It is the removal of solutes and water from body across a semipermeable membrane (dialyzer)
care during and after the dialysis is very important to prevent the entry of pathogens in to the body.
It is the removal of solutes and water from body across a semipermeable membrane (dialyzer)
care during and after the dialysis is very important to prevent the entry of pathogens in to the body.
Peritoneal dialysis is a treatment for kidney failure that uses the lining of your abdomen, or belly, to filter your blood inside your body. Health care providers call this lining the peritoneum. A more convenient method of dialysis in home itself.
Defines Lumbar Puncture, Discusses the Indications of Lumbar Puncture, Contraindication, and complications of Lumbar Puncture, Equipment used and preparation required for the procedure, positioning the infant and assessing the landmarks for the procedure and the procedure of Lumbar Puncture. Interpretation of CSF, and the Nursing Care Post Procedure and the important key points to remember.
Acute kidney failure happens when your kidneys suddenly lose the ability to eliminate excess salts, fluids, and waste materials from the blood. Acute kidney failure is also called acute kidney injury or acute renal failure. It's common in people who are already in the hospital. It may develop rapidly over a few hours.
A cardiac event monitor is a device that you control to record the electrical activity of your heart (ECG). This device is about the size of a pager. It records your heart rate and rhythm. Cardiac event monitors are used when you need long-term monitoring of symptoms that occur less than daily
Peritoneal dialysis is a treatment for kidney failure that uses the lining of your abdomen, or belly, to filter your blood inside your body. Health care providers call this lining the peritoneum. A more convenient method of dialysis in home itself.
Defines Lumbar Puncture, Discusses the Indications of Lumbar Puncture, Contraindication, and complications of Lumbar Puncture, Equipment used and preparation required for the procedure, positioning the infant and assessing the landmarks for the procedure and the procedure of Lumbar Puncture. Interpretation of CSF, and the Nursing Care Post Procedure and the important key points to remember.
Acute kidney failure happens when your kidneys suddenly lose the ability to eliminate excess salts, fluids, and waste materials from the blood. Acute kidney failure is also called acute kidney injury or acute renal failure. It's common in people who are already in the hospital. It may develop rapidly over a few hours.
A cardiac event monitor is a device that you control to record the electrical activity of your heart (ECG). This device is about the size of a pager. It records your heart rate and rhythm. Cardiac event monitors are used when you need long-term monitoring of symptoms that occur less than daily
Dialysis is a treatment for people whose kidneys are failing. When you have kidney failure, your kidneys don't filter blood the way they should. As a result, wastes and toxins build up in your bloodstream. Dialysis does the work of your kidneys, removing waste products and excess fluid from the blood
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.
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It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
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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
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3. Dialysis (from Greek dialusis,
meaning dissolution, dia, meaning through, and
lysis, meaning loosening or splitting) 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.
4. CONT….
Dialysis may be used for those with an acute disturbance
in kidney function (acute kidney injury, previously acute
renal failure), or progressive but chronically worsening
kidney function–a state known as chronic kidney disease
stage 5 (previously chronic renal failure or end-stage renal
disease).
5. Dialysis is an artificial process used to remove water
and waste substances from the blood when the
kidneys fail to function properly.
It generally works through osmosis and filtration of
fluid across a semipermeable membrane with the use
of a dialysate.
Dialysis is the procedure used to correct fluid and
electrolyte imbalances and to remove waste
products in renal failure.
6. PURPOSE
The purpose of dialysis is to maintain fluid electrolyte and acid base balance and
to remove endogenous and exogenous toxins
7. A semipermeable membrane
is a thin layer of material that
contains holes of various
sizes, or pores.
This replicates the filtering
process that takes place in the
kidneys, when the blood
enters the
larger
kidneys and the
substances are
separated from the smaller
ones in the glomerulus.
8. is used to remove fluid and uremic waste
products from the body when the kidneys cannot
do so.
It may also be used to treat patients with edema
that does not respond to treatment, hepatic coma,
hyperkalemia, hypercalcemia, hypertension,
and uremia.
9. Indications for Dialysis
• The need for dialysis may be acute or chronic.
1. Acute dialysis is indicated
A.when there is a high and rising level of serum potassium, fluid
overload, or impending pulmonary edema, increasing acidosis,
pericarditis, and severe confusion.
B.to remove certain medications or other toxins (poisoning or
medication overdose) from the blood.
2. Chronic or maintenance dialysis is indicated inchronic
renal failure, known as end-stage renal disease (ESRD
12. KIDNEYS
The kidneys are a pair of organs, each about the
size of a fist, located on either side of your spine.
13. LOCATION
Located at the Near of the abdominal cavity
in the retroperitoneal space.
14. * Urine formation
Excretion of waste products
Regulation of electrolytes
Regulation of acid base balance
Control of blood pressure
Secretion of prostaglandins
Synthesis of vitamin D to active form
KIDNEY FUNCTIONS
15. PRINCIPLE OFDIALYSIS
Dialysis works on the principles of the diffusion of solutes
and ultrafiltration of fluid across a semi-permeable
membrane.
Diffusion describes a property of substances in water.
. Substances in water tend to move
. From an area of high concentration
. Toan area of low concentration.
. Blood flows by one side of a semipermeable membrane
. A dialysate (or special dialysis fluid) flows by the opposite
side.
Diffusion
Osmosis
Ultra filtration & solvent drag
17. . Water moves from an
area of high pressure
to an area of lower
pressure
OooOOO
. More efficient in fluid
removal than osmosis
Molecules which are
dissolved in the
solvent also get
removed- solvent drag
Ultra filtration & Solvent drag
20. It is the removal of solutes and water
from body across a semipermeable
membrane (dialyzer .
21. HEMODIALYSIS
It is the procedure of cleansing the blood of
accumulated waste products. It is used for patient
with end stage renal failure or for acutely ill
patient who require short term.
22.
23. Cleanses the blood of accumulated waste
products
Removes the by-products of protein
metabolism such as urea, creatinine, and
uric acid.
Removes excessive fluids
Maintains or restores the buffer system of
the body
Maintains or restores electrolyte levels
FUNCTIONS OF HEMODIALYSIS:
25. Other chronic disease
. No vascular access
. Hemorrhage
. hypertension
. Very old people
. Inability to cope with treatment
regimen
. Coagulopathy
. Inability to survive procedure
CONTRAINDICATIONS
27. Dialyzer(Artificial Kidney)
" Plastic chamber - contains bundles
of capillary
tube through which blood circulates
while
dialysis solution travels outside the
bundle in
opposite counter current direction.
Diffusion & ultrafiltration happens
here.
28. Membranes using in dialyser
Cellulose
-Substituted Cellulose-
cellulose acetate
-Cellulosenthetic-Cellosyn/
Hemophan
-Synthetics-polyacrylonitrile,
polysulfone, polymethyl methacrylate
29. Blood Delivery system
Blood Pump - moves blood from access
site through the dialyzer &
back to the patient
Blood flow Rate - 250-500 ml/min
30. METHODS OF CIRCULATORYACCESS
Arteriovenous fistula- An arteriovenous
fistula is an abnormal connection or
passageway between an artery and a vein.
31. Usually radial artery and cephalic vein are anastomosed in nondominant arm.
Vessels in the upper arm may also be used.
After the procedure the superficial venous system of the arm dilates.
By means of two large bore needles inserted into the dialated venous system,
blood may be obtained and passess through the dialyzer.
The arterial end is used for the arterial flow and the distal end is used forthe
reinfusion of dialysed blood.
Healing of AVF requires at least 6 to 8 weeks; a central vein catheter isused.
32. ARTERIOVENOUS GRAFT-
If a patient is not a good candidate for an
arteriovenous fistula, an arteriovenous graft
is considered.
33. CENTRAL VEIN CATHETER-
• A third type of vascular access is a venous
catheter. A venous catheter is a plastic tube
which is inserted into a large vein, usually in the
neck.
34. REQUIREMENT FOR HEMODIALYSIS….
Access to patients circulation .
dialyzer with Dialysis machine and
semipermeable membrane.
Appropriate dialysis bath.
Time- approximately 4 hrs, three times
weekly.
Place- dialysis centre or home (if feasible
38. PROCEDURE
Patient access is prepared and cannulated
Heparin is administered
Heparin and red blood flows through
semipermeable dialysis in one direction and
dialysis solution surrounds the membrane and
flows in the opposite direction.
Dialysis solution consist of highly purified water
to which sodium, potassium , calcium,
magnesium chloride, and dextrose have been
added, bicarbonate is added to achieve the the
proper pH balance.
39. Through the process of diffusion solute
in the form of electrolytes, metabolic
waste products acid base balance
components can be removed or added
to the blood.
Excess water is removed from the
blood (ultrafiltration).
The blood is then returned to the
body through patient access.
43. PERITONEUM-
forms the lining of
The peritoneum is
the serous membrane that
the
abdominalcavity .
It covers most of the intra-
abdominal (or coelomic)
organs, and is composed of a
layer
supported
of mesothelium
by a thin layer
of connective tissue.
44. CONTI
T…he peritoneum supports the
abdominal organs and serves
as a conduit for their blood
vessels, lymph vessels, and
nerves.
45. PHYSIOLOGY
The semipermeable peritonealmembraneallows
solutesand watertobetransported from the
vascular system totheperitonealcavityand vice
versa.
46. Peritoneal dialysis:
Introduction
Peritoneal dialysis(PD) is a treatment for
patients with severe chronic kidney disease.
A dialysis technique that uses the patient's own body
tissue-peritoneal membrane inside the abdominal
cavity as a filter.
47.
48. A.PERITONEAL DIALYSIS-
Peritoneal dialysis is a way to remove waste
products from your blood when your kidneys can
no longer do the job adequately.
49. Goals of PD
• Remove toxic substances andmetabolicwastes
• Reversethe symptoms of uremia
• Reestablish normal fluid and electrolytebalance
• Maintain a positive nitrogenbalance
• Prolong life
• Havethe maximum level of qualityof life
55. Preinsertion preparation
of the patient
Determine the catheterexitsite
Site:
Midline
3 cm below umbilicus
Lateral site
At the lateral border of the rectusmuscles
On a line, half way between the umbilicus and anterior
superior iliac spine
Left lateral side is preferred as it avoids caecum
56. Pre operative care of the
patient
Takebathorhaveashowerin the morning
Abdominal hair shouldbeclipped
Empty boweland bladderbeforecatheterinsertion
Enema canbegiven
Staphylococcusaureusscreening
Administerantibioticsprophylactically
57. • A trocarisused topuncturetheperitoneum asthepatient tightens theabdominal
muscles by raisingthehead.
• The catheter is threaded through the trocarand positioned.
• Previously prepared dialysate is infused into the peritoneal cavity, pushing the
omentum (peritoneal lining extending from the abdominal organs) away from the
catheter.
• The physician may then secure the catheter with a purse-string sutureand
applyantibacterialointment and asteriledressingoverthesite
58.
59. Composition of PD solution
Components
Na 132 mmol/l
Ca 1.25mmol/l
Mg 0.5mmol/l
Cl 100mmol/l
Lactate 35mmol/l
Glucose 1.36-4.25g/dl
Osmolarity 347-486
pH 5.2
61. PROCEDURE
Equipment preparation
Assemble the equipments needed
Check physician’s order for the concentration of dialysate
and medications to be added
Heparin : to prevent clotting
KCl: to prevent hypokalemia
Antibiotics : peritonitis
Insulin : for diabetic patients
62. PROCEDURE
Warm the dialysate solution to body
temperature:
Toprevent patient discomfort and abdominal
pain
Todilate the vessels of peritoneum
Dry heating should be done
Too cold solution causes pain, cramping, and
reduce clearance
63. Not recommended....
Soaking the bag of solution inwarmwater
Useof microwaveto heat thefluid
Avoid too coldsolution
66. Performing the exchange
Infusion
The dialysate is infused bygravity intothe
peritoneal cavity.
A period of about5 to 10 minutes isusually
required to infuse 2 L offluid.
67. • Dwell or equilibration and
drainage of dialysate
• Theprescribeddwell,orequilibration, timeallowsdiffusion and osmosis tooccur.
• Diffusionof small molecules,suchasureaand creatinine, peaks in thefirst 5 to
10 minutes of thedwelltime.
• Attheend of thedwell time, thedrainageportionof theexchangebegins.
• Thetubeisunclampedand thesolutiondrains fromthe peritonealcavity by
gravitythroughaclosedsystem.
• Drainageisusuallycompleted in 10 to30 minutes.
68. Performing the exchange
Drainage fluid
• Colorless or straw-colored
• Should not be cloudy
• Bloody drainage may be seen in the first few exchanges
Entire exchange time
1 to 4 hours (depending on prescribed dwell time)
72. Continuous cycling peritoneal
dialysis
Patientcarries PD solutionin theabdominalcavity
throughouttheday butperformsnoexchanges.
At bedtime ,patient hooks upto the cycler ,which
drainsand refillstheabdomenwithsolutionthreeor
moretimes in thecourseof the night.
73. Intermittent peritoneal
dialysis(IPD)
• Intermittentperitonealdialysis isoffered topatientsona
temporary basis when their blood pressure is low or in
childrenwithacuterenal failuretotideoveracrisis.
• Itisperformed forashortperiodof 12-24 hours,2-3 times
weekly.
• Commonroutinehourlyexchangeconsistsof 10 min
infusion, 30mindwell timeand a 20 mindrain time.
77. Infectious complications
Treatment
Initial one to three rapid exchanges with 1.5%
dextrose solution – to wash out mediators of
inflammation
Drainage fluid – examined for cell count ,
Gram’s stain, culture
Intraperitoneal or intravenous antibiotics
Unresolved peritonitis after 4 days of
appropriate therapy necessitates catheter
removal
78. Advantages of PD over HD
1. Easytousewithoutsophisticatedequipments
2. Easytomanage in homeand communityhealthcare
facilities
3. more independence andmobility
4. Dialysis treatment of choiceforchildren
5. Mayallowbetterblood pressureandvolumecontrol
with cardiovascularbenefits
6. Maygive betterqualityoflife
7. Lowerrisk of HepatitisC
8. Equalorbettersurvival inearlyyears
79. . Haemoglobin : 15 days
. Urea, creatinine, Na+, K+ : I
month
. Serology : 2 months
Investigation
80. MEDICALMANAGEMENT
Monitor patient
. Level of consciousness
. Vital Signs
Maintain airway
Administer Oxygen (per state/local protocols)
Support ventilations if or as necessary
Control any bleeding from the shunt or access site
Place patient in position of comfort
Transport to closest appropriate facility
82. Medications Common to Dialysis
Patients
Vitamins - water soluble
Phosphate binder ---- GIVE WITH MEALS
Phoslo (calcium acetate)
Renagel (sevelamere hydrochloride)
Caltrate (calcium cabonate)
Amphojel (aluminum hydroxide)
Iron Supplements -
don't give with phosphate binder or calcium
Antihypertensives - hold prior to dialysis
87. storation of "normal"
renal function
eedom from dialysis
turn to "normal" life
verses pathophysiological
changes rela
nal Failure
ss expensive than dialysis
after 1 st year
Advantages
88. Life long medications
Multiple side effects from
medication
Increased risk of tumor
Increased risk of infection
Major surgery
Disadvantages
89.
90. Nursing management
Potential for developing infectionrelated tothe
catheter
Assess the site for any signs of infection; any
redness, rebound tenderness, swelling,drainagefrom
theexitsiteorchange invital signs
Maintain strictaseptictechniquewhilecarrying
out theprocedure
91. Nursing management
Potential for developing cardiacandrespiratory
complications related to the uremic state and
presence of fluid intheperitoneum
Frequent cardiac andrespiratoryassessment
Watch for signs of fluidaccumulation;heart
failure, and pulmonaryedema
Auscultatethe baseof lungs forcrackles
Assess for signs of pericarditis;substernalpain,
low grade fever, and pericardialfrictionrub.
92. Nursing management
Acute painand abdominal discomfortrelatedto
the dialysateinfusion
Warm the dialysateto bodytemperature
Altered nutrition less thanbodyrequirement
related tothe proteinloss
High protein, fiber rich wellbalanceddiet
Limit carbohydrateintake
94. Nursing management
Altered body image related totheabdominal
catheter and bagandtubing
Assess for any suchproblem
Allow the patient to express his feelings
and concerns about body image
disturbances.
• Assist in selecting of properclothing
•
Provide an opportunity to the patient
to meet similar patients who are well
adjusted with the condition
95. Nursing management
Altered sexual patterns andsexualdysfunction
Provideprivacy tothe patientsothat he can
discuss hisproblem
Nursecan start thediscussion byasking aboutany
concerns related tosexuality