GROUP

B9
Objective:
At the end of the time given to group B9, the students are expected to:
Define, know the purpose, identify equipments and perform the before, during and after
nursing responsibilities:
CVP manometer
Peritoneal dialysis set
Dialyzing solution
Hemodialysis machine
Incubator/Isolette
Billi light
Central venous pressure
What is CVP?
What are the Purposes?
To assess cardiac function, to evaluate venous return to the heart, and to indirectly gauge
how well the heart is pumping.
To gain access to a large vessel for rapid, high-volume fluid administration and to facilitate
frequent blood withdrawal for laboratory samples.
Equipment
Mask
Sterile Gloves
Antiseptic Pad
CVP manometer set


IV solution (usually normal saline)
IV Pole
Extension tubing/Catheter
Additional stopcock (to attach CVP manometer to catheter)
Site
Neck vein:
External/Internal Jugular Veins
Site
Factors
that
increase
CVP
include:
Hypervolemia
forced exhalation
Tension pneumothorax
Heart failure
Pleural effusion
Decreased cardiac output
Cardiac tamponade
Mechanical ventilation and the application of positive end-expiratory pressure
(PEEP)
Pulmonary Hypertension
Pulmonary Embolism
Factors
that
DECREASE
CVP
include:
Hypovolemia
Deep inhalation
Distributive shock
Complications
Nursing Responsibilities:
BEFORE
DURING
AFTER
DIALYSIS
Anatomy & Physiology
The urinary system consists of the kidneys, ureters, urinary bladder, and urethra. The
kidneys filter the blood to remove wastes and produce urine. The ureters, urinary bladder, and
urethra together form the urinary tract, which acts as a plumbing system to drain urine from the
kidneys, store it, and then release it during urination.
Function of the Kidneys
Removing wastes and water from the blood
Balancing chemicals in your body
Helping control blood pressure
Helping to produce red blood cells
Producing vitamin D
Production of hormones
Calcitriol
Erythropoietin
Renin
Assessment
o Inspection
o Auscultation
o Palpation
o Percussion
Inspection
The nurse inspects the abdomen and the flank regions with the client in both the supine
and the sitting position. The client is observed for asymmetry (e.g., swelling) or discoloration
(e.g., bruising or redness) in the flank region.
Auscultation
The nurse listens for a bruit which is an audible swishing sound produced when the
volume of blood or the diameter of the blood vessel changes over each renal artery on the mid-
clavicular line. A bruit is usually associated with blood flow through a narrowed vessel.
Palpation
Renal palpation identifies masses and areas of tenderness in or around the kidney. The
abdomen is lightly palpated in all quadrants. The nurse asks about areas of tenderness or
discomfort and examines non-tender areas first. If tumor or aneurysm is suspected, palpation
may harm the client.
Percussion
A distended bladder sounds dull when percussed. The nurse begins percussion on the skin
of the lower abdomen and continues in the direction of the umbilicus until dull sounds are no
longer produced.
Diagnostic and Laboratory Test
Urinalysis
CT scan
Renal biopsy
Causes of Kidney Failure
1. Diabetes
2. High blood pressure (hypertension)
3. Kidney inflammation (glomerulonephritis)
4. Multiple cysts in the kidneys (polycystic kidney disease)
Dialysis
Dialysis is a process for removing waste and excess water from the blood, and is used
primarily as an artificial replacement for lost kidney function in people with renal failure.
Types of Dialysis
Hemodialysis
Peritoneal Dialysis
Peritoneal Dialysis
In peritoneal dialysis, wastes and water are removed from the blood inside the body using
the peritoneal membrane of the peritoneum as a natural semipermeable membrane. Wastes and
excess water move from the blood, across the peritoneal membrane, and into a special dialysis
solution, called dialysate.
Purpose
Removal of end products of protein metabolism from blood
Maintain tolerable levels of electrolytes
Correct acidosis
Removal of excess fluid
Types of Peritoneal Dialysis
Continuous ambulatory peritoneal dialysis (CAPD)
Automated peritoneal dialysis (APD)
Peritoneal Dialysis Set
Transfer Set
Peritoneal dialysis drainage system
Dialysis Solution
Cycler
Procedure
Before starting peritoneal dialysis, a surgeon places a plastic tube (catheter) called
Tenchkoff into your abdomen and will recommend waiting at least a month before
starting treatment to give the area time to heal.
CAPD
1. An exchange begins by draining the old fluid into the waste bag. The new fluid is then
drained into your peritoneal cavity. The process is painless and takes about 30-40 minutes
to complete.
2. The new fluid is left in the peritoneal cavity for a number of hours
3. As blood passes through the peritoneum, special chemicals in the dialysate fluid draw out
waste products and excess fluid from the blood into the fluid.
4. After the set time has passed, you will begin the process again, exchanging the old fluid
for the new fluid.
APD
1. A machine is used to control the drainage of fluid. Fill the APD machine with fluid
before you go to bed. As you sleep, the machine automatically performs a number of
exchanges.
2. You will usually need to be attached to the APD machine for 8-10 hours. You will then
usually have one last fill of fluid that is kept in your cavity all day before it is drained
away the following evening.
3. During the night, an exchange can be temporarily interrupted if, for example, you need to
get up to go to the toilet.
4. A power cut or other technical problem is not a worry as long as you resume treatment
within 24 hours.
The process of doing peritoneal dialysis is called an EXCHANGE. You will usually complete 4
to 6 exchanges each day using the following steps:
1. Fill: Dialysis fluid enters your peritoneal cavity.
2. Dwell: While the fluid is in your peritoneal cavity, extra fluid and waste travel across the
peritoneal membrane into the dialysis fluid. (4-6 hours)
3. Drain: After a few hours, the dialysis fluid is drained and replaced with new fluid.
Nursing Responsibilities
Before:
Document vital signs including temperature, orthostatic blood pressures (lying, sitting, and
standing), apical pulse, respirations, and lung sounds.
Weigh daily or between dialysis runs as indicated.
Measure and record abdominal girth.
Note BUN, serum electrolyte, creatinine, pH, and hematocrit levels prior to peritoneal dialysis
and periodically during the procedure.
Maintain fluid and dietary restrictions as ordered.
Have the client empty the bladder prior to catheter insertion.
Explain all procedures and expected sensations.
Warm the prescribed dialysate solution to body temperature (98.6 F or 37 C) using a warm
water bath or heating pad on low setting.
During:
Use strict aseptic technique during the dialysis procedure and when caring for the
peritoneal catheter. Peritonitis is a common complication of peritoneal dialysis
Add prescribed medications to the dialysate; prime the tubing with solution and connect
it to the peritoneal catheter, taping connections securely and avoiding kinks.
Instill dialysate into the abdominal cavity over a period of approximately10 minutes.
Clamp tubing and allow the dialysate to remain in the abdomen for the prescribed dwell
time. Keep drainage tubing clamped at all times during instillation and dwell time.
Dialysate should flow freely into the abdomen if the peritoneal catheter is patent.
During instillation and dwell time, observe closely for signs of respiratory distress, such
as dyspnea, tachypnea, or crackles.
After prescribed dwell time, open drainage tubing clamps and allows dialysate to drain by
gravity into a sterile container. Note the clarity, color, and odor of returned dialysate.
Accurately record amount and type of dialysate instilled (including any added
medications), dwell time, and amount and character of the drainage.
Monitor BUN, serum electrolyte, and creatinine levels.
After:
Assess vital signs, including temperature.
Time meals to correspond with dialysis outflow.
Teach the client and family about the procedure.
Advantages of PD
1. Few dietary or fluid restrictions.
2. Independence and ability to normalize daily routines.
3. The ability to do the dialysis at home.
Possible Complications
Peritonitis
Respiratory difficulty
Hernia
Hyperglycemia
Nutrition & DIet
Protein
Calories
Fluid and Sodium
Vitamins and Minerals
Fiber
INCUBATOR
OR ISOLETTE
what is
an
Incubator?
Incubator
is an equipment to provide optimal condition of temperature, humidity and oxygen for
survival of preterm, low birth weight or high risk infants. Is
important to delay or to prevent cold stress
that produces additional hazards to the
newborn as hypoxia, hypoglycemia and
metabolic acidosis.
Parts of
Incubator
Functions
of
Incubator
indications
NURSING RESPONSIBILITIES
Nurses
are the
heart of healthcare
Bili Light
(Phototherapy)
Bili Light
Is a phototherapy tool to treat newborn jaundice (hyperbilirubinemia), the therapy uses a
blue light (420-470 nanometers) that converts bilirubin so that it can be excreted in the
urine and feces.
Purpose
Use for treatment of hyperbilirubinemia in the newborn, which is higher levels causes
brain damage (kernicterus) , leading to cerebral palsy, auditory neuropathy, gaze
abnormalities and dental enamel hypoplasia. This relatively common therapy lowers the
serum bilirubin level by transforming bilirubin into water-soluble isomers that can be
eliminated without conjugation in the liver.
Possible Complications
Skin conditions could temporarily worsen
Itchy skin
Red skin due to exposure to the lights
Burning of the skin
Increased insensible water loss
Cutaneous reactions in infants with cholestatic jaundice receiving phototherapy.
Patient Preparation
New born will have a blood test or skin test to check the bilirubin level before the
treatment.
Positioning
Infants receiving phototherapy should be placed lying flat on a radiant warmer or in a
bassinet. Small or premature infants can remain in an infant incubator during
phototherapy. The infant should be naked with the exception of eye protection and a diaper
to maximize the surface area of skin exposed to light. The phototherapy device should be
placed at the side of the infants bed with the light shining on the infant and covering as
much surface area as possible.
Nursing care for infants receiving phototherapy(bili light)
1.Ensure Effective Irradiance
Position phototherapy lamps or mattreses to provide the most skin exposure possible. Light
sources should be close to the infant possible, with the exception of halogen-lamp
phototherapy units
2.Provide Eye Protection
Opaque eye shields must be used during phototherapy to protect the infants eyes from
retinal damage. Avoid eye patches that are too tight, as they may apply undue pressure to
the infants delicate eye.
3. Assess Skin Exposure
The largest surface area of the infants body, the trunk , should be positioned in the
centerof the light, where irradiance is highest.
4.Proper Positioning
Frequent turning to expose different areas of skin has not been shown to improve the
effectiveness of conventional(single) phototherapy.
5.Assess And Adjust Thermoregulation Devices
Some phototherapy units can cause a significant increase in the infants body temperature.
When phototherapy is directed over an incubator, immediately and sustained fluctuations
can occur in the thermal environment.
6.Promoting Elimination And Skin Integrity
The photo products of bilirubin require elimination from the body in the stool or urine.
Some of photochemical reactions induced by phototherapy are reversible, meaning that the
isomers can converted back to unconjugated bilirubin if they are not eliminated in the
stool.
7.Hydration
Several studies have documented an increase in transepidermal water loss during
phototherapy. Excessive fluid losses via the skin are of particular concern in the smallest,
most immature infants during the first week of life.
8.Promoting Parent-Infant Interaction
Phototherapy necessarily separates the neonate from its mother and may interfere with the
process of establishing lactation. Unless jaundice is severe, phototherapy can be safely be
interrupt at feeding time to allow continuation of breastfeeding, parental visits, and skin to
skin care.
9.Monitoring Bilirubin Levels
The most significant decline in bilirubin level occurs first 4 to 6 hours after initiating
phototherapy.
THANK YOU