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ST. ANTHONY COLLEGE OF ROXAS CITY COLLEGE OF NURSING HEMODIALYSIS NURSING

Observation Guide OBJECTIVES: Upon completion of the (4) hour observational experience in a hemodialysis unit, the students will be able to: 1. State services provided by the dialysis unit. 2. Describe the equipment used for hemodialysis and the principles behind it. 3. Discuss the quality of life of patients with chronic renal failure and interventions for the patient on hemodialysis. 4. Discuss the effects of the hemodialysis on their lifestyles, and the lifestyles of their families. 5. Identify the responsibilities of the nurse in assessment and management of client on hemodialysis. PREPARATION: 1. Review section on hemodialysis in your med-surg textbook. 2. Complete worksheet for dialysis. #1 - #13 prior to rotation day. Show to CI prior to rotation duty. ACTIVITIES: 1. Observe activities at the dialysis unit. a. initial assessment of client. b. equipment check and set-up. c. hooking up client to equipment. d. monitoring of client and equipment. e. infection control procedures. f. medications given by the nurse (e.g., heparin) g. client reactions to procedure and lifestyle. 2. Ask the a. nurse to 1. describe the services the agency/unit provides. 2. describe the clientele and their specific needs. 3. describe the hemodialysis equipment. 4. state his/her responsibilities as a dialysis nurse. b. client to describe 1. his/her medical condition/prognosis. 2. feelings regarding his/her condition and hemodialysis. 3. his concerns, means of coping, and hopes. 3. Share with your clinical group your observations and experience during post-conference. 4. Submit completed worksheet to your clinical instructor.

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WORKSHEET FOR HEMODIALYSIS OBSERVATION EXPERIENCE Answer 1-13 prior to dialysis rotation: 1. Explain the purpose of dialysis.

2. State whether the following lab values are usually high or low in the dialysis patient and give an example of the cause. A. Blood components Hct Hgb RBC B. Electrolytes Na+ K+ HCO3 Ca PO4 3. Explain the three principles that allow the process of hemodialysis to work. Diffusion

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Osmosis

Ultrafiltration

4. Explain how each type of access is created and the advantages and disadvantages of each. AV Fistula

AV Graft

Temporary catheters

5. How do you access patency of an access site?

6. Describe the normal diet order for a dialysis patient and why each alteration is necessary. Give examples of food to take or avoid.

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7. What is the typical fluid restriction for dialysis patients? What are the two main complications that occur when a fluid restriction is not followed? How do they occur (Physiological process)?

8. Why is it necessary to weigh a dialysis patient each day? What does weight indicate?

9. Is it normal for a dialysis patient to have no urinary output? Explain your answer.

10. Why is heparin frequently administered during treatments? What is its effect on the patient after a hemodialysis treatment?

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11. Why do dialysis patients frequently need anti-hypertensive medications? How do these medications affect the patient who will undergo hemodialysis?

12. What types of antacids are prescribed? What is the indication for antacids in those with ESRD?

13. Name at least 3 complications of hemodialysis treatment. Explain the cause/s, signs/symptoms, & treatment for each.

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--------------Answer after observation. 14. During your experience, what problems did you observe while the clients were on the machine?

15. Describe the effects of hemodialysis on the lives of the clients you spoke with.

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