer, through which filtration of waste components in the blood occurs. Once filtered the waste-free blood is channeled back into the patient's vascular system via a second tube. To reduce transmission of diseases and infections, the nurses use new sets of cannular and tubes on each patient thus eliminating potential errors and risks. During the process of vascular access, the nurse offers information to the patient concerning safe site access and site exit measures.

Throughout the procedure, the attending nurse continually monitors the patient's vital signs and makes necessary documentation. In case of derangements, they consult physicians for advice on the most appropriate course of action. Nevertheless, the registered nurse educated the patient on several subjects inluding the importance of constantly receiving dialysis, dietary education, complications of the renal replacement therapy, medication adherence and adverse effects of medication therapy. The nurse answers any patient issues arising raised by the patient and offers clarifications. After the end of the procedure, the patient receives medications and an appointment for later dialysis sessions.

References

Kiousi, E., & Grapsa, E. (2015). The role of an out-patient renal clinic in renal disease management. Journal of Translational Internal Medicine, 3(1), 3-7.