Author: Obaid

CYCLOPHOSPHAMIDE PROTOCOL FOR RPGN

ONE HOUR PRIOR THE INFUSION HYDRATES WITH 500CC NORMAL SALINE FOR ONE HOUR.
HALF AN HOUR PRIOR THE INFUSION GIVE :-
ONDANSETRON 8MG TAB (ONE TAB.) STAT
MESNA(UROMETEXAN) 200MG IN 100CC NORMAL SALINE IV OVER 30 MIN.
CYCLOPHOSPHAMIDE(ENDOXAN) INFUSION AS FOLLOW:
1000MG + MESNA 400 MG IN 500CC NORMAL SALINE TO BE INFUSED OVER ONE HOUR.

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MANAGEMENT OF HEMODIALYSIS VASCULAR ACCESS

MANAGEMENT OF HEMODIALYSIS VASCULAR ACCESS

MANAGEMENT OF HEMODIALYSIS VASCULAR ACCESS

SOME DEFINITIONS BEFORE TALKING ABOUT STEPS FOR MANAGEMENT OF HEMODIALYSIS VASCULAR ACCESS

  1. Arteriovenous Fistula (AVF) – is the result of a surgical creation of an anastomosis between an artery and a vein, which allows arterial blood to flow through the vein, causing venous engorgement, enlargement, and thickening of the venous wall. The arterial limb and anastomosis are never cannulated.
  2. Arteriovenous Graft (AVG) – is a biologic, semi biologic or synthetic (such as Gortex or Teflon or Polytetrafluorethylene -PTFE), implanted subcutaneous and interposed between an artery and a vein. Needles are inserted into the graft material in order to remove and return blood during hemodialysis.
  3. Central Venous Catheter (CVC) – is a device used on a long- term or short- term basis as circulatory access for hemodialysis. CVC is made of silicone rubber, rigid or semi-rigid material of a varying length and is radio-opaque. A double lumen catheter (Quinton Cath) is most commonly used. This catheter is placed in the internal or external jugular, subclavian or placed percutaneously in the femoral vein.
  4. Long-Term CVC (Permcath) – is indicated for patients in whom permanent AV access is no longer possible, or who are waiting for native AV fistula to mature/develop or who are waiting for the creation of permanent AV access. These catheters are usually placed in the internal jugular vein or the subclavian vein and a subcutaneous tunnel is created that allows the catheter to exit the chest wall. There is a dacron cuff on the catheter that will facilitate tissue growth into it to hold the catheter in place and provide a barrier to bacteria growth.

 

Hemodialysis

Hemodialysis, also spelled hemodialysis, commonly called kidney dialysis or simply dialysis, is a process of purifying the blood of a person whose kidneys
PROPER MANAGEMENT OF HEMODIALYSIS VASCULAR ACCESS

 

  1. To establish a safe procedure for accessing the patient’s circulatory system using AVF/AVG or CVC access for hemodialysis treatment.
  2. To provide effective management to optimize the hemodialysis delivery dose.

  1. Hemodialysis access shall only be used for hemodialysis treatment as described in this policy.
  2. The use of hemodialysis central venous catheters for other purpose is restricted to circumstances where there is no other alternative to access a vein.
MANAGEMENT OF HEMODIALYSIS VASCULAR ACCESS Procedures Responsible Person/s
Explain to the patient and family members the need for vascular surgery to create AVF or AVG; or a hemodialysis central venous catheter for hemodialysis treatment. Nephrologist
Complete a written order for creation of AVF or AVG or insertion of a temporary or permanent central venous catheter. Nephrologist
Contact the Vascular Surgeon and writes a consultation for vascular surgery intervention. Nephrologist
In the event of malfunction of AV access or clotted AVF, AVG or central venous catheters; the Nephrologist shall assess the patient and contact the Vascular Surgeon. Nephrologist

Vascular Surgeon

Insert temporary central venous catheter for hemodialysis in the ICU. In special cases, the nephrologist may insert the central venous catheter in the Dialysis Unit. Nephrologist
Insert the hemodialysis permanent central venous catheter (Permcath) in the Cardiac Catheterization Laboratory (CCL) or Operating Room Vascular Surgeon
Use aseptic technique to access; perform exit-site care and manipulation of the hemodialysis central venous catheter. Dialysis Registered

Nurse

Perform catheter care pre or post-hemodialysis treatment on the day of dialysis in the unit. Dialysis Registered

Nurse

For permanent AV access:

1.       Blood pressure or venipunctures are not performed on the AV access limb.

2.       Circular occlusive dressings are not applied on the AV access limb at all times.

3.       Patient is instructed not to wear restrictive clothing that impedes blood flow to the AV access limb

 

Dialysis Registered

Nurse

Give teaching to the patient to care of his/her AVF, AVG, or central venous catheter as follows:

1.  Assess the level of the patient’s knowledge of their hemodialysis access, which includes purpose, description, care, assessment and emergency care. Provide instruction as required, utilizing expertise and knowledge from all members of the renal multidisciplinary team.

2. Teach the patient the importance of good hygiene.

3. Instruct the patient/family member in the care of vascular access and to recognize the signs and symptoms of infection.

 

Dialysis Registered

Nurse

Refer to Patient Teaching Policy about Central Venous Catheter care and Care of AV Graft and AV Fistula. Dialysis Registered

Nurse

Advice the patient to contact the hospital immediately if he/she encounters problems with vascular access. The patient is given an emergency telephone number to contact the hemodialysis unit or the patient can go to the nearest hospital, emergency services. Dialysis Registered

Nurse

Nephrologist

Documents assessment, management and patient education of vascular access clearly and legibly on the Focus Charting Sheet. Dialysis Registered

Nurse

Nephrologist

Advice the patient to contact the hospital immediately if he/she encounters problems with vascular access. The patient is given an emergency telephone number to contact the hemodialysis unit or the patient can go to the nearest hospital, emergency services. Dialysis Registered

Nurse

Nephrologist

 

REFERENCE FOR MANAGEMENT OF HEMODIALYSIS VASCULAR ACCESS 

  1. Clinical Practice Guidelines for Vascular Access, National Kidney Foundation
  2. Handbook of Dialysis, John T. Daugirdas, Todd S. lng
  3. CBAHI 3’“ Edition Standards
  4. JClA 5″‘ Edition Standards

EMERGENCY MANAGEMENT OF HYPOGLYCEMIA

EMERGENCY MANAGEMENT OF HYPOGLYCEMIA

Hypoglycemia – refers to a condition wherein the blood glucose falls less than 60 mg/dl or drops rapidly from a higher level with or without the presence of signs and symptoms.

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INTRAVENOUS INSULIN ADMINISTRATION USING SYRINGE PUMP

To standardize methods of intravenous insulin administration.
To provide guidelines for monitoring patients receiving insulin infusion.
To reduce the occurrence of possible complications.

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How should I take my medication?

Many patients simply nod to acknowledge the receipt of information but can we always verify and confirm their understanding? Do we always have the time to cover all the important points?

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NURSING MANAGEMENT OF PATIENT WITH PERMANENT PACEMAKER POLICY

Permanent Pacemaker Policy

 

permanent pacemaker policy

Cardiac Pacemaker – is an electronic device that delivers direct electrical stimulation to stimulate the myocardium to depolarize, initiating a mechanical contraction. Pacing may be accomplished through a permanent implantable system, a temporary system with external pulse generator and percutaneously threaded leads, or a transcutaneous external system with electrode pads placed over the chest.

PERMANENT PACEMAKER POLICY

  1. A credentialed physician will oversee the pacemaker management and manipulation.
  2. Only CCU/ICU Registered Nurses who have demonstrated competency may nurse the patient with pacemaker as per physician order.
  3. All patients with permanent pacemaker will be continuously monitored for heart rate and rhythm after pacemaker insertion.
  4. Adequate cardiac output will be ensured with efficient monitoring of vital signs and urine output.
What do be done…? or what are the steps included in Permanent Pacemaker Policy Who should do it…?
Provide postoperative monitoring, analgesia and care as ordered. CCU/ICU Registered

Nurse

Provide an electronically safe environment for the patient that can interfere with pacemaker function or cause pacemaker failure and permanent pacemaker damage. and to follow the steps in the Permanent Pacemaker Policy CCU/ICU Registered

Nurse

Physician

Avoid use of electric razors, direct placement of defibrillator paddles over pacemaker generator and exposure to MRI. CCU/ICU Registered

Nurse

Physician

Alarm limits will be set 5 beats below rate limit and 5 to 10 beats above upper rate limits. CCU/ICU Registered

Nurse

Physician

Monitor pacemaker function with cardiac monitoring and 12 lead ECG. CCU/ICU Registered

Nurse

Record ECG rhythm strip, inspect for pacemaker spikes and evidence for failure to sense or failure to capture according to the Permanent Pacemaker Policy. CCU/ICU Registered

Nurse

Physician

Assess the patient’s vital signs and hemodynamic status with adequate tissue perfusion and cardiac output as evidenced by optimum level of consciousness, free from dizziness, shortness of breath, chest discomfort or lightheadedness. CCU/ICU Registered

Nurse

Assess/Report for dysrhythmias and treat as indicated. CCU/ICU Registered

Nurse

Physician

Monitor for signs and symptoms of pneumothorax. CCU/ICU Registered

Nurse

Restrict movement of affected extremity and resume range of motion of extremity gradually. CCU/ICU Registered

Nurse

Assess the pacemaker pocket in the acute post implant phase for evidence of hematoma / bleeding. CCU/ICU Registered

Nurse

Monitor for evidence of lead migration and perforation of heart by observing for muscle twitching, cough, chest pain and signs and symptoms of cardiac tamponade. CCU/ICU Registered

Nurse

Assess for signs and symptoms of infection, as redness, edema, drainage, elevated white blood cell count, continued pain and elevated body temperature. CCU/ICU Registered

Nurse

Physician

Effective pain management measures will be instituted as ordered. CCU/ICU Registered

Nurse

Physician

Pain Management

Nurse

Provide appropriate teaching on pacemaker placement, how it works, settings and signs of pacemaker malfunction to report. CCU/ICU Registered

Nurse

Physician

Patient Educator

Quality Point of View on Nursing Care of Patients on Thrombolytic Therapy

EMERGENCY MANAGEMENT OF HYPOGLYCEMIA

known as Thrombolysis, is a treatment to dissolve dangerous clots in blood vessels, improve blood flow, and prevent damage to tissues and organs. Thrombolysis may involve the injection of clot-busting drugs through an intravenous (IV) line or through a long catheter that delivers drugs directly to the site of the blockage. Thrombolysis is often used as an emergency treatment to dissolve blood clots that form in arteries feeding the heart and brain.

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What is nursing care of patient with transcutaneous pacing?

Transcutaneous pacing is initiated as a temporary short-term measure when there has been a failure of the normal conduction of the heart to produce an electrical impulse resulting in a hemodynamic compromise in the

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