Part Three

- Nursing care for patients with kidney failure

It is the kidney losing all of its function, or this loss is gradual, and it is called chronic kidney failure, and the kidney is able to perform part of its functions. Or it is acute kidney failure, in which the kidneys suddenly fail to perform their functions, which causes death.

Kidney functions

1- Excretion of substances in excess of the body’s needs, such as salts and fluids

2-Reabsorption of salts that the body needs, such as sodium

3- Maintaining blood pH balance

4-Stimulates the spinal cord to form red blood cells

5- It secretes renin, which regulates blood pressure

Causes of kidney failure

Ø    Reasons related to blood division, which are the lack of blood supply to the kidneys, which causes the kidneys to stop working

Ø    Causes related to the kidneys, such as kidney inflammation

Ø    Causes specific to the post-renal parts, such as the ureters and the bladder, as a result of obstruction of the bladder or the right or left ureter, or both, with a stone, which prevents the passage of urine and collects in the ureter and returns to the kidneys again and destroys the kidney cells. Kidney failure causes death by 50%, but if it is discovered early, the patient can be saved or treated.

Symptoms of acute kidney failure

1 - Nausea and vomiting 

2 - Scratching 

3 - Spasms

4 - Swelling in the extremities

5 - Pleural exudation 

6 - The amount of urine is less than 400 cc/day (normal is 1500 cc/day)

Symptoms of chronic kidney failure

1 - Anemia 

2 - Fatigue easily 

3 - Increased creatinine in the blood

4 - Low specific density in urine 

5 - Swelling in the limbs 

6 - Rapid bleeding

7 - The patient needs dialysis in the following cases: urea 35 ml/liter

Cretinine     800 μmol/L       Bicarbonate       12 mmol/L

The purpose of washing

1- Removing urea and creatine from the blood 

2- Maintaining the appropriate proportion of salts in the body

3- Removing excess fluids from the blood

Types of washing

Peritoneal dialysis is done through the peritoneal membrane.        Hemodialysis is done through the blood

Disadvantages of peritoneal dialysis

1- Penetration of the bladder, intestines, or blood vessels during cannulation through the peritoneal membrane

2-  A clot in the cannula, but it can be removed with heparin

3-  Ascites

Nursing responsibility towards the peritoneal dialysis patient

1-  Observing the patient’s temperature, pulse, breathing, pressure, weight, inside and outside, and informing the doctor if there is a collection of fluid inside the patient’s abdomen of more than 300 cm.

2-  Change the location of the cannula at least once a day

3-  Keep spare parts dry and clean

4-  Relieve the patient’s pain by reducing the rate of entry of peritoneal dialysis fluid

Disadvantages of hemodialysis

1- Infection with blood diseases such as AIDS and hepatitis

2- Blood clotting

3- Low blood pressure

4- Limiting the patient’s movement for more than 4 hours

5- Bleeding due to heparin

Nursing department towards the hemodialysis patient

1-  Observe vital relationships constantly

2-  Test the clotting time constantly

3-  Clean the cannula connection site daily and apply an antibiotic

4-  The cannula site must be protected from destruction

5-  Providing the patient with food during washing

To prevent kidney failure

o     The patient should be turned every two hours to prevent stones

o     Monitor the urine, its quantity and color, and inform the doctor of any change in the color, quantity or turbidity of the urine

o     Conducting urea tests

o     Monitor the bladder to prevent urine accumulation in it, because accumulation in the bladder leads to the formation of stones

o     Blood pressure monitoring and treatment because chronic high blood pressure is considered a cause of kidney failure

o     Giving the patient an amount of fluids of no less than 2500 cc/day

o     Speedy treatment of hypoglycemia

Treating any kidney infections

o     Detecting and breaking up stones

o     We must prevent medications that are excreted through the kidneys because this leads to more destruction of the kidney cells - observing the inside and outside and informing the patient.

- The patient’s meal should be rich in carbohydrates and reduce the amount of protein in meals. A normal person needs 1 gm of protein per kg of body, but in the case of a patient with kidney failure, he needs 6. g/kg - Reducing table salt in meals

As for patients with kidney failure, the following must be taken into account:

If the amount of fluid coming out is small, we must do the following

◾   Reduce fluids for the patient

◾   As for the patient’s food, it must contain large amounts of carbohydrates, while reducing protein and completely eliminating table salt from the patient’s meals.

◾   The patient’s weight must be monitored daily, and if any increase is noticed, tests must be performed on the patient to determine the levels of creatinine, sodium, and potassium in the blood.

◾    For the dialysis patient, blood tests must be performed before dialysis to discover whether he is suffering from hepatitis or AIDS.

◾   We must allocate a special artificial kidney device for hepatitis C patients to prevent the spread of the disease. The artificial kidney unit must be sterilized after each patient.

◾   Heparin should be given to prevent blood clots

◾   Giving the patient advice about meals

Medications and treatment for patients with kidney failure

◾  The ideal solution is to transplant a kidney. One is sufficient and it is implanted in the lower part of the abdomen, for example. It does not require removing the diseased kidney, but rather leaving it to reduce inflammation. However, when the kidney is not available, it is necessary to perform dialysis with medications and pay attention to food.

◾  Someone might say, why do you publish the names of medicines in a daily newspaper? The answer is that these medicines are not a secret and must be made clear to patients with kidney failure, just like all chronic diseases, all aspects of which must be clear to everyone.

◾  We do not imagine a healthy person who would buy medications for kidney patients as preventative measures because they treat the condition but do not protect against the disease.

◾  A patient with kidney failure must follow the advice of the doctor and nutritionist in choosing the correct times when taking medications in order to ensure the effectiveness of medications that may conflict with other medications or with diets.

◾   We will talk about some medications that are prescribed to some patients with kidney failure.

1-     Medications that reduce phosphorus absorption:

Such as Caltrate, Ulsaheal, or Amphojel, these medications should be taken with meals due to their effectiveness when taken with a meal, as they work to prevent the absorption of phosphorus in the meal. Calcium carbonate may be prescribed to increase calcium, so it is recommended to take it between meals in these cases.

2-     Iron:

Iron medications are prescribed for patients who suffer from anemia that accompanies some patients with kidney failure. These medications should be taken between meals or at night when the stomach is empty. These medications should not be taken with medications that reduce phosphorus absorption, as food and medications that reduce phosphorus absorption reduce iron absorption.

3-     Ascoplex:

These tablets contain vitamin C, which helps absorb iron. Therefore, they should be taken with iron tablets, and the best time to take them is three hours after eating dinner.

4-     Potassium medications: such as Kayexalate

It is used when the level of potassium in the blood is high, and it should not be taken with orange juice, milk and its derivatives, or foods that contain high amounts of potassium.

These medications may cause constipation, so it is recommended to eat foods rich in fiber, such as salads and fruits with their peels.

5-     Blood pressure medications:

If the patient is taking medications to treat blood, he should ask the doctor about the possibility of taking these medications before performing dialysis. The doctor will tell him whether he should take these medications before the dialysis process or not.

6-     Diabetes medications:

A diabetic patient who uses insulin or tablets should take them with a meal at home before he comes for dialysis.

The most important tests performed for patients in dialysis units:

◾   Hemoglobin analysis                               every 1 month

◾   Kidney function tests (urea - creatinine)        every 1 month

◾   Complete blood count analysis                             every 1 month

◾   Liver function analysis, virus tests         every 3 months

Renal resection

The unit's nursing supervisor reviews the patient's data to ensure that the specified treatment session will be conducted on the specified date according to the daily schedule in the case of old patients.

Coordination is made between the unit supervisor and the secretariat to create a new file to store the patient’s papers. He is given a list of the instructions he follows before and during each session, the follow-up system, food, and the financial system he follows. The patient is added to the daily washing schedule in line with the system followed in the unit, taking into account the appointments that suit the patient according to Instructions of the treating physician in the case of new patients.

The nurse ensures that the patient follows the instructions related to keeping his tools or personal belongings in the designated place outside the unit in the locker room.

Preparing the patient to enter the unit by ensuring that the patient takes off the clothes he is coming in and wears his dressing gown or wears his own robe or pajamas if this will make him feel more comfortable, provided that the clothes are clean and in good condition. Then the patient washes his hands and dries them well before entering the unit.

The patient obtains his own identification card

Follow up on the procedures for the patient’s exit from the unit after the end of the session by giving the patient his card from the unit’s secretariat to hand it over to the place designated for dialysis patients in the outpatient clinic. Then he receives his belongings that he left when he entered the unit. The unit’s nursing supervisor also explains the follow-up system and attendance times for the sessions to the patient. His family or those with him how to act in emergency situations. They must also be given the direct phone number of the unit to ensure rapid action in case of emergency.

The head of the unit in the morning, or whoever performs her work at noon and night, writes down the names and numbers of patients for whom sessions were conducted during her presence, and signs the statement, along with writing the name of the doctor who followed up with him during the sessions, and sends it to the accounts.

Reports on the patient's daily sessions are summarized each month in one report and then at the end of each year in one report. This includes monthly research for each patient.