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SYLLABUS
I. Introduction :
Health knowledge is constantly changing. Every care has been taken to ensure accuracy of
the health information. Todays nursing practice has evolved through many changes influenced by
advances in science and technology. As modalities for diagnosing and treating illness & managing
patients in different stages of health illness continuum changes, several nursing procedures are
added in to nursing practice leading to provide in service / continue education to the graduated /
trained nurses.
Since the demand for Clinical Nursing services have evolved rapidly, along side of
medicine is developing. The emerging health problems like kidney diseases are adding more strain
on individual life as well the family and social system. India has very little to offer in terms of
infrastructural facilities for renal care. Where as the national health policy recognizes the need for
establishing training courses for specialty nurses required for tertiary care institutions like
Kokilaben Hospital Currently the specialized Renal nursing courses does not exist, where as very
few structured dialysis training programs exist that to for technicians.
With the view of above fact we the faculty of KDA nursing college and expertise of the
Nephrology department and team of Kokilaben Hospital Mumbai as well the nurse educators after
having deliberate discussion prepared this syllabus for the Certificate Course in Renal Nursing. I
am certain that the syllabus (focused hands on skills) will be able to prepare the registered nurse
as a nurse specialized to work in renal / Nephrology units effectively.
1.1) Philosophy :
It is believed that the registered nurses to be trained in renal nursing in order to provide competent
care to the patients sufferings from kidney diseases.
The expanded roles of nurses and advances in technology necessitate additional training to prepare
them for effective participation in renal care through specialized training program like Certificate
course (09 months).
1.2) Aim : The certificate course envisaged to provide opportunity for hands on training and
enable nurses to function and deliver good care emerging with health needs of patients
having renal diseases and disorders leading to renal failure.
1.3) Course Description (Desirability of courses : Full time, 09 months certificate course)
The Certificate Course in Renal Nursing is designed to prepare Registered Nurses (GNM
or B.Sc (N) / PB B.Sc (N) specially trained nurses, who will be equipped with recent
theory knowledge in the subject, as well providing competent nursing care to the clients in
various health care settings in Renal / Dialysis units; and to acquire the skills & attitude in
providing advance quality care to the patients, their families and communities at all the
three levels of care.
The Certificate Course in Dialysis nursing is designed to prepare Registered Nurses (GNM
of B.Sc (N) / PB B.Sc (N) specially trained Dialysis nurses, who will equipped with recent
theory knowledge in the subject, as wll providing competent nursing care to the clients in
various health care settings in Renal / Dialysis units ; and to acquire the skills & attitude in
providing advance quality care to the patients, their families and communities at all the
three levels of care.
1.5) Attendance, Progress and Conduct : A student pursuing the course should work in
Concern department for the full period prescribed for the training in the same institute.
Student will attend the activities such as patient care in the hospital, clinical rounds,
Clinical case presentations, case studies, Journal review Meetings, symposia, Seminars,
Assignments, Laboratory work and Conferences, Research project & Report writing etc.
Student should attend 90% Theory and 100% Practical prior to final examination.
II. Infrastructure Facilities :
1) Staffing :
1.1. Teaching Staff Nurse Educators, Experts & Recourse Persons
1.2. Paramedical Staff Technician
1.3. Non teaching Staff Adm. Officer, Librarian & House keeping.
2) Physical Infrastructure facilities :
2.1) Class room Nursing College C R No 4
2.2) Clinical Material to conduct the course
- Patients admitted in Renal / Nephrology Unit
- Patients attending dialysis (IPD / OPD)
- Equipments in dialysis units.
2.3) Nephrology, Urology & ICU Dialysis units
Facilities to perform dialysis in ICCU, NICU, Obstretric & Pediatric units
2.4) Fundamentals of Nursing lab of Nursing colleges.
III. Academic Profile:-
1] Admissions Terms & Condition:
1.1) The academic calendar proposed : year 2010 2011
1.2) Criteria for admission : Registered Nurse: Bsc (N), PB Bsc(N) / GNM
Diploma (Minimum two yrs esperience)
1.3) Number of seats for Admission : 15 to 20
1.4) Course fees : Rs 30000 ( Tuition fees Rs 25000 + Uniform 4000 + Lib 1000)
1.4) Admission Procedure : By interview of all applicants by a committee
Interview committee
1. Head of the institute Conducting course
2. Conordinator of the Course
3. One Subject specialist / Expert
4. A representative from Management Committee.
2) Organization of the Course Content
(Duration : 09 month fellowship certificate course)
2.1 Distribution of the course : Total Weeks = 39
1. Teaching Theory and Clinical 39 weeks = 1560 Hrs
2. Theory hours (40 to 42 hrs / wk) 09 weeks = 360 Hrs
3. Integrated Clinical practice 27 weeks = 1080 Hrs
(Including action Research)
4. Examination (including preparation) 01 weeks = 40 Hrs
5. Vacation 01 weeks = 40 Hrs
6. Public Holiday (as & when) 07 days = 40 Hrs
2.2 Course Objective (General):
At the end of course the student will be able to develop an understanding of philosophy,
principals, methods, issue, management in renal nursing. Course aims to develop skills and
attitude in providing competent care to the patient having renal diseases and disorders in the
Hospital and home.
2.3) Objective : At the end of this training nurses will be able to,
1. Describe the concept and principals of nursing management of the patients having renal
diseases and disorders
2. Provide quality care to the patients having renal diseases & disorder through nursing
process approach.
3. Organize and demonstrate the skills in the management of Nephrology U nit, Dialysis
Unit and Kidney transplant Unit.
2.4 Course of Studies (Theory 360 hrs +1080 hrs Practical) = 1440
Grant Total of Practicum : 15800 Marks & Sent to University : Out of 100 marks
4) Monitoring g the Progress :
a) Candidate4 is required to maintained the Worki diary. Procedure books, Nursing care plkans,
Nursing care srudies, Nursing care presentation and Case record of each clinical posting. This will
help for the p[erformance evaluation & allotment of Internal Assessment Marks to the student.
b) Progress report should be submitted every 3 months to the course coordinators by the student &
certified by the Head of the institution.
c) Clinical Practice : It will be planned activity based oin Clinical rotation plan with integration of
theory input in to practical aspect of the nursing care of the patient having renal diseases and
disorders as well dialysis , admitted in the different critical care units of different age groups and
also visiting day care centers (OPD). The clinical practice will help to enhance hands on skills and
specialized nursing care among the students. There for all the clinical experience wii be assessed
and evaluated as concurrent activity of the fellowship course by the clinical experts and
supervisors.
NB : 1. Student should attend 90% Theory & Clinical Practice. However student should
make up 100% attendance for integrated practice before awarding the fellowship certificate.
(University will depute an observe from the same discipline to supervise the conduct of
final examination)
4.3 Eligibility : 1. Student should attend 901% Theory & Clinical Practice however student
should make up 100% attendance for integrated practice before awarding the fellowship
certificate.
2) Head of the institution will have to certify the students comnpentency, performance and
completion of the prescribed period of the training prior to appearing for final Examination.
4.4 Examiners : There should be one internal and one external examiner.
4.5 Standard of Passing : In order to pass a candidate should obtain at least 50% marks
separately in Internal Assessment & External Examination in each of the theory paper and
practical. (Subject to discussion)
5. Certification : The Principal / Course coordinator shall submit the complete Result of
examination held by the institution. The result will be submitted along with the Certificates duly
signed by the course coordinator and principal of the Nursing College, which are proposed to be
issued to the Successful candidates. The Registrar of MUHS shall after verification sign and issue
the certificates to Successful candidates
RENAL NURSING 9 MONTHS CERTIFICAE COURSE
INDEX
NO SR NO CONTENT PAGE NO / ANNEXURE
I Introduction 1 to 2
1.1 Philosophy 2
1.2 Aim 2
1.3 Course description 2
1.4 Desirability of Course 2
1.5 Attendance, Progress & Conduct 2
II Details of Infrastructure 2
1 Staffing 2
1.1 Teaching Staff Annexure 3, page 3
Nurse educator
Nephrologist & Urologist
1.2 Paramedical Staff- Technician Annexure 3, page 3
1.3 Non Teaching Annexure 3, page 3
Adminbistrator
Librarian
Housekeeping
2 Physical Infrastructure 3
2.1 Classroom Nursing College class room no 4 Annexure -5.1
2.2 Clinical Material Patients Annexure -4.1
Clinical Material Equipments Annexure -4.2
2.3 Dialysis Unit, Urology Unit, Nephrology Unit, Critical Care
Unit
III Academic Section 3
1 Admission to the course 3
1.1 Proposed calendar (duration of course) 3
1.2 Criteria for admission 3
1.3 Admission process 3
2 Organisation of the Course & Course Content 4
2.1 Distribution of Course 4
2.2 Course Objectives (General) 4
2.3 Course Objectives (Specific) 4
2.4 Course of Study (Theory & Practical) 5
3 Curriculum & Course Content Annexure 1, page 6
3.1 Theory
3.2 Clinical Experience (including internal assessment) 7
Bibliography Annexure 2
4 Scheme of Examination 8
4.1 Scheme of Assessment (Internal & External) at college level 9
4.3 Eligibility of Examination 9
4.4 Criteria of Examiners 9
4.5 Standard of passing 9
5 Certification 9
IV Annexure / Enclosure
IV Annexure / Enclosure
SR CONTENT ANNEXURE
NO
2 Bibliography Annexure 1
4 Clinical Materials
5 Infrastructure
TOTAL 360
RENAL NURSING 9 MONTHS FELLOWSHIP CERTIFICATE COURSE
TOPIC LIST
BLOCK UNIT TITLE HRS LECTURER / TEACHING /
ALLOTED RESOURCE LEARNING
PERSON METHOD
CLINICAL NURSING I
# Introduction of Course 1 Nurse Educator Lecture
1 Renal Diseases & Nursing Management 146
1 Normal Kidney function 18 Doctor Lecture
- Basic anatomy of Renal and Urinary Tract 2
- Basic Physiology 2
- Assessment of Kidney and Urinary Tract 6
- Nursing Process Approach in Renal Disease 8 Nurse Educator Lecture
- Diseases of Kidney 45 Doctor Lecture
# Primary Glomerular diseases 3
- Focal
- Diffuse
- Immunosuppressive
- Post Infectious Glomerulonephritis
# Membrabo proliferative Nephropathies 3
- Nephropathies
- IgA Nephropathy
- Hereditary Nephropathy
# Nephrotic Syndrome 3
- Minimal change Nephropathy
- Membranous Nephropathy
# Focal & Segmental Glomerularsclerosis 1
# Thrombotic microangiopathy 1
# Thrombotic Thrombocytopenic purpura 1
# Hemolytic Uremic syndrome 1
# Tubulointerstial disease including 1
# Chronic Tubulointerstial disease 1
# Analgesic Nephropathy 1
# Renal Vascular Disease 1
# Adult Polycystic disease 1
# Other cystic kidney disease 1
# Urinary tract infections 1
# Nephrolithiasis 1
# Recurrent renal stones 1
# Acute Renal Colic 2
# Nursing Management in Renal Diseases 20 Nurse Lecture
Educator
4 Kidney in Systemic Diseases 43 Doctor Lecture
# Diabetic Nephropathy 1
# Kidney in Multiple Myelome
# Renal Amliodosis 1
# Other Non Amyliodosis Dysproteinmea 1
# Sickle cell disease
# Vasculitis 1
# ANCA positive vasculitis
# Churg Strauss syndrome 1
# Polyarteritis nodosa 1
# Anti GBM disease ( good pastures disease)
# Lupus nephriris 1
# Antiphospholipid syndrome
# Scleroderma renal crisis 1
# Rheumatoid arthritis 1
# Sarcodiosis 1
# HIV & Renal Disease 1
# Hepatitis B & Hepatitis C related renal disease
# Kidney in Endocarditis 1
# Renal Tuberculosis 1
# Kidney & Malaria 1
# Schistostomasis 1
# Hypertension 1
# CKD and body system abnormalities 3
Electrolyte
Metabolic
CKD and hematological system
GI system
Immunology
Medication Metabolism
CKD and cardiovascular system
CKD and respiratory system
Musculoskeletal
Integument
CKD and CNS
Reproductive
Endocrine
Psychosocial
Assessment of Body system abnormalities& role of Nurse
# Management of anemia 2
Definition of anemia
Etiology of anemia in CKD
Iron deficiency and its assessment
Erythropoetin
Newer erythropoietic stimulating agents
# Fluid electrolyte & acid base balance 2
Fluid balance
Uremic toxins, Small, middle and large molecule
Hyper and hyponatremia
Hypo and Hyperkalemia
Basic understanding of acid- base
Acidosis, its cause, features and management
Alkalosis, its causes, features, and management
# Renal Bone Disease and its management 2
Normal bone remodeling
Pathogenesis of renal bone disease
Types of Renal bone disease
Investigations of renal bone disease
Management of renal bone disease
Nurse
# Nursing Management of Kidney Disorders in Systemic Diseases 18 Lecture
Educator
5 Pregnancy & the Kidney 10 Doctor Lecture
# Renal Physiology in Pregnancy 1
# UTI in Pregnancy 1
# ARF in Pregnancy 1
# Hypertension in pregnancy 1
# Gestational Hypertension
# Pre Eclampsia & Eclampsia 1
# Chronic Hypertension in pregnancy 1
# Pre existing Renal disease in pregnancy women 1
# Disorders of renal tract 1
# Pregnancy while on dialysis 1
# Renal Transplantation during pregnancy 1
6 Drugs & the kidney 8 Doctor Lecture
# Prescribing drugs in Renal impairment 1
# Cardiac drugs ESRD 1
# NSAId & the kidney 1
# Analgesic in Renal failure 1
# Opiods in Renal failure 1
# Poisioning & Dialysis 1
# Lithium & Salicylate 1
# Ethylene Glycol Poisioning 1
7 Acute & Chronic Renal Failure 12 Doctor Lecture
# Definition of AKF 1
# Classification of AKF
# Pathophysiology 1
# Pathogenesis and clinical features 1
# Assessment of AKF
# Management of AKF & role of Nurse 1
# Definition of CKD 1
# Pathophysiology
# Pathogenesis and clinical features 1
# Assessment of CKD 1
# Management of CKD & role of Nurse 1
# Body Adaptation of CKD 1
# Factors causing progression of CKD 1
# Retarding progression of CKD 1
# Assessing progression of CKD 1
8 Nursing Management of Patients in Renal Disorders 12 Nurse Lecture
Educator
2 Basics of Dialysis 65
1 Introduction to Basics of Dialysis 3+2 Doctor, Nurse Lecture &
Educator Demonstrati
on
History of dialysis 1
Dialysis definition 1
Biophysics of Dialysis 1
Principle of diffusion 1
Principles of convection 1
2 Patient assessment and initiation of dialysis 5 Doctor Lecture
Assessment of patient for need of dialysis 1
Indication og dialysis 1
Early indications for dialysis
Later on indications for dialysis
Role of Nurse initiation dialysis 1
Preparation of dialysis procedure (pt & unit) initiation of dialysis 1
Through out assessment 1
3 Dialysis prescription, dialysis target and adequacy of Dialysis 5+2 Doctor, Lecture
Nurse
Educator
Urea kinetics 1
Urea reduction ratio and Kt/v
Dialysis prescription 1
Assessment of dialysis adequacy
Concept of recirculation 1
Daily dialysis
Role of Nurse in maintaining body fluid 2
4 Nutritional assessment of patient 4 Doctor Lecture
Normal requirement of nutrition 1
Factors causing malnutrition in dialysis
Effect of poor nutrition on outcome of patient
Assessment of nutritional status 1
Recommendation of nutrition requirement in dialysis 1
Management of malnutrition in dialysis 1
Role of nurse in Nutritional Management
5 Principle and assessment of body fluid status 4 Doctor Lecture
Fluid distribution in body 1
Maintenance of extracellular fluid status
Mechanim and causes of edema 1
Assessment of increased extra-cellular volume 1
Role of Nurse in maintaining body fluid 1
6 Principle, composition and types of dialysis fluid 4
Basics of dialysis fluid requirement 1
Types of fluid availability 1
Modification of dialysis fluid for patient management 1
Role of Nurse 1
7 Principles,design,types of machine and its basic function 5 Technician Lecture,
Demonstrat
ion
Extra-corporeal blood circuit 1
Dialysate circuit 1
Dialysate preparation in machine
Monitors and control in dialysis machine 1
Newer machines 1
Orientation of Dialysis Machine 1
8 Electronics, electronic safety & setting up of dialysis machine 4 Technician Lecture,
Demonstrat
ion
Basic electronics of machine 1
Cleaning and disinfection of machine 1
Testing of machine 1
Responsibility of Nurse 1
9 Trouble shooting with machine 2 Technician Lecture,
Demonstrat
ion
Assessment and handling of alarms in blood circuit 1
Assessment and handling of alarms in dialysate circuit 1
10 Water Standard & principle of water treatment for dialysis 5 Technician Lecture,
Demonstrat
ion
Drinking water Vs dialysis water 1
Standard of dialysis water requirements 1
Filters, Deionisation and water softener 1
RO
Calculation of requirement in unit
Water distribution system in dialysis unit 1
Assessment and maintenance of water quality
Role of Nurse 1
11 Membrane Material, Flux, afficiency, permeability & 5 Technician Lecture,
clearance Demonstrat
ion
Membrance material, old and newer 1
Low flux and high flux membranes 1
Bioincomaptability of membranes
Solute transport across membrane 1
Design of membranes 1
Sterilization of membrane 1
12 Temporary and permanent vascular access, including AV 6 Nurse Educator Lecture,
Demonstration
Fistula and graft
. Central vein access ( Femoral, jugular and Subclacvian) 4
AV shunt
AV Fistula
AV Graft
Permacath
Role of Nurse assisting in Procedures 2
13 Principle and practice of cannulation 3 Nurse Lecture,
Educator Demonstrat
ion
Methods of cannulation 1
Button hole technique 2
14 Heparins and non-heparin anticoagulant 6 Nurse Lecture
Educator
Heparinization principles 1
Low molecuiar weight heparin 1
Regional citrate anti-coagulation 1
Citrate solution 1
Other anti-coagulants for haemodialysis 1
Saline dialysis
Role of Nurse 1
CLINLCAL NURSINF II
3 Hemodialysis Dialysis, Peritoneal Dialysis & Nursing 90
Management
Introduction to Hemodialysis 2 Doctor Lecture
Hemodialysis 1
Hemofiltration 1
Hemodiafiltration
Orientation to Hemodialysis & principles 2 Doctor Lecture
1 Principles and methods of reprocessing 2 Nurse Lecture,
Educator Demonstrat
ion
Background and principles of re-use 1
Reuse methods
Assessing dialyser performance 1
2 Universal precautions, principles and practices / Role of Nurse 3 Nurse Lecture,
Educator Demonstrat
ion
Diagnosis of infection 1
Principles of universal precautions 1
Methods of disinfection ( Instruments, machine and unit itself) 1
Waste disposal
3 Hepatitis B, hepatitis C, HIV and other infection in 3 Nurse Lecture,
hemodialysis Educator Demonstrat
ion
Common infection in diaysis patients 1
Hepatitis B vaccination 1
Basics of management of HBV and HCV,
Hand wash and its solution 1
4 Dry weight and fluid management in Hemodialysis 2 Nurse Lecture,
Educator Demonstrat
ion
Concept of dry weight 1
Fluid movement during dialysis
Various approaches for removal of fluid during dialysis 1
Consequences of excess fluid in body
5 Nursing care of patient on Hemodialysis 6 Nurse Lecture,
Educator Demonstrat
ion
Assessment of patient on dialysis 2
Nursing diagnosis
Nursing intervention with rationale
Outcome of expected short term nursing care & long term
nursing care
a Assessment Machine / dialyser 2
b Vascular access Arteriovenous fistula, Arteriavenous graft
Pharmacological therapy Nurse role
Nutrition & Fluid therapy
Meeting Psychosocial Needs of patient 2
Promoting home / Community care
Continuing care home hemodialysis
Assess for complication
Complications of Dialysis
6 Hypotension , hypertension and its management 5 Doctor Lecture
Causes of hypotension during dialysis 2
Management of cause of hypotension
Symptomatic management of hypotension
Causes of hypertension 2
Management of cause of hypertension
Symptomatic management of hypertension
Management of inter dialytic hypertension 1
7 Cardiovascular complication 3 Doctor Lecture
Pericarditis 1
Arrhythmias 1
Coronary ischemia during dialysis 1
8 Neurological and hematological complications 3 Doctor Lecture
Dialysis disequilibrium syndrome 1
Bleeding during dialysis 1
Cerebrovascular accident during dialysis 1
9 Longterm complication of hemodialysis and its management 4 Doctor Lecture
Dialysis amyloidosis 1
Accelerated atherosclerosis 1
Hyperparathyroidism
Hemosiderosis 1
Dialysis ascites
Nurse Role in Home and Community 1
Specific Hemodialysis Therapies
10 Sorbent dialysis and hemoperfusion 3 Technician Lecture
Principles of Sorbent dialysis 1
Component Sorbent dialysis
Function of Sorbent dialysis
Uses of Sorbent dialysis
Hemoperfusion and its uses 1
Plasmapheresis 1
11 Principles of CRRT and SLED 3 Intensivist Lecture,
Demonstration
Principles of CRRT 1
Types and advantages of CRRT
CRRT Machines
SLED 1
Role of CRRT and SLED in clinical care
CRRT Continous Renal Replacement therapies 1
12 Principles of dialysis in a pesiatric patient Specific Group / Role of 3 Doctor Lecture
Nurse
Causes of ESRD in pediatric patienhts 1
Dialysers and catheters
Vascular access in pediatric patient 1
Dialysis prescription in pediatric patient
Setting of pediatric dialysis unit 1
Monitoring of pediatric patients on dialysis
DIALYSIS NURSING CERTIFICATE COURSE
Bibliography
Books :
1. Jermy Levy : Oxford Handbook of Dialysis ; 2nd Ed,2004 Oxford University Press, New York
2. Allen R Nissenson : Handbook of dialysis Therapy ; 4th Ed, 2008 Elsevie, Philadelphia
3. John T Daugirdas : Handbook of Dialysis; 4th Ed, 2007, Wolter Kluwers, New Delhi
4. Sharon L Lewis : Medical surgical Nursing ; Assessments & management of Clinical problems 7th
ed.2007, Elsevier, India, pg 1136-1232
5. Gabriel M Danovitch, Handbook of Kidney transplantation, 4th ed; 2005; by wolter Kluwer, India
6. Nicholas A Boon. Davidsons Principles and Practice of medicine; 20th ed; 2006; by Churchill
Living stone, India, pg 455-518
7. Lee Goldman. Cecil Medicine Vol-1 & 2; 23rd ed, 2007; Elsevier, Philadelphia, p 805-936
8. Suzanne C Seltzer; Brunner & Siddhartha, Medical surgical Nursing 11th ed, 2008 Pub. J.B.
Lippincott co. New Delhi
9. Luckmann & Sorensen. Medical surgical Nursing A psychophysiology approach. 4th ed, 1993 Pub
W.B. Saunders co.
10. Joyce M. Black, E.M. Jacobs; Medical, Surgical Nursing; Clinical Management for continuity of
Care; 5th ed.; 1997; by W.B. Saunders company. (part I & II) India
11. M A Salam. Principals and Practice of Urology; a comprehensive text; 1st Ed; 2002; by MAS
publication, Bangladesh
12. Wilma J Phipps : Shafers Medical Surgical Nursing, 7th ed, 1980, B I Publication, India, p 619-672
13. Jermy Levy : Oxford Handbook of Dialysis Therapy; 2nd Ed, 2004, Oxford University Press, New
York
14. Allen R Nissenson : Handbook of Dialysis Therapy; 4t Ed, 2008 Elsevier, Philadelphia
15. John T Daugirdas: Handbook of Dialysis; 4th Ed, 2007, Wolter Kluwers, New Delhi
Journals
1. Nature Clinical Practice Nephrology, International Society of Nephrology, Vol 4, No9, Sep
2008, USA
2. Perltoneal Dialysis International, International Society of Peritoneal Dialysis, Vol 29 No 3
May-June 2009, Canada
3. Kidney International, International Society of Nephrology, Vol 73, No 108, April 2008,
USA
4. Nephrology Nursing Journal, American Nephrology Nurses Association, Vol 32, Nov-Dec
2006, USA