This document discusses dialysis and renal failure. It provides information on the causes of renal failure, diagnosis of renal failure, treatment options which include dialysis and transplantation, and types of dialysis including hemodialysis and peritoneal dialysis. It describes how each type of dialysis works, factors in selecting between them, and their effects on lifestyle.
In medicine, dialysis is the process of removing excess water, solutes, and toxins from the blood in people whose kidneys can no longer perform these functions naturally. This is referred to as renal replacement therapy.
In medicine, dialysis is the process of removing excess water, solutes, and toxins from the blood in people whose kidneys can no longer perform these functions naturally. This is referred to as renal replacement therapy.
Medical Surgical Nursing PERITONEAL DIALYSIS 2024.ppsxSalah Nazar
type of dialysis that uses peritoneal semipermeable membrane to remove excessive wastes and fluids from the blood in peritoneal vessels to a dialysate solution that implant into peritoneal cavity than drain it outside the body.
Dialysate Solution: the liquid material that passes through the peritoneal membrane in dialysis process
Peritoneal Dialysis (PD): type of dialysis that uses peritoneal semipermeable membrane to remove excessive wastes and fluids from the blood in peritoneal vessels to a dialysate solution that implant into peritoneal cavity than drain it outside the body.
Preoperative and Postoperative management.pptYousifAhmedDA
Preoperative evaluation is one of important thing in managing a successful operation without it ,a pateint may encounter life threating condition during or after surgery
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?
Dialysis
1. DIALYSIS
Dr. Frank Edwin
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2. CAUSES OF RENAL
FAILURE
Diabetes
Untreated high blood pressure
Inflammation
Heredity
Chronic infection
Obstruction
Accidents
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3. 1.Renal Failure Diagnosis
Symptoms: Anorexia, Nausea, Vomiting, Oliguria
• ? Precipitating factors
Signs: Anaemia, Hypertension, Fluid Overload etc
Biochemistry:
– Blood
• Urea >7mmol/l
• Creatinine >120umol/l
• Electrolytes: Rising K+
– Creatinine Clearance (GFR <<120ml/l)
– Urine: Proteinuria
May be Acute or Chronic
Acute – Reversible or Irreversible
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4. 2. Treatment Options
No Treatment
Monitoring & Predialysis
– Control symptoms
– Preserve Residual Renal Function
• Control rising BP (Antihypertensives)
• Control Renal Bone Disease (Ca2+
, Vit D)
• Prevent/Treat Anaemias (Erythropoietin, Blood)
Dialysis
Renal Transplantation
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5. Dialysis
Definition
Artificial process that partially replaces renal
function
Removes waste products from blood by
diffusion (toxin clearance)
Removes excess water by ultrafiltration
(maintenance of fluid balance)
Wastes and water pass into a special liquid –
dialysis fluid or dialysate
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6. Types
Haemodialysis (HD)
Peritoneal Dialysis (PD)
They work on similar principles:
Movement of solute or water across
a semipermeable membrane
(dialysis membrane)
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7. Diffusion
Movement of solute
Across semipermeable membrane
From region of high concentration to
one of low concentration
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8. Ultrafiltration
Made possible by osmosis
Movement of water
Across semipermeable membrane
From low osmolality to high osmolality
Osmolality – number of osmotically active
particles in a unit (litre) of solvent
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9. Selection for HD/PD
Clinical condition
Lifestyle
Patient competence/hygiene (PD -
high risk of infection)
Affordability / Availability
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10. 1.
2.
Blood cells are too big to pass through the dialysis membrane,
but body wastes begin to diffuse (pass) into the dialysis solution.
3.
Diffusion is complete. Body wastes have diffused through the membrane,
and now there are equal amounts of waste in both the blood and the
dialysis solution.
11. The process of ultrafiltration in PD
11.
2
2.
Blood cells are too big to pass through the semi-permeable membrane,
but water in the blood is drawn into the dialysis fluid by the glucose.
3.
Ultrafiltration is complete. Water has been drawn through the peritoneum
by the glucose in the dialysis fluid by the glucose in the dialysis fluid. There is
now extra water in the dialysis
12. Haemodialysis
Dialysis process occurs outside the
body in a machine
The dialysis membrane is an artificial
one: Dialyser
The dialyser removes the excess fluid
and wastes from the blood and returns
the filtered blood to the body
Haemodialysis needs to be performed
three times a week
Each session lasts 3-6 hrs
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13.
14. Requirements for HD
Good access to patients circulation
Good cardiovascular status (dramatic
changes in BP may occur)
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15. Performing HD
HD may be carried out:
In a HD Unit
At a Minimal Care / Self-Care Centre
At Home
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16. HD Unit
Specially designed Renal Unit within a
hospital
Patients must travel to the Unit 3x a week
Patients are unable to move around while on
dialysis; may chat, read, watch TV or eat
Nursing staff prepare equipment, insert the
needles and supervise the sessions
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17. Minimal / Self-Care Dialysis
Patients take a more active role
Patients prepare the dialysis machine,
insert the needles, adjust pump speeds
and machine settings and chart their
progress under the supervision of
dialysis staff
Patients must travel to the unit 3x / week
Patients need to be on a fixed schedule
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18. Home Haemodialysis
Use of machines set up at home
Machines have many safety devices inbuilt
Thorough patient training
Requires the help of a partner at home every
time
Suitability is assessed by the haemodialysis
team
Ideal for patients who value their independence
and need to fit in their treatment around a busy
schedule
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19. HD Access
2 types of access for HD:
– Must provide good flow
– Reliable access
A fistula: arterio-venous (AV)
Vascular Access Catheter
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20. AV Fistula
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21. AV Fistula
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22. Vascular Access Catheter
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23. AV Fistula Access
Matures in about 6 weeks
Ensure good working order
– Avoid tight clothing or wrist watch on fistula arm
– Assess fistula daily; notify immediately if not
working
– Avoid BP cuff on fistula arm
– Avoid blood sampling on fistula arm (except daily
HD Rx)
– Avoid sleeping on fistula arm
– Grafts (synthetic) may be used to create an AV
fistula
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24. Vascular Access Catheter
Double lumen plastic tube
May be placed in Jugular, Subclavian or
Femoral vein
May be temporary or permanent
Temporary – awaiting fistula or maturation
Permanent – poor vessels for fistula creation
e.g. children and diabetics
Catheters must be kept clean, dry and dressed
to prevent infection
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25. Effects of HD on Lifestyle
Flexibility:
– Difficult to fit in with school, work esp if unit is far from
home. Home HD offers more flexibility
Travel:
– Necessity to book in advance with HD unit of places of travel
Responsibility & Independence:
– Home HD allows the greatest degree of independence
Sexual Activity:
– Anxiety of living with renal failure affects relationship with
partner
Sport & Exercise:
– Can exercise and participate in most sports
Body Image:
– Esp with fistula; patient can be very self conscious about it
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26. Problems with HD
Rapid changes in BP
– fainting, vomiting, cramps, chest pain, irritability, fatigue, temporary
loss of vision
Fluid overload
– esp in between sessions
Fluid restrictions
– more stringent with HD than PD
Hyperkalaemia
– esp in between sessions
Loss of independence
Problems with access
– poor quality, blockage etc. Infection (vascular access catheters)
Pain with needles
Bleeding
– from the fistula during or after dialysis
Infections
– during sessions; exit site infections; blood-borne viruses e.g.
Hepatitis, HIV
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27. Peritoneal Dialysis (PD)
Uses natural membrane (peritoneum) for
dialysis
Access is by PD catheter, a soft plastic tube
Catheter and dialysis fluid may be hidden
under clothing
Suitability
– Excludes patients with prior peritoneal scarring e.g.
peritonitis, laparotomy
– Excludes patients unable to care for self
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28. Addendum to Principles (PD)
Fluid across the membrane faster than solutes; therefore
longer dwell times are needed for solute transfer
Protein loss in PD fluid is significant ~ 8-9g/day
Protein loss ↑s during peritonitis
PD patients require adequate daily protein averaging
1.2 – 1.5g/kg/day
Other substances lost in the dialysate
– Amino acids, water soluble vitamins, some medications and
hormones
Calcium and dextrose are absorbed from the dialysate
fluid into the circulation
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29. Addendum to Principles (PD)
Standard dialysis solution contains:
• Na+
– 132 mEq/l
• Cl-
– 96 -102 mEq/l
• Ca2+
– 2.5 – 3.5 mEq/l
• Mg2+
– 0.5 -1.5 mEq/l
Dialysis solution buffer:
– Sodium lactate
– Pure HCo3
-
– HCo3
-
/Lactate combinations
Lactate is absorbed and converted to HCo3
-
by
the liver
Dextrose solution strengths: 1.5%, 2.5%,
4.25%
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31. CAPD
Dialysis takes place 24hrs a day, 7 days a week
Patient is not attached to a machine for treatment
Exchanges are usually carried out by patient after
training by a CAPD nurse
Most patients need 3-5 exchanges a day i.e.
– 4-6 hour intervals (Dwell time) 30 mins per exchange
May use 2-3 litres of fluid in abdomen
No needles are used
Less dietary and fluid restriction
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32. CAPD Exchange
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33. APD
Uses a home based machine to perform
exchanges
Overnight treatment whilst patient sleeps
The APD machine controls the timing of
exchanges, drains the used solution and fills the
peritoneal cavity with new solution
Simple procedure for the patient to perform
Requires about 8-10 hrs
Machines are portable, with in-built safety
features and requires electricity to operate
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34. PD Access
Done under
LA or GA
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35. DIET
Why is diet important?
– Managing the diet can slow renal disease
– The need for dialysis can be delayed
– The diet affects how patients feel
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36. CONTROLLING YOUR
DIET
Foods to control are those
containing:
Protein
Potassium
Sodium
Phosphorous
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37. PROTEINS
Animal protein
Dairy (milk, cheese)
Meat (steak, pork)
Poultry (chicken, turkey)
Eggs
Plant protein
Vegetables
Breads
Cereals
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39. SODIUM
Regulates blood volume and pressure
Avoid salt
Use Alternate food seasonings: lemon and
limes, spices, seafood seasoning, Italian
seasoning, vinegars, peppers
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40. FLUIDS
Healthy kidneys remove fluids as
urine
Check for fluid and sodium retention
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41. PHOSPHOROUS
Phosphorus is a mineral which combines with
calcium to keep bones and teeth strong
Too little calcium and too much phosphorus
Need to control the phosphorus in the diet
Need to take a phosphate binder or a calcium
supplement
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42. VITAMINS
Folic acid
Iron supplements
Do not take OTC’s without
consulting the doctor.
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43. MANAGING YOUR DIET
INDICATORS OF GOOD CONTROL:
Weight loss or gain
Blood pressure
Swelling of hands and feet
Blood samples
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44. LAB MONITORING
Haemoglobin
Albumin
Calcium
Phosphorus
GFR
(24 hour urine)
Sodium
Potassium
Urea
Creatinine
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45. Lifestyle Changes with PD
Flexibility
– Can be performed almost anywhere
– Least impact on work / school life (esp APD)
Travel
– Dialysis supplies can be delivered to most parts of
the world; travel more flexible. APD machines are
portable; will fit into a car boot, can be carried by
train/air
Responsibility
– Requires more responsibility from patient but more
independence
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46. Lifestyle Changes with PD
Sports/Exercise
– Most are possible
– Advice on swimming, lifting, contact sports
Sexual Activity
– May affect relations based on patient anxiety
Delivery & Storage of Supplies
– Home delivery and storage
– A month’s supplies – 40 boxes; space to store
– Specially recruited and trained delivery staff
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47. Problems with Treatment
Monotomy of treatment
– The treatment never goes away against days off with
HD
Body Image Problems
– Esp with a permanent catheter
– Abdominal stretching
Fluid Overload
– Much less a problem than with HD
Dehydration
– Less common than fluid overload
Abdominal Discomfort
– Bloated feeling
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48. Problems with Treatment
Poor drainage
– Common problem esp with new patients
– Fibrin plug
– Catheter displacement
Leakage
– Fluid may leak around catheter exit site. (May leak
into scrotum)
– Stop PD temporarily
– Resite catheter (use new one)
Infections
– Exit site infections
– Tunnel infection
– peritonitis
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49. Problems with Treatment
Hernia
– Aggravation of pre-existing herniae (repair)
– Evolution of new herniae
Declining effectiveness of the peritoneum
– e.g. repeated infection
– Effect of glucose in the dialysis fluid
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50. Comparison of Dialysis Treatment Options
PD Unit HD Home HD
Home Dialysis √ × √
Convenient Sessions √ × √
Socializn with other CRF pats × √ ×
Home Equipment/Supplies √ × √
Special diet/fluid allowance √ √ √
Sports/exercises participation Most Most Most
Full day activity -work/school √ Not alwys √
Direct assist–partner/family × × √
Travel √ Delivery of
supplies to most
destins easy.
Some notice req
√ Prior
arrangements
must be made
well in advance
× Prior
arrangements must
be made well in
advance
51. This platform has been started by Parveen Kumar Chadha with
the vision that nobody should suffer the way he has suffered
because of lack and improper healthcare facilities in India. We
need lots of funds manpower etc. to make this vision a reality
please contact us. Join us as a member for a noble cause.
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52. Our views have increased the mark of the
96,000
Thank you viewers
Looking forward for franchise,
collaboration, partners.
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53. Contact us:- 011-25464531, 9818569476
E-mail:- nursingnursing@yahoo.in
We are also available on
Justdial New Delhi.
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