SCHOOL OF NURSING SCIENCE AND RESEARCH,

SHARDA UNIVERSITY

SUBJECT
ADVANCE NURSING PRACTICE

ASSIGNMENT ON

TRACHEOSTOMY

Submitted to:- Submitted by:-

Ms. Kiran Sharma Ms. Bhawna joshi
HOD and Professor Msc. 1st Year
Medical Surgical Nursing Deptt. SNSR
SNSR
 Introduction
Dialysis ( from Greek word dialusis , meaning dissolution , dia meaning through , and lysis ,
meaning loosening ) is a process for removing waste and excess water from the blood , and used primarily
as an artificial replacement for lost of kidney function in people with renal failure.

Goal: The goal of dialysis is to remove accumulated fluid and toxins to maintain their concentrations below
the level as they produce uremic symptoms.

Types of dialysis
A) Hemo dialysis
B) Peritoneal dialysis

A. Hemo dialysis
Hemo simply means blood. Dialysis means “to pass through ”; it removes nitrogenous waste
products , excess fluids and electrolytes from the blood by means of artificial kidney.

B. Peritoneal dialysis
It removes nitrogenous products , excess fluid and electrolytes from the body by means of peritoneal
membrane.

Purposes of hemodialysis
 To remove waste products ( urea , creatinine , excessive substance)
 To maintain fluid balance .
 To remove toxins in case of poisoning.
 To relieve suffering caused by excess fluids and metabolic wastes in the blood.

Duration : It should be undertaken 3 times a week for approximate 3 to 4 hrs.

Indications of Hemodialysis
 Fluid overloads not responding to Diuretics .
 Uremic convulsion.
 Persistent dyspnea, vomiting and restlessness.
 Signs of pericarditis , pericardial effusion , and pericardial friction rub.
 Aid base problems.
 Electrolyte problems.
 Intoxications
 Overloads of fluids.
 uremic symptoms

Complications :
o Hypotension
 o Clot formation
o Muscle cramps and
o Septicemia

Articles Required

Articles Rational
a) Fistula cannula (16G , 17G)  For Hemodialysis cannulatiom

b) Betadine  To reduce the inflammation on consequently the

infection in the vascular access site.
c) Inj.Heparin  To prevent thrombosis in the blood circuit.
d) Normal saline  To flushing of blood in and out of dialysis
machine.
 To maintain same concentration , as that of
blood.
e) RO( reverse osmosis) water  Used to mix the dialysate for dialysis.
f) Erythropoietin hormone  To increase red blood cell production.
g) Hemodialyzer  To filter waste and fluids from a dialysis patient
blood.
h) Visking Tubings  To remove or exchange of small molecules from
macromolecules in solution based on differential
diffusion.

Component for pre dialysis assessment are :

A- Access
B- Breathing
C- Cardio vascular status / changes

A= Access
 Look and feel access , bruit present ,confirm condition and patency of access before connecting to
machine .

B= Breathing
 Observe respiratory rate and rhythm.
 Auscultate lungs
 Are there rales or ronchi ?

C= Cardiovascular status
 Check vital signs
 Assess skin changes , lungs and heart sound ,edema , peripheral pulses.
  Rule out MI/Angina
Patient monitoring :
1) prior to dialysis ( weight , blood pressure , temperature and access site)
2) during dialysis ( blood pressure and pulse rate )
3) lab tests : urea creatinine , albumin , cholesterol , hb , potassium , phosphorous , calcium ,
hematocrit , bicarbonate.

Procedure
1) Pre dialysis
 Before the patient arrives for schedules session dialysis machine will be prepared .
 The patient arrived and carefully weighed . Blood pressure should be taken along with body
temperature.
 Assess is set up. Numbing the entry site before the needle are inserted –the two most
common are lignocain , a local anesthetic injected under skin.

2) Dialysis
 Pump and timer are started . hemodialysis is underway .
 Every half hourlyblood pressure is taken
 A session of dialysis remove 5-10 pound of fluid from the patient body .
 Amount of fluid to be removed is set by the dialysis nurses according to patient estimated
dry weight.

3) Post dialysis
 following the hemodialysis patient may feel washout syndrome. The patient feel fatigue
and extreme week.
 Weight measurement .

Nursing responsibilities

1) Care Before dialysis

 Informed consent
 Explanation and ask the to void.
 Check the vital sign and weight at the beginning and atleast every 30 minute.
 Check for fistula patency and cannula every hour for first 24 hr of insertion.
 Palpation of thrill and auscultation of bruits.
 Withhold antihypertensive and antidiuretic on the day of hemodialysis.

2) Care during dialysis

 Regular observation of complications.
 Check and record vital signs in every 15 minute
 Serve food as per patient interest.
  Patient is allowed to read , write , sleep ,talk or watch television.
 Back care and diversional therapy.
 Inform to doctor if complications

3)Care after dialysis

 Check and record vital sign , weight after hemodialysis and total ultrafiltration.
 Record the condition of the patient.
 Explain about care after hemodialysis.
 Inform the family and patient of date for next dialysis.
 Send the patient home or ward.

Peritoneal dialysis

Introduction: peritoneal dialysis was first used in 1923.

Approximately 10-15% of patient is receiving dialysis are on peritoneal dialysis.

Definition: It removes nitrogenous waste product , excess fluids and electrolytes from the blood by
means of peritoneal membrane.
It involve repeated cycle of instilling dialyzing solution into the peritoneal cavity through a catheter into
it.

Indication :
 Fluid overload
 Uremic convulsion
 When hemodialysis is not possible , due to lack of vascular cacess , small children , hypotension on
hemodialysis , unstable cardiovascular and respiratory status .
 Willingness of client.

Contraindication
 History of multiple abdominal surgery.
 Severe abdominal pathology.
 Inguinal hernias.
 Severe obstructive pulmonary disease.
 Excessive obesity wit fat deposition.
 Pre-existing vertebral disease.
Process of peritoneal dialysis
There are three phases in peritoneal dialysis.
1) Inflow
A prescribed amount of dialysate solution is instilled usually two liters in adult over about 10-
15 minute.
 2)Dwell
Osmosis and diffusion take place between the patient blood and the peritoneal cavity.

3)Drain
Draining of peritoneal fluid take place approximately 20-30 min and may be facilitated by gently
massaging the abdomen.

Articles required:

 Dialyste solution
 Peritoneal catheter
 A chair
 Iv pole
 Heating pad
 Scale
 Masks
 Dialysate waste bag
 Disinfectant
 Depending on the machine type , supplies for documenting your patient care

Articles Rationale
Dialysate solution For maintain body fluid during exchange.
A chair To perform exchange
Iv . pole Used to hang dialysate bag
Heating pad To maintain temperature of dialysate solution
Scale Used to help track weight of patient
Disinfectant Used to keep surface clean
Masks To minimize the risk of infection
Dialysis supplies Help for exchange

Procedure
 Explain the procedure to the patient.
 Informed consent .
 Obtain baseline data.
 Bladder and bowel should be empty.
 Shaving of abdomen.
 Warm dialyzing solution to37c.
 Flush all tubes to prevent air from entering the cavity.
 Remove old contaminated dressing of catheter site.
 Assess sign and symptoms of infection .
 Use pre cut gauze –pieces over catheter sites.
  Inj Gentamycin 20mg may be used in each 4 cycle.
 Daily test for Bun , Na, phosphate level in the blood.

Nurses responsibilities
Dietary management
 Provide high protein diet.
 Provide less sodium and potassium but high phosphorous diet.
 Avoid bananas , dry fruits , kiwis and orange juice.

Pharmacological management
 Erythropoietin
 Iron
 Active vitamin D
 Vitamin E
 B complex , vitamin and folic acid
 Bibliography

 G.N Mandal(2016) A Text book of Medical Surgical Nursing. Kathmandu Nepal:Makalu

publication house.

 http://health.answers.com/Q/What_are_the_nursing_responsibilities_in_peritoneal_dialysis.

 http://wps.prenhall.com/wps/media/objects/737/755395/peritoneal_dialysis.pdf.

 https://www.greatsampleresume.com/job-responsibilities/dialysis-nurse-responsibilities/.