GROUP

B9

Objective:

At the end of the time given to group B9, the students are expected to:

Define, know the purpose, identify equipments and perform the before, during and after nursing responsibilities:

CVP manometer

Peritoneal dialysis set

Dialyzing solution

Hemodialysis machine

Incubator/Isolette

Billi light

Central venous pressure

What is CVP?

What are the Purposes?

To assess cardiac function, to evaluate venous return to the heart, and to indirectly gauge how well the heart is pumping.

To gain access to a large vessel for rapid, high-volume fluid administration and to facilitate frequent blood withdrawal for laboratory samples.

Equipment

Mask

Sterile Gloves

Antiseptic Pad

CVP manometer set

IV solution (usually normal saline)

IV Pole

Extension tubing/Catheter

Additional stopcock (to attach CVP manometer to catheter)

Site

Neck vein:

External/Internal Jugular Veins

Site

Factors that increase CVP include:

Hypervolemia

forced exhalation

Tension pneumothorax

Heart failure

Pleural effusion

Decreased cardiac output

Cardiac tamponade

Mechanical ventilation and the application of positive end-expiratory pressure (PEEP)

Pulmonary Hypertension

Pulmonary Embolism

Factors that DECREASE CVP include:

Hypovolemia

Deep inhalation

Distributive shock

Complications

Nursing Responsibilities:

BEFORE

DURING

AFTER

DIALYSIS

Anatomy & Physiology

The urinary system consists of the kidneys, ureters, urinary bladder, and urethra. The kidneys filter the blood to remove wastes and produce urine. The ureters, urinary bladder, and urethra together form the urinary tract, which acts as a plumbing system to drain urine from the kidneys, store it, and then release it during urination.

Function of the Kidneys

Removing wastes and water from the blood

Balancing chemicals in your body

Helping control blood pressure

Helping to produce red blood cells

Producing vitamin D

Production of hormones

Calcitriol

Erythropoietin

Renin

Assessment

o Inspection

o Auscultation

o Palpation

o Percussion

Inspection

The nurse inspects the abdomen and the flank regions with the client in both the supine and the sitting position. The client is observed for asymmetry (e.g., swelling) or discoloration (e.g., bruising or redness) in the flank region.

Auscultation

The nurse listens for a bruit which is an audible swishing sound produced when the volume of blood or the diameter of the blood vessel changes over each renal artery on the mid-clavicular line. A bruit is usually associated with blood flow through a narrowed vessel.

Palpation

Renal palpation identifies masses and areas of tenderness in or around the kidney. The abdomen is lightly palpated in all quadrants. The nurse asks about areas of tenderness or discomfort and examines non-tender areas first. If tumor or aneurysm is suspected, palpation may harm the client.

Percussion

A distended bladder sounds dull when percussed. The nurse begins percussion on the skin of the lower abdomen and continues in the direction of the umbilicus until dull sounds are no longer produced.

Diagnostic and Laboratory Test

Urinalysis

CT scan

Renal biopsy

Causes of Kidney Failure

1. Diabetes

2. High blood pressure (hypertension)

3. Kidney inflammation (glomerulonephritis)

4. Multiple cysts in the kidneys (polycystic kidney disease)

Dialysis

Dialysis is a process for removing waste and excess water from the blood, and is used primarily as an artificial replacement for lost kidney function in people with renal failure.

Types of Dialysis

Hemodialysis

Peritoneal Dialysis

Peritoneal Dialysis

In peritoneal dialysis, wastes and water are removed from the blood inside the body using the peritoneal membrane of the peritoneum as a natural semipermeable membrane. Wastes and excess water move from the blood, across the peritoneal membrane, and into a special dialysis solution, called dialysate.

Purpose

Removal of end products of protein metabolism from blood

• Maintain tolerable levels of electrolytes

• Correct acidosis

• Removal of excess fluid

Types of Peritoneal Dialysis

Continuous ambulatory peritoneal dialysis (CAPD)

Automated peritoneal dialysis (APD)

Peritoneal Dialysis Set

Transfer Set

Peritoneal dialysis drainage system

Dialysis Solution

Cycler

Procedure

Before starting peritoneal dialysis, a surgeon places a plastic tube (catheter) called Tenchkoff into your abdomen and will recommend waiting at least a month before starting treatment to give the area time to heal.

CAPD

1. An exchange begins by draining the old fluid into the waste bag. The new fluid is then drained into your peritoneal cavity. The process is painless and takes about 30-40 minutes to complete.

2. The new fluid is left in the peritoneal cavity for a number of hours

3. As blood passes through the peritoneum, special chemicals in the dialysate fluid draw out waste products and excess fluid from the blood into the fluid.

4. After the set time has passed, you will begin the process again, exchanging the old fluid for the new fluid.

APD

1. A machine is used to control the drainage of fluid. Fill the APD machine with fluid before you go to bed. As you sleep, the machine automatically performs a number of exchanges.

2. You will usually need to be attached to the APD machine for 8-10 hours. You will then usually have one last fill of fluid that is kept in your cavity all day before it is drained away the following evening.

3. During the night, an exchange can be temporarily interrupted if, for example, you need to get up to go to the toilet.

4. A power cut or other technical problem is not a worry as long as you resume treatment within 24 hours.

The process of doing peritoneal dialysis is called an EXCHANGE. You will usually complete 4 to 6 exchanges each day using the following steps:

1. Fill: Dialysis fluid enters your peritoneal cavity.

2. Dwell: While the fluid is in your peritoneal cavity, extra fluid and waste travel across the peritoneal membrane into the dialysis fluid. (4-6 hours)

3. Drain: After a few hours, the dialysis fluid is drained and replaced with new fluid.

Nursing Responsibilities

Before:

• Document vital signs including temperature, orthostatic blood pressures (lying, sitting, and standing), apical pulse, respirations, and lung sounds.

• Weigh daily or between dialysis runs as indicated.

• Measure and record abdominal girth.

• Note BUN, serum electrolyte, creatinine, pH, and hematocrit levels prior to peritoneal dialysis and periodically during the procedure.

• Maintain fluid and dietary restrictions as ordered.

• Have the client empty the bladder prior to catheter insertion.

• Explain all procedures and expected sensations.

• Warm the prescribed dialysate solution to body temperature (98.6° F or 37° C) using a warm water bath or heating pad on low setting.

During:

• Use strict aseptic technique during the dialysis procedure and when caring for the peritoneal catheter. Peritonitis is a common complication of peritoneal dialysis

• Add prescribed medications to the dialysate; prime the tubing with solution and connect it to the peritoneal catheter, taping connections securely and avoiding kinks.

• Instill dialysate into the abdominal cavity over a period of approximately10 minutes. Clamp tubing and allow the dialysate to remain in the abdomen for the prescribed dwell time. Keep drainage tubing clamped at all times during instillation and dwell time. Dialysate should flow freely into the abdomen if the peritoneal catheter is patent.

• • During instillation and dwell time, observe closely for signs of respiratory distress, such as dyspnea, tachypnea, or crackles.

• After prescribed dwell time, open drainage tubing clamps and allows dialysate to drain by gravity into a sterile container. Note the clarity, color, and odor of returned dialysate.

• Accurately record amount and type of dialysate instilled (including any added medications), dwell time, and amount and character of the drainage.

• Monitor BUN, serum electrolyte, and creatinine levels.

After:

• Assess vital signs, including temperature.

• Time meals to correspond with dialysis outflow.

• Teach the client and family about the procedure.

Advantages of PD

1. Few dietary or fluid restrictions.

2. Independence and ability to normalize daily routines.

3. The ability to do the dialysis at home.

Possible Complications

Peritonitis

Respiratory difficulty

Hernia

Hyperglycemia

Nutrition & DIet

Protein

Calories

Fluid and Sodium

Vitamins and Minerals

Fiber

INCUBATOR OR ISOLETTE

what is an Incubator?

Incubator

is an equipment to provide optimal condition of temperature, humidity and oxygen for survival of preterm, low birth weight or high risk infants. Is important to delay or to prevent cold stress

that produces additional hazards to the newborn as hypoxia, hypoglycemia and

metabolic acidosis.

Parts of Incubator

Functions of Incubator

indications

NURSING RESPONSIBILITIES

“Nurses are the heart of healthcare”

Bili Light

(Phototherapy)

Bili Light

Is a phototherapy tool to treat newborn jaundice (hyperbilirubinemia), the therapy uses a blue light (420-470 nanometers) that converts bilirubin so that it can be excreted in the urine and feces.

Purpose

Use for treatment of hyperbilirubinemia in the newborn, which is higher levels causes brain damage (kernicterus) , leading to cerebral palsy, auditory neuropathy, gaze abnormalities and dental enamel hypoplasia. This relatively common therapy lowers the serum bilirubin level by transforming bilirubin into water-soluble isomers that can be eliminated without conjugation in the liver.

Possible Complications

Skin conditions could temporarily worsen

Itchy skin

Red skin due to exposure to the lights

Burning of the skin

Increased insensible water loss

Cutaneous reactions in infants with cholestatic jaundice receiving phototherapy.

Patient Preparation

New born will have a blood test or skin test to check the bilirubin level before the treatment.

Positioning

Infants receiving phototherapy should be placed lying flat on a radiant warmer or in a bassinet. Small or premature infants can remain in an infant incubator during phototherapy. The infant should be naked with the exception of eye protection and a diaper to maximize the surface area of skin exposed to light. The phototherapy device should be placed at the side of the infant’s bed with the light shining on the infant and covering as much surface area as possible.

Nursing care for infants receiving phototherapy(bili light)

1.Ensure Effective Irradiance

Position phototherapy lamps or mattreses to provide the most skin exposure possible. Light sources should be close to the infant possible, with the exception of halogen-lamp phototherapy units

2.Provide Eye Protection

Opaque eye shields must be used during phototherapy to protect the infants eyes from retinal damage. Avoid eye patches that are too tight, as they may apply undue pressure to the infant’s delicate eye.

3. Assess Skin Exposure

The largest surface area of the infant’s body, the trunk , should be positioned in the centerof the light, where irradiance is highest.

4.Proper Positioning

Frequent turning to expose different areas of skin has not been shown to improve the effectiveness of conventional(single) phototherapy.

5.Assess And Adjust Thermoregulation Devices

Some phototherapy units can cause a significant increase in the infant’s body temperature. When phototherapy is directed over an incubator, immediately and sustained fluctuations can occur in the thermal environment.

6.Promoting Elimination And Skin Integrity

The photo products of bilirubin require elimination from the body in the stool or urine. Some of photochemical reactions induced by phototherapy are reversible, meaning that the isomers can converted back to unconjugated bilirubin if they are not eliminated in the stool.

7.Hydration

Several studies have documented an increase in transepidermal water loss during phototherapy. Excessive fluid losses via the skin are of particular concern in the smallest, most immature infant’s during the first week of life.

8.Promoting Parent-Infant Interaction

Phototherapy necessarily separates the neonate from its mother and may interfere with the process of establishing lactation. Unless jaundice is severe, phototherapy can be safely be interrupt at feeding time to allow continuation of breastfeeding, parental visits, and skin to skin care.

9.Monitoring Bilirubin Levels

The most significant decline in bilirubin level occurs first 4 to 6 hours after initiating phototherapy.

THANK YOU J