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V A dialyzer is actually a semipermeable membrane designed
into thousands of small 'capillary' like tubes and placed into a
cartridge as shown in the adjoining picture. This effectively
creates two compartments, one for the blood flow and
another for the dialysate flow.
V A dialysate is a solution that contains electrolytes and other
substances at physiological concentration.
V The blood flow and the dialysate flow are in opposite
directions.
m  

 

V ?emodialysis machine is required to pump the blood at


requisite flow. Apart from this, the machine mixes three
different components of dialysis solution to make it into a
dialysate with physiological concentrations of electrolytes.
V The machine also monitors the flow parameters and the
pressures in the circuit.
V The amount of ultrafiltration ( removal of excess fluid from
the body) can be programmed into the machine and current
day machines will precisely remove the fluid to the last
milliliter.
m  
îhen blood with toxins and
high concentrations of
substances is exposed to
a solution with normal
concentrations of
substances, there is a
natural gradient towards
the dialysate and all the
waste products and
excess water are 'washed'
away by the dialysate.
m  
mm

V mialysis is a process whereby solute
composition of a solution (blood) is altered by
exposing to it to a second solution (dialysate)
through a semipermeable membrane (
peritoneum, dialyzer membrane).
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V As an elective decision, dialysis is initiated in one of the
following situations:
V when estimated GFR falls below 10 mL/min
V îhen symptoms of kidney failure start appearing.

 


V wevere Breathlessness due to fluid congestion in lungs
V Very high levels of potassium
V Bleeding tendencies
V Pericarditis ( inflammation of covering around heart)
V Encephalopathy ( clouding of brain due to high levels of
toxins)
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wince initiation of dialysis is commonly elective, it is
prudent to be prepared for the situation.
Preparation includes
V getting educated for dialysis options
V deciding on the modality of dialysis (
hemodialysis vs. peritoneal dialysis)
V getting a small surgery called AV fistula
construction
V Getting vaccinated against certain infections
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V An access for letting blood
'in and out' of the body.
V A machine that will pump
the blood and monitor the
entire process.
V An artificial kidney (
dialyzer) that purifies blood
of the toxins.
V A solution ( dialysate) that
helps in the process of
dialysis.
The blood is taken out through AVF or AVG ( or a
catheter). This blood flow is mainatained at a
good velocity with the help of a blood pump
in the dialysis machine.

This blood then reaches the dialyzer where


there are two compartments. One
compartment contains the blood and the
other contains the 'dialysate'. These
compartments are separated by a semi-
permeable membrane. The actual 'cleansing'
of blood occurs here.
The clean blood is then returned to the body
through a second needle in the veins or
second 'port' of the catheter.

Once the blood comes out of the body, it has a


tendency to clot. To prevent this, a drug called
'?eparin' is circulated through the circuit. This
is done by a syringe pump located on the
dialysis machine.
Pressures inside the circuit are monitored by the
machine and any inadvertent air leak is
trapped in the air chamber along the circuit.
mw?ARGE GOALw
Ê RwÊG PRORTEw 1. Fluid and electrolyte
1. Promote balance maximized.
homeostasis. 2. omplications
2. Maintain comfort. prevented/minimized.
3. miscomfort alleviated.
3. Prevent 4. mealing realistically
complications. with current situation;
4. wupport patient independent within
independence/self-care. limits of condition.
5. misease
5. Provide information process/prognosis and
about disease therapeutic regimen
process/prognosis and understood.
treatment needs. 6. Plan in place to meet
needs after discharge .
 ./.0 1 2.).2 32
m  
V Maintain or teach asepsis for dressing changes and wound care,
catheter care and handling, and peripheral V and central venous
access management.
V îash hands and teach other caregivers to wash hands before
contact with patient and between procedures with patient. * 
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V Limit visitors. 


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V Encourage intake of protein- and calorie-rich foods. 
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V Encourage fluid intake of 2000 ml to 3000 ml of water per day
(unless contraindicated). *!  

 


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V Encourage coughing and deep breathing; consider use of
incentive spirometer. 









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V Administer or teach use of antimicrobial (antibiotic) drugs as
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V Place patient in protective isolation if patient is at very high risk.
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V Recommend the use of soft-bristled toothbrushes and stool
softeners to protect mucous membranes.
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V Teach patient or caregiver to wash hands often, especially
after toileting, before meals, and before and after
administering self-care. /


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V Teach patient the importance of avoiding contact with those
who have infections or colds.
V Teach family members and caregivers about protecting
susceptible patient from themselves and others with
infections or colds.
.m01 322m132 20 3*
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V Teach patient, family, and caregivers the purpose and proper
technique for maintaining isolation.
V Teach patient to take antibiotics as prescribed. 
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V Teach patient and caregiver the signs and symptoms of
infection, and when to report these to the physician or nurse.
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V memonstrate and allow return demonstration of all high-risk
procedures that patient or caregiver will do after discharge,
such as dressing changes, peripheral or central V site care,
peritoneal dialysis, self-catheterization (may use clean
technique). 

 






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I WOULD LIKE TO SHARE WITH YOU
A BALANCE STATEMENT WHICH CAN
BALANCE YOUR WHOLE BEING«.

´Be aware of wonder. Live a balanced


life - learn some and think some and
draw and paint and sing and dance and
play and work every day some.µ