CNA573 Contemporary Renal Replacement Therapy

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CNA573 Contemporary Renal Replacement Therapy

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CNA573 Contemporary Renal Replacement Therapy

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Course Code: CNA573
University: University Of Tasmania

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Country: Australia

Question
The purpose of this assessment is to demonstrate development of your skill, knowledge and decision making ability in clinical practice over time.
This Workplace Clinical Assessment consists of a pathway to demonstrate your learning achievement and can take place over several occasions.
Following are lists of skills, knowledge and decision making that are designed to help you demonstrate specific learning within your practice area. It will be you, in consultation with your workplace assessor, who decides what you will be assessed for. Your decision will be based upon your level of knowledge and skill as identified in the Clinical Practice Survey.
Answer:

Introduction
Haemodialysis is a process of blood purification; it entails the removal of waste products in the blood. Clinical practice is of the essence in hemodialysis nursing world. Having basic and competent understandings of various nursing practice diagnosis is essential in the management of the dialysis process, (Nistor, 2015). This reflection offers my assessment skills on key areas in health care nursing practice touching on hypotension, cramps, vomiting, headaches, vomiting, A-V Access surveillance and anticoagulant free dialysis assessment.
Hypotension management
Hypotension can occur during hospital admission or developed during the patient’s hospitalization or at times caused by iatrogenic complications. Non-traumatic conditions occurring out of hospitals are associated with increased hospital mortality, while those developing in emergency care settings or during acutely decompensated heart failure, COPD and community-acquired occurrence is associated with high mortality. Its occurrence happens at below normal blood pressures ranges of 120/80mmHg, (Dasgupta, Farrington, Simon, Davies, Davenport & Mitra, 2016 pp. 325). Main causes can be attributed to a decrease in cardiac output, dilation of blood vessels low blood volume, nervous system impairment, and other medications. Intradialytic hypotension is a common hemodialysis type occurring. It leads to a rapid reduction in the volume of blood due to the ultrafiltration process ad reduction in extracellular osmolarity process. Its management entails usage of midodrine, and vasopressin analogous. Further, usages of new classes of drugs such as adenosine receptor antagonists have been used selectively to manage the state, (Kuipers et al., 2016 p. 21.
Cramps
Cramps are more observed among patients needing high ultrafiltration rates. Cramps during dialysis are related to a reduction in muscle perfusion which occurs in response pt hypovolemia. Vasoconstrictive responses occur which can shut the blood in the central pathways which can promote muscle cramps. Further changes occurring in intra and extracellular potassium balance and calcium ionization often can disturb neuromuscular transmission casing cramps. Further, they can be linked to intra dialectic cramps which ascertain the presence of dialytic treatment linked to cramps. Its management treatment can be undertaken using physical manoeuvres to smoothen muscles. Moreover, usage of dialysate of sodium, potassium, and calcium can be affected. Reassessing dry weight and patient counseling can be effective in the reduction of interdialytic weight gain and usage of bicarbonate dialysis, (Flythe et al., 2018).
Vomiting, headaches, and vomiting
Vomiting and nausea are often associated with kidney. Low blood pressure and excess weight gain are the most often associated causes. The symptoms are commonly associated with a kidney condition, coupled with low blood pressure and weight gain can have contributing effects. Nausea and vomiting can have effects of discontinuation of dialysis treatment process. Medication management of nausea and vomiting entails regulation of fluid removal levels and further prescription of anti-nausea medication, (Singh et al., 2016 pp. 803-805). Further, the dialysis process, may at times induce severe headaches which often result in large quantity shifts in electrolyte and water balance, (Goksan, Karaali-Savrun, Ertan & Savrun, 2004 ). They can result from low blood pressure. Management is offered through over the counter drugs. Over the counter drugs such as acetaminophen can be used to minimize headaches.
A-V access surveillance
Haemodialysis vascular access often referred to as lifeline is critical to a lifeline. Functional arteriovenous access offers a lifeline access for hemodialysis is crucial as it provides enough blood for adequate dialysis. Common causes of AV failure are linked to stenosis and development of thrombosis. Stenosis assessment can be detected using various techniques which often calls close monitoring. Clinical observation, flow measurement, pressure determination, and recirculation measurement is crucial in the assessment of stenosis. Further, stenosis can be accessed through direct visualization though none invasive techniques such as venography or color duplex imaging, (Inston et al., 2017 pp. 4-7).
Managing access and patency of diagnosing accuracy of A-V access depends on timely interventions. Related linked to vascular access is often the common causes of hemodialysis hospitalizations among dialysis patients. Thus, prevention of complication development can be effective in reducing morbidity, mortality and reducing associated complications which reduces the health care system.
A-V access assessment can be undertaken using physical examination process which is the cornerstone of clinical monitoring. Elements of access can include inspection of arm, shoulder, face, neck, and breast, palpation assessment and auscultation. Physical assessment of vascular access is often a simple method which can be performed readily. Access flow measurement can be further implemented; this can measure significant stenosis which assesses monthly blood flow access. Further assessment of venous pressure monitoring can be undertaken using a dialysis machine using a pressure transducer at the beginning of hemodialysis, (Khawaja et al., 2016 pp. 104-107).
Surveillance and monitoring of AV access is a critical care component in hemodialysis of patients. Physical examination and clinical assessment are the key fundamental tools to be used in detecting access problems.
Anticoagulation hemodialysis
Haemodialysis process entails renal replacement therapies which call for adequate blood flow. Often some forms of the anticoagulation process such as usage of heparin are critical in preventing thrombosis. The anticoagulation process during hemodialysis process entails monitoring and determination of activated clotting times. Usage of low dose or minimum heparin use methods is effective. Further other methods such as anticoagulation with citrates and prostacyclin and heparin-protamine medicines have been effectively been used.
Anticoagulation process in normal hemodialysis often can consist of standard doses of heparin which is offered as bolus given at the start of treatments and midpoints so as to maintain the needed stable anticoagulation steps.  Further heparin modelling can be undertaken using initial bolus administration followed with fixed heparin infusing in order to maintain the activated clotting time which is normally between 200-250 seconds. Activated clotting time is often performed from activating agents in fresh samples of blood and assessment of time taken. This therapeutic medication process offers a systematic anticoagulation during the dialysis treatment, (Jose et al., 2015).
The anticoagulation process during dialysis is a treated approach which prevents coagulation process. Most used agents function through inhibition of plasmatic coagulation. Other methods of management such as immune-mediated induced heparin thrombocytopenia often lead to life-threatening complications related to heparin therapy which calls for caution which necessities to shift to non-heparin methods, (Wong et al., 2016 pp. 630-635).
References
Dasgupta, I., Farrington, K., Davies, S.J., Davenport, A. and Mitra, S., 2016. UK National Survey of practice patterns of fluid volume management in haemodialysis patients: a need for evidence. Blood purification, 41(4), pp.324-331.
Flythe, J.E., Hilliard, T., Lumby, E., Castillo, G., Orazi, J., Abdel-Rahman, E.M., Pai, A.B., Rivara, M.B., Peter, W.L.S., Weisbord, S.D. and Wilkie, C.M., 2018. Fostering Innovation in Symptom Management among Hemodialysis Patients: Paths Forward for Insomnia, Muscle Cramps, and Fatigue. Clinical Journal of the American Society of Nephrology, pp.CJN-07670618.
Göksan, B., Karaali-Savrun, F., Ertan, S. and Savrun, M., 2004. Haemodialysis-related headache. Cephalalgia, 24(4), pp.284-287.
Inston, N., Schanzer, H., Widmer, M., Deane, C., Wilkins, J., Davidson, I., Gibbs, P., Zanow, J., Bourquelot, P. and Valenti, D., 2017. Arteriovenous access ischemic steal (AVAIS) in haemodialysis: a consensus from the Charing Cross Vascular Access Masterclass 2016. The journal of vascular access, 18(1), pp.3-12.
Jose, M.D., Longmuir, H., Dodds, B., Bereznicki, L., Prasad, R., Batt, T.J., Strippoli, G.F. and Palmer, S.C., 2015. Anticoagulation for people receiving long?term haemodialysis. Cochrane Database of Systematic Reviews, (9).
Khawaja, A.Z., Cassidy, D.B., Shakarchi, J.A., McGrogan, D.G., Inston, N.G. and Jones, R.G., 2016. Systematic review of drug eluting balloon angioplasty for arteriovenous haemodialysis access stenosis. The journal of vascular access, 17(2), pp.103-110.
Kuipers, J., Oosterhuis, J.K., Krijnen, W.P., Dasselaar, J.J., Gaillard, C.A., Westerhuis, R. and Franssen, C.F., 2016. Prevalence of intradialytic hypotension, clinical symptoms and nursing interventions-a three-months, prospective study of 3818 haemodialysis sessions. BMC nephrology, 17(1), p.21.
Nistor, I., Palmer, S.C., Craig, J.C., Saglimbene, V., Vecchio, M., Covic, A. and Strippoli, G.F., 2015. Haemodiafiltration, haemofiltration and haemodialysis for end?stage kidney disease. Cochrane Database of Systematic Reviews, (5).
Singh, T., Guirguis, J., Anthony, S., Rivas, J., Hanouneh, I.A. and Alkhouri, N., 2016. Sofosbuvir?based treatment is safe and effective in patients with chronic hepatitis C infection and end stage renal disease: a case series. Liver International, 36(6), pp.802-806.
Wong, S.S.M., Lau, W.Y., Chan, P.K., Wan, C.K. and Cheng, Y.L., 2016. Low-molecular weight heparin infusion as anticoagulation for haemodialysis. Clinical kidney journal, 9(4), pp.630-635.

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