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

When a child is sent home on peritoneal dialysis, the family is faced with enormous challenges. Despite the coordination of community resources, there are few opportunities for relief from the many tasks required to keep a child home on dialysis. The intensity and duration of the home care required for children awaiting renal transplantation have often led to overwhelming parental stress, marital discord and burn-out. These events can lead to the detriment of the well-being of the child and may result in a higher incidence of peritonitis. Many families had identified the need for some form of relief. Recognizing this, the staff of the home dialysis program of the Toronto Hospital for Sick Children (HSC) joined forces with the staff at Bloorview Children's Hospital (a chronic care/rehabilitation centre) to develop a respite program for these families. The HSC staff provided staff education, medical back-up and financed the equipment and supply costs while the Bloorview Hospital provided the accommodation and the medical and nursing staff to care for the children. In addition to providing parental relief, Bloorview Hospital was able to provide extended care to children requiring peritoneal dialysis until their parents were able to care for them at home. This enabled HSC to use their beds for more acutely ill children. Initial evaluation of the program was favourable and efforts are now being made to streamline the system.

Occasionally in hemodialysis units there are situations where registered nurses are unable to assist an individual whose behaviour is abusive or escalating in that direction, and the person cannot re-establish self-control and appropriate behaviour. Such abusive behaviour may arouse concern for the physical and psychological safety or security of the nurse and that of other patients and visitors. Interdisciplinary conferences were held to develop a policy document and guidelines to aid caregivers should abusive situations occur. These were the result of collaboration between physicians, nurses, social workers, a dietician and the clinical nurse specialist from psychiatry. The policy statement and guidelines include nursing actions, physician interventions and recommendations for follow-up conferences.

To test the feasibility of using general health status as a practical dialysis outcome measure, in a longitudinal pilot study, two well-validated instruments were administered to patients from our dialysis unit or clinic. The instruments were administered three times, at eight-week intervals for seven months to 41 hemodialysis (HD) patients. Forty-five transplant (Tx) patients were surveyed once as a validating control. Sociodemographic, imaging and biochemical data were tested as outcome predictors. Unexpected hospitalizations and adverse intercurrent events were used as additional outcome measures. Preliminary analysis shows HD patients scoring low, while Tx patients scored higher (healthier). These preliminary results suggest that assessment of general health status is a valid and practical outcome measure.

There are several treatment options for end stage renal disease (ESRD)--renal transplantation, peritoneal dialysis, hemodialysis or no treatment. The treatment of choice will vary from individual to individual and some of the treatments may not be suitable for, or available to each individual. This is a case presentation of Maria, who, over 18 years has had all of the treatment options available for ESRD. Maria moved from treatment with peritoneal dialysis to transplant, and then following her second transplant failure, she commenced hemodialysis. While on hemodialysis she exhausted all of the vascular access options available, requiring an innovative permanent inferior vena cava catheter. Finally, she decided to withdraw from treatment. The nursing role throughout the treatment course is highlighted, with a focus on the nursing interventions during the last two years, at which time Maria exercised her right to withdraw from treatment.

Advances in recent technology and the trend toward reducing dialysis times has had a detrimental effect on morbidity and mortality rates. Urea Kinetic Modeling provides the dialysis staff with essential information to help ensure optimum care and increase the probability of success. Urea Kinetic Modeling has not been utilized by many centres because it was thought to be too time consuming and too complicated. Simplification of the variables without jeopardizing the outcome makes Urea Kinetic Modeling a much more feasible option to determine dialysis adequacy. All parameters in Urea Kinetic Modeling are dependent, interrelated and all are required to describe dialysis adequacy. Urea Kinetic Modeling allows the physician, dietician and nurse to individualize dialysis prescriptions, determine excessive or inadequate protein intake and to review delivered versus desired treatment times.