Le Journal CANNT = CANNT journal : the journal of the Canadian Association of Nephrology Nurses and Technicians最新文献

The lives of the ESRD population have been enhanced and prolonged by improved conservative management, efficient dialysis and successful transplantation. However, practitioners are noting some significant morbidity in these long-term surviving nephrology patients. Clinical signs of renal osteodystrophy can be very subtle and insidious. Bone pain, muscle weakness, and pruritus can be vague symptoms. Calciphylaxis, which is classified as a skin disorder is an extremely rare, painful, and progressive complication. Typically, the patient presents with vascular calcifications, cutaneous ulcerations and tissue necrosis. The treatment regimen for bone disease in the ESRD population will be reviewed. The symptoms of calciphylaxis, diagnostic tests and prognosis will be discussed. Four case studies describe our recent experience. Emphasis will be on the intense multidisciplinary care required for this devastating and often fatal syndrome.

Patients with end stage renal disease (ESRD) often suffer compromised self-esteem and lowered self-confidence, isolation from the larger community and increased dependence on the health care system. Despite improved technology and medical care, such concepts as "quality of life" and "feeling well" still elude these patients. There is a growing realization in the health care field that other interventions and approaches are needed. This article will describe how the creative arts can activate, motivate and promote wellness for ESRD patients. The focus is on the use of professional artists, dancers and writers to help restore a sense of wholeness, health, and happiness to patients' lives. This preliminary work which explores the belief that art and artistic experiences have healing properties, will hopefully result in a more comprehensive research project in the near future.

Thrombus formation is a common cause of hemodialysis catheter malfunction. When thrombus or fibrin sheath restrict the flow of blood through one or both lumens, the catheter may need to be replaced. A less invasive, potentially lower cost option may be the instillation of low dose urokinase to degrade fibrin and restore catheter function. This study examines the efficacy of urokinase in improving blood flow and maintaining catheter patency. In a one-year period, urokinase was utilized in 25 dual lumen hemodialysis catheters (20 temporary, five permanent) in 22 patients. Blood flow and arterial and venous pressures were monitored before and after instillation. Urokinase administration successfully restored function in 20 catheters (80%). Paired t-tests demonstrated a significant improvement in blood flow and arterial pressure (p < 0.01) following urokinase. Catheter patency was extended for a mean of 18.0 days (range 0-90 days). The cost effectiveness of urokinase was evaluated in terms of direct costs, such as the cost of urokinase or materials to replace catheters, and indirect costs such as nursing and physician time and delays in dialysis scheduling. The results of this study suggest that judicious use of urokinase is a cost-effective, non-invasive method of restoring blood flow and extending patency in hemodialysis catheters.

Nocturnal hemodialysis has proven to be an effective and safe modality with many benefits. Using NHD parameters, two in-centre conventional hemodialysis (CHD) patients participated in a three-week in-hospital trial to test the viability of an in-hospital nocturnal hemodialysis (NHD) program. One RN was responsible for the initiation and monitoring of all treatments. In order to objectively measure results, we maintained a daily log detailing alarm situations, response time for both technical and medical support, and required interventions. Patient and staff comments were recorded daily. Miscellaneous problems were also documented. Both patients were given quality of life questionnaires and patient satisfaction surveys pre- and post-trial. Occasionally, difficulties with machine and vascular access problems were encountered. Results revealed that subjectively, both patients felt much better on NHD when compared to CHD, however they found that their personal lives were adversely affected by their absence from home. Upon completion of the trial, the accumulated data was analyzed and recommendations were made. It was decided that a staff/patient ratio of 1:3 would be safe providing that the physical environment allowed the RN to oversee all functions. Due to patient dissatisfaction with treatments six nights per week, it was suggested that flexibility with patient scheduling was essential. However, it was agreed that six nights per week would be advantageous within a chronic care facility offering hemodialysis therapy. To ensure complete medical coverage, renal fellow integration within the nocturnal project was recommended. In conclusion, we feel that the adaptation of NHD to the in-centre setting is viable with the appropriate patient population and physical environment.

Nurses' utilization of case study analysis often focuses on medically-based knowledge which is intertwined within our daily practice. Reflection on nurse-patient interactions with nursing theory as the analytic tool is infrequently undertaken. The case study analysis presented within this paper analyzes an exemplar utilizing the theoretical works of Patricia Benner.