Ganda Sihotang Blocking A1 Hemodialysis

The objectives of hemodialysis are to extract toxic nitrogenous substances from the blood and to remove excess water. A dialyzer (also referred to as an artificial kidney) serves as a synthetic semipermeable membrane, replacing the renal glomeruli and tubules as the filter for the impaired kidneys. In hemodialysis, the blood, laden with toxins and nitrogenous wastes, is diverted from the patient to a ma- chine, a dialyzer, where toxins are filtered out and removed and the blood is returned to the patient. Hemodialysis is used for patients who are acutely ill and re- quire short-term dialysis (days to weeks) and for patients with advanced CKD and ESRD who require long-term or permanent renal replacement therapy. Hemodialysis pre- vents death but does not cure renal disease and does not compensate for the loss of endocrine or metabolic activities of the kidneys. The preferred method of permanent access is an arteriovenous fistula (AVF) that is created surgically (usually in the forearm) by joining (anastomosing) an artery to a vein, either side to side or end to side Most patients receive intermittent he- modialysis that involves treatments three times a week with the average treatment duration of 3 to 4 hours in an outp aient setting. The patient and a caregiver can also perform hemodialysis at home. With home dialysis, treat- ment time and frequency can be adjusted to meet optimal patient needs. With the initiation of dial- ysis, disturbances of lipid metabolism (hypertriglyceridemia) are accentuated and contribute to cardiovascular complica- tions. Heart failure, coronary heart disease, angina, stroke, and peripheral vascular insufficiency may occur and can in- capacitate the patient.

Adequate dialysis costs from P25,000 to P46,000 per month

Continuous renal replacement therapies

. CRRT provides slow and balanced fluid removal that even unstable patients - those with shock or severe fluid overload - can more easily tolerate. CRRT is indicated in any patient who meets criteria for hemodialysis therapy but cannot tolerate intermittent dialysis due to hemodynamic instability. CRRT is better tolerated by hemodynamically unstable patients because fluid volume, electrolytes and pH are adjusted slowly and steadily over a 24 hour period rather than a 3 4 hour period. There are two options for vascular access for CRRT, venovenous and arteriovenous. Venovenous access is by far the most commonly used in the modern ICU. Suitable for use in hemodynamically unstable patients. Precise volume control, which is immediately adaptable to changing circumstances. Very effective control of uremia, hypophosphatemia and hyperkalemia. Rapid control of metabolic acidosis Improved nutritional support (full protein diet). Available 24 hours a day with minimal training. Expense probably the same as IHD. Anticoagulation to prevent extracorporeal circuit from clotting. Complications of line insertion and sepsis. Risk of line disconnection. Cost the same as HD

Peritoneal Dialysis -The process uses the patient's peritoneum in the abdomen as a membrane across which fluids and dissolved substances (electrolytes, urea, glucose, albumin and other small molecules) are exchanged from the blood. PD may be the treatment of choice for patients with renal failure who are unable or unwilling to undergo hemodialysis or renal transplantation. -The amount of dialysis that occurs depends on the volume of the dwell, the regularity of the exchange and the concentration of the fluid. APD cycles between 3 and 10 dwells per night, while CAPD involves four dwells per day of 2-2.5 litres per dwell, with each remaining in the abdomen for 48 hours -The costs and benefits of hemodialysis and PD are roughly the same

PD equipment is cheaper but the costs associated with peritonitis are higher.[4] Patient's on PD are seen less often in the ER as they are typically more compliant with treatment, and dialysis occurs more frequently and thus not allowing the waste to accumulate in the blood for several days.
-PD is less efficient at removing wastes from the body than hemodialysis, and the only drawback is the presence of the tube presents a risk of peritonitis due to the potential to introduce bacteria to the abdomen;[3] peritonitis is best treated through the direct infusion of antibiotics into the peritoneum with no advantage for other frequently used treatments such as routine peritoneal lavage or use of urokinase[9] The tube site can also become infected NURSING MANAGEMENT
Promoting Pharmacologic Therapy

Patients undergoing hemodialysis who require medica- tions (eg, cardiac glycosides, antibiotic agents, antiarrhyth- mic medications, antihypertensive agents) are monitored closely to ensure that blood and tissue levels of these med- ications are maintained without toxic accumulation. Promoting Nutritional and Fluid Therapy Diet is important for patients on hemodialysis because of the effects of uremia. Goals of nutritional therapy are to minimize uremic symptoms and fluid and electrolyte imbalances; to maintain good nutritional status through adequate protein, calorie, vitamin, and mineral intake; and to enable the patient to eat a palatable and enjoyable diet. Meeting Psychosocial Need Patients requiring long-term hemodialysis are often concerned about the unpredictability of the illness and the disruption of their lives. Calculate Dosage The standard HD prescription targets fluid removal to a clinically derived estimate of dry weight. Dry weight is currently defined as the lowest weight a patient can tolerate without the development of symptoms or hypotension. So based on the dry weight and the clients weight during the start of the procedure we can come up with the ultrafiltration rate.