Hemodialysis on End Stage Renal Disease Patients and the Increasing Role for the Nurse
It is a difficult condition of a kidney failure when one's kidney could no longer carry out the proper metabolism system to eliminate waste products. Kidney is the essential organ that is responsible in waste elimination, including others like detoxification process of drugs and toxic materials, also in controlling water balance, salt balance, blood pressures and secrete hormones (Crawford, 2002).

When both kidneys fail to function, which comes to the End Stage Renal Disease, there is suddenly a loss of control to the fluid balance. The kidney cannot filter the fluid and therefore metabolism waste, toxic, salt and water accumulate in the blood, causing swell on the tissues, high blood pressure and heart disease.

Until now, there is no medication offered to cure ESRD. The current treatments to this disease are hemodialysis, peritoneal dialysis, or kidney transplant.

Hemodialysis as…...

mla

Bibliography

Counts, C., and Holmes, K.T. Oct, 2002. Clinical Research: We Can Make a Difference. Nephrology Nursing Journal Vol. 29, No. 5.

Crawford, W.H. Jr. 2002. End-Stage Renal Disease. Retrieved November 09, 2002 from University of Southern California School of Dentistry. Web site:  http://www.usc.edu/hsc/dental/PTHL312abc/312c/25/chapter.pdf 

End Stage Renal Disease. Retrieved November 09, 2002 from Aksys Personal Hemodialysis System. Web site:  http://www.aksys.com/therapy/images/ESRD.pdf 

Kshirsagar, A.V., Hogan, S.L., Mandelkehr, L., and Falk, R.J. 2000. Length Of Stay And Costs For Hospitalized Hemodialysis Patients Nephrologists vs. Internists. Journal of American Society of Nephrology 11:1526-1533, 2000. American Society of Nephrology.

Introduction, Analysis of Existing Evidence, and Quality Improvement Process Hemodialysis patients are at high risks of infection due to their impaired immune defenses and repetitive access of the bloodstream via vascular access types. The treatment process of hemodialysis involves using different processes and equipment that sometimes worsen the patients’ conditions. For example, frequent antibiotics administration to these patients generates antimicrobial resistance and multidrug-resistant organisms. Central venous catheters (CVCs) are among the most commonly used vascular access types. While the use of CVCs is geared toward enhancing the health and wellbeing of hemodialysis patients, they enhance the risk of hospital-acquired infections. This paper provides a brief overview of the practice problem, analyzes existing evidence on this issue, and describes the quality improvement process and the Quality model that will be used to address this practice problem.
Practice Problem
The lifeline for patients suffering from long-term hemodialysis is a well-functioning vascular access. This is primarily…...

mla

References

Apata et al. (2017, April 2). Chlorhexidine-Impregnated Transparent Dressings Decrease Catheter-related Infections in Hemodialysis Patients: A Quality Improvement Project. The Journal of Vascular Access, 18(2), 103-108.

Gahlot et al. (2014, Apr-Jun). Catheter-related Bloodstream Infections. International Journal of Critical Illness & Injury Science, 4(2), 162-167.

Hymes et al. (2017). Dialysis Catheter-Related Bloodstream Infections: A Cluster-Randomized Control Trial of the ClearGuard HD Antimicrobial Barrier Gap. American Journal of Kidney Diseases, 69(2), 220-227.

Nguyen et al. (2017, June 29). National Healthcare Safety Network (NHSN) Dialysis Event Surveillance Report for 2014. Clinical Journal of the American Society of Nephrology, 12, 1-8.

Saxena, A.K., Panhotra, B.R. & Al-Mulhim, A.S. (2005). Vascular Access Related Infections in Hemodialysis Patients. Saudi Journal of Kidney Diseases and Transplantation, 16(1), 46-71.

Thompson et al. (2017, December). Catheter-related Blood Stream Infections in Hemodialysis Patients: A Prospective Cohort Study. BMC Nephrology. doi: 10.1186/s12882-017-0773-5

In an acute care setting, such Veterans Affairs, this objective is executed by educating patients about how to maintain a healthy diet and lifestyle after the leave the facility, while in a long-term care setting-such as Cobble Hill-this objective is executed on a daily basis by providing nutritious meals for elderly residents. And finally, in an ambulatory, out-patient care setting-such as Atlantic -- the clinical nutritionist works to support patients in maintaining a diet that addresses their personal healthcare needs, while still living independently within a larger community. Perhaps the most significant similarity between facilities is the notion of nutrition as merely one component of a comprehensive care program; hence the necessity of a clinical nutritional to work in conjunction with a full medical, administrative, and social support staff. The apparent goal of such an approach is to promote multiple aspects of health and well-being among patients, regardless setting…...

mla

References

Cite Health. (2010). Long Island College Hospital. Retrieved December 19, 2010 from  http://citehealth.com/dialysis-centers/new-york/cities/brooklyn/long-island-college-hospital 

Cobble Hill Health Center. (2010). Resident Services. Retrieved December 19, 2010 from  http://www.cobblehill.org/services 

United States Department of Veterans Affairs. (2010). Patient Information. Retrieved December,

19, 2010 from http://www.brooklyn.va.gov/patients/index.asp

Translation Evidence Into Nursing Health Care Practice. Chapter 6, "Translation Evidence Leadership" Article: Bakke, C.K. (2010). Clinical cost effectiveness guidelines prevent intravascular catheter-related infections patients' hemodialysis.
Briefly summarize your selected issue and propose new evidence-based practice strategies.

Pressure ulcers, commonly known as bedsores, are frequently observed in otherwise healthy bed-ridden patients in nursing homes. To promote wellness amongst this patient population, it has been suggested that regular turning and positioning of the patients by caregivers should be used to reduce their occurrence. Turning and positioning has long been used amongst healthcare practitioners for a variety of bed-ridden patients, usually at regimented intervals spanning 4-2 hours (Thomas 2001). Based upon the previous research conducted upon this population, the suggested shortened interval is 1-11/2 hours for repositioning of the patient (Thomas 2001).

Q2. Describe the theoretical basis for your strategies.

The theoretical basis for this initiative lies in the idea that passive movement can reduce…...

mla

References

Bluestein, D. & Javaheri, A. (2008). Pressure ulcers: Prevention, evaluation, and management.

American Family Physician, 78(10):1186-1194. Retrieved from:

 http://www.aafp.org/afp/2008/1115/p1186.html 

Krapil, L.A. & Gray, M. (2008). Does regular repositioning prevent pressure ulcers?

ecause this is true, it is critically clear that the nursing leadership manager's role is one of a vital nature and that support for nurses in their role is the primary component that must necessarily be integral to leadership in nursing in dialysis units if the turnover of nurses is reduced to the lowest possible level. The nursing leadership manager's role is one that must proactively deal with burnout of these dialysis unit nurses instead of attempting to address these as they occur. Prevention is 'key' toward this end. As the demands grow for quality and competent nursing staff so does the need grow for competency in leadership nursing manager roles. ecause the dialysis unit nurse is very closely involved in their patient's care and because these patients are required to report for treatment several days a week for several hours a day the nurse's mental, physical and emotional…...

mla

Bibliography

Aiken, L.H., & Patrician, P. (2000). Measuring organizational traits of hospitals: The Revised Nursing Work Index. Nursing Research, 49, 146-153.

Aiken, L.H., & Sloane, D.M. (1997). Effects of organization innovation in AIDS care on burnout among urban hospital nurses. Work Occupation, 42, 453-477.

Aiken, L.H., Clarke, S.P., Sloane, D.M., Sochalski, J., & Silber, J.H. (2002). Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction [Electronic version]. JAMA, 288, 1987-1993.

Aiken, L.H., Clarke, S.P., Sloane, D.M., Sochalski, J.A., Busse, R.A., Clarke, H., Giovanetti, P., Hunt, J., Rafferty, a.M., & Shamian, J. (2001). Nurses' reports on hospital care in five countries [Electronic version]. Health Affairs, 20, 43-53.

Intradialytic weight gain has become a major problem for End Stage enal Disease (ESD) patients who are dependent on hemodialysis. This issue has resulted in more complications and hospitalizations of ESD patients who need effective IDWG management programs that are driven by nurses. This project proposes a project that is geared towards improving IDWG management for these patients by 10% through a 12-week educational program. The paper demonstrates how the project will be implemented in a 19 chair dialysis clinic that functions 6 days every week in order to accommodate 150 hemodialysis patients. The discussion includes a description of the proposed change, rationale for selecting it, implementation methods, and expected results. The author provides evaluation of baseline data collected from patients during implementation and conclusions based on the collected data.
Objectives of CNL Internship Project

The objectives or aim of this CNL Internship Project is to coordinate a plan of care that…...

mla

References

Barnett, T., Li, Y.T., Pinikahana, J. & Si-Yen, T. (2008, February). Fluid Compliance among Patients having Haemodialysis: Can an Educational Programme Make a Difference? Journal of Advanced Nursing, 61(3), 300-306.

Lingerfelt, K. & Thornton, K. (2011). An Educational Project for Patients on Hemodialysis to Promote Self-Management Behaviors of End Stage Renal Disease. Nephrology Nursing Journal, 38(6), 483-489.

Mento, A., Jones, R. & Dirndorfer, W. (2002). A change management process: Grounded in both theory and practice. Journal of Change Management, 3(1), 45-70. Retrieved from EBSCO Host, AN 7329277.

Appendix

Critique of esearch Part Quantitative article Critique esultso Data analysisOf the fifty- seven patients undergoing hemodialysis through the use of central venous catheter (CVC), three- quarters were men aged 20 - 59 years; fifty- seven percent of subjects belonged to the Christian Catholic church and sixty-four percent were married. With regard to their educational qualification, forty- six percent of subjects had completed primary education while one in five patients was uneducated. With respect to CVC implant, seven out of ten implants were noted to have been installed within patients internal right jugular veins, whereas twelve percent were within their right femoral veins. Concerning causes for removal of implants, seventy percent were on account of maturation of AVF, while twenty percent were account of infection. Concerning hemodialysis dosage (gauged in terms of Kt/ V), eighty- two percent depicted > 250 ml/ min blood flow while seventy percent showed values ranging from…...

mla

Referencesde Lima Guimarães, G., Goveia, V. R., Quispe Mendonza, I. Y., dos Reis Corrêa, A., Silqueira de Matos, S., & Oliveira Guimarães, J. (2017). NURSING INTERVENTIONS FOR HEMODIALYSIS PATIENTS THROUGH CENTRAL VENOUS CATHETER. Journal of Nursing UFPE/Revista de Enfermagem UFPE, 11(3).Jeffs, L., Saragosa, M., Law, M. P., Kuluski, K., Espin, S., & Merkley, J. (2017). The role of caregivers in interfacility care transitions: a qualitative study. Patient preference and adherence, 11, 1443.Loiselle, C. G. (2011). Canadian essentials of nursing research. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.

Online Haemodialfiltration
HDF is a strategy that that enables high potential of hydraulic and solute permiabilityof synthetic membranes hence they can be properly exploited. The high cost of the fluids in bags that are commercially prepared as well as the improvement of technology of dialysate preparation and fluid filtration has made it possible in recent years for the development of the novel technique known as online HDF. In this technique a particular amount of freshly prepared ultrapure dialysate is taken daily from daily dialysate inlet line and then processed with several filtration steps before they are used as replacement fluid. With this technique, large amounts of replacement solutions that are relatively inexpensive are made available and HDF can be carried out with a high fluid turnover under the utilization of pre- and post-dilution or even consecutive pre-post dilution in proportions that differ (Yvonne, 2011).

On-line hemodifiltration provides the largest amount when it…...

mla

References

Keller, D.(2011). Hemodiafiltration, Hemodialysis Show Similar Survival Rates. Retrieved June 18,2014 from  http://www.medscape.com/viewarticle/746131 

van der Sande FM, Kooman JP, van Kuijk WH, Leunissen KM. (2001). Management of Hypotension in Dialysis Patients: Role of Dialysate Temperature Control. Retrieved June 18,2014 from  http://www.sjkdt.org/article.asp?issn=1319-2442;year=2001;volume=12;issue=3;spage=382;epage=386;aulast=van 

Yvonne, W. (2011). Online haemodiafiltration. Retrieved June 18,2014 from http://www.biomedsearch.com/article/Online-haemodiafiltration/264921864.html

RxPG Medical Solutions Private Limited (2008).Dialysis

Critical Pathway: Chronic enal Failure
Advanced Pathophysiology

egents Online Degree Program

Critical Pathway: Chronic renal failure

Chronic renal failure is often occasioned by chronic kidney disease, immune disorder, trauma among other conditions. It does not have any specific symptoms and might include feeling unwell generally and experiencing a reduced appetite. It is diagnosed following screening of individuals who are identified to be at risk of kidney problems, like individuals with diabetes or high blood pressure and others who have blood relative with chronic kidney disease. It always seems complex when trying to come up with the right diagnosis for a patient.

M.A. is a 60-year-old man who has a stage V chronic kidney disease mainly as a result of diabetic nephropathy and a 12-year of type 2 diabetes. He has symptomatic peripheral vascular insufficiency, and 3 years ago he had undergone coronary artery bypass 3. Within the ten months that passed, Mr. M.A. had been…...

mla

References

Ahern J, Kruger DF, Gatcomb P, Petit W, Tamborlane W.,(1989). The Diabetes Control and Complications Trial (DCCT): the trial coordinators perspective. Diabetes Educ 15:236 -- 281

Bassilios N, Launay-Vacher V, Khoury N, et al. (2001) Gabapentin neurotoxicity in a chronic haemodialysis patient. Nephrol Dial Transplant.

Blum RA, Comstock TJ, Sica DA, et al.(1994). Pharmacokinetics of gabapentin in subjects with various degrees of renal function. Clin Pharmacol Ther;56(2):154-159

Brawek B, Loffler M, Dooley DJ, Weyerbrock A, Feuerstein TJ.(2008) Differential modulation of K (+)-evoked (3)H-neurotransmitter release from human neocortex by gabapentin and pregabalin. Naunyn Schmiedebergs Arch Pharmacol.:376(5):301-307

NxStage
Company Background

Environmental Scan

Five Forces & Value Chain

Strategic Alternatives

Strategic Plan

Acquisitions

esource Allocation

NxStage is a medical equipment manufacturer specializing in hemodialysis products for use in the home. Their main flagship, NxStage SystemOne, constitute two-thirds of the company's revenues. The product has been on the market for several years, but NxStage has never been able to turn a profit, nor has it been able to develop a viable second major product. This has created a strategic dilemma for the company as to how best to enhance shareholder value going forward.

The external environment is generally challenging, especially in light of regulatory changes that aim to drive down the cost of medical care, not necessarily good for a company like NxStage that has a differentiated product. There is some demand for the product, but also substitution from dialysis clinics, which can be offered at a lower total cost, making them attractive for payers. In light of…...

mla

References

Baribeau, P. (2012). Task ownership boosts employee engagement. Tribe HR. Retrieved March 24, 2014 from http://tribehr.com/blog/task-ownership-boosts-employee-engagement

Baxter. (N.d.). Corporate Overview. Retrieved from Baxter:  http://www.baxter.com/about_baxter/company_profile/corporate_overview.html 

BSI. (2014). Balanced scorecard basics. Balanced Scorecard Institute. Retrieved March 11, 2014 from https://balancedscorecard.org/Resources/AbouttheBalancedScorecard/tabid/55/Default.aspx

Clin, J. (2012). Comparing mandated health care reforms: the Affordable Care Act, accountable care organizations, and the Medicare ESRD program. Dialysis Advisory Group of the American Society of Nephrology., 1535-1543.

The results revealed that this route did not lead to any needle stick injuries. The ESA worked as efficaciously as it would have if needles were used and this was proved by the maintenance of the hemoglobin levels. It was observed that 91% of the nursing staff was in favor of the needle free administration of ESA. This study therefore concluded that drugs with detached needles present further routes to prevent needle stick injuries in the future. (Chow et. al, 2009)
Seeing how needle stick injuries can lead to emotional, health related and financial dilemma, experts are working on ways to reduce their occurrence. The study by Chow et al. (2009) shows one way in which these incidences can be reduced. Molen et al. (2011) stated that education reduces the occurrence of needle stick injury. He conducted a study in which one group was educated in a workshop and given…...

mla

References

Adams, D. 2012 Needle stick and sharps injuries: implications for practice. Nursing Standard. 26 (37), pp. 49-57.

Aziz, A.M., Ashton, H., Pagett, A., Mathieson, K., Jones, S., and Mullin, B 2009 Sharps

management in hospital: an audit of equipment, practice and awareness. Br J. Nurs 18(2), pp. 92 -- 8

Blenkharn, J. 2009. Sharps management and the disposal of clincal waste. British Journal of Nursing, 18 (14).

U.S. Healthcare
Hard Economic and Finance Choices in U.S. Healthcare

The United States has recently undergone a financial crisis that has made the government, and the citizens, more conscious of what things cost and have produced debates regarding the costs of items. One debate that has intensified in volume is that over the large, and ballooning cost of healthcare. Although the Affordable Healthcare Act is supposed to take care of a portion of that, evidence shows that costs will remain exorbitant. The main reason for that is the research and development costs of therapies and associated drug treatments. Currently, new therapies have been coming on the market that are able to prolong the lives of cancer patients, but a cost-benefit analysis prove that these therapies are too costly. The debate then is whether a few weeks, months, years of life are worth hundreds of thousands to millions of dollars. This paper…...

mla

References

Short, N.M. (2013). Overview: The Economics and Finance of Health Care. In J.A. Milstead (Ed.), Health policy and politics: A nurse's guide (4th ed.) (pp. 191 -- 206). Sudbury, MA: Jones and Bartlett Publishers.

Stein, R. (2010, November 8). Review of prostate cancer drugs Provenge renews medical cost-benefit debate. The Washington Post. Retrieved from   dyn/content/article/2010/11/07/AR2010110705205.html ?http://www.washingtonpost.com/wp -

Sullivan, J.D. (2010). End Stage Renal Disease economics and the balance of treatment modalities. Journal of Service Science & Management, 3(1), 45 -- 50. Retrieved from the Walden Library databases.

In both the case of the dialysis machine sale and the funeral services, a common theme of trust pervades both. These purchasing decisions are completely different than picking out a new car, buying a new iPod, iPad or iPhone, or choosing which new digital camera to buy. These decisions are more driven by how those products contribute to our own sense of who we are and provide us a measure of freedom in defining ourselves while providing enjoyment. All powerful brands, with Apple being one of the most formidable globally, sell not only functionality of their products but the image that goes along with it. This is completely different than choosing a dialysis machine or a funeral home and funeral director. In these instances the uncertainty is far greater, the risk of making a mistake far more intensive, and the level of self-scrutiny is very intense. No one wants to…...

mla

References

Cleary, Paul D., Schlesinger, Mark, & Blumenthal, David. (1991). Factors Affecting the Availability and Use of Hemodialysis Facilities. Health Care Financing Review, 13(2), 49.

Langreth, R.. (2008, November). The Home Cure. Forbes, 182(10), 66.

Glen L. Urban. (2005). Customer Advocacy: A New Era in Marketing. Journal of Public Policy & Marketing, 24(1), 155-159.

Towards of the goal of fulfilling the mission to "help those we care for to experience the best life possible," nursing services provided at the Sarah Neuman Center include:
Twenty-four nursing in a secure residential setting.

Twenty-four medical coverage supported by onsite and on-call physicians.

Onsite medical specialist consulting services.

Individualized therapy sessions, to include speech therapy, physical therapy, art and music therapy.

Nutritional services supported by staff dietitians.

Onsite pharmaceutical and laboratory services. (Sarah Neuman, para. 9)

Patients that require long-term residential care are often transferred to the Bronx nursing home which provides all of the above services, in addition to highly individualized care services and therapies for "more complex clinical needs" (Bronx, para. 4). These needs include-but are not limited to-progressive Alzheimer's, severe vision impairment, severe speech and swallowing impairments, and chronic kidney disease requiring hemodialysis.

Structural Support of Mission

That each facility essentially provides the same services in various degrees helps to support the mission…...

mla

Works Cited

"Bronx." jewishhome.org. Jewish Home Lifecare, 2010. Web. 01 January, 2011.

"Manhattan." jewishhome.org. Jewish Home Lifecare, 2010. Web. 01 January, 2011.

"Sarah Neuman." jewishhome.org. Jewish Home Lifecare, 2010. Web. 01 January, 2011.

"Research Institute on Aging." jewishhome.org. Jewish Home Lifecare, 2010. Web. 01 January,

However, recently, anesthesiologists have suggest a low to mid thoracic epidural combined with adequate general anesthesia. This anesthetic technique will allow for adequate inter-operative monitoring. After the operation, the anesthesiologist must continue to monitor the patient for either hypertension, hypotension and hypoglycemia. The presence of either of these conditions may alter the course of the medication given to the patient once the patient is removed from the anesthesia.
Respiratory System

Neurofibroma can cause systemic problems within the various components of the Respiratory System. As has already been presented, Neurofibromas can cause partial blockages within upper parts of the trachea. However, Neurofibromas can also pose challenges or the anesthesiologist when dealing with nasal, sinus or maxilofacial cavities with Neurofibromas present within. One example of how devastatingly complex the Neurofibroma can become is seen when a benign neurofibroma can cause a superior vena cava compression. Such was the case of a 21-year-old female…...

Chronic kidney disease (CKD) is a significant public health issue that affects millions of people worldwide. Hemodialysis is a common treatment for end-stage renal disease, but it is associated with various complications, including inflammation. Inflammation is a key mediator in the progression of CKD and is linked to the development of complications such as cardiovascular disease and protein-energy wasting. Dietary patterns play a crucial role in modulating inflammation and may impact the outcomes of hemodialysis patients.

Several studies have investigated the relationship between dietary patterns and inflammation in hemodialysis patients. One study by Mafra et al. (2014) found that a....

Findings on the Relationship between Dietary Patterns and Inflammation in Hemodialysis Patients

Inflammation is a complex biological process that plays a crucial role in the pathophysiology of various chronic diseases, including end-stage renal disease (ESRD). Hemodialysis patients are particularly susceptible to chronic inflammation due to the accumulation of uremic toxins, oxidative stress, and impaired immune function.

Dietary patterns have been implicated in the regulation of systemic inflammation, and several studies have investigated the association between specific dietary patterns and inflammation in hemodialysis patients.

Observational Studies

Observational studies have consistently demonstrated a positive association between pro-inflammatory dietary patterns and elevated inflammation markers in hemodialysis patients.....