RENAL DIALYSIS.
RRT
Renal Replacement Therapy.
Dialysis is the artificial process of eliminating waste (diffusion) and unwanted water (ultra filtration) from the blood.
Dialysis is a procedure that cleans and filters the blood. It rids the body of harmful wastes and extra salt and fluids. It also controls blood pressure and helps our body keep the proper balance of chemicals such as potassium, sodium, and chloride.
Dialysis is a Greek word meaning "loosening from something else".
Dialysis and Urolithiasis and its dietary managementSyeda Yousra
Dialysis : principle, types, working ,dietary management its drawbacks and prevention
Urolithiasis :types , causes, most prone regions, diets for recovery and further prevention and treatment.
RENAL DIALYSIS.
RRT
Renal Replacement Therapy.
Dialysis is the artificial process of eliminating waste (diffusion) and unwanted water (ultra filtration) from the blood.
Dialysis is a procedure that cleans and filters the blood. It rids the body of harmful wastes and extra salt and fluids. It also controls blood pressure and helps our body keep the proper balance of chemicals such as potassium, sodium, and chloride.
Dialysis is a Greek word meaning "loosening from something else".
Dialysis and Urolithiasis and its dietary managementSyeda Yousra
Dialysis : principle, types, working ,dietary management its drawbacks and prevention
Urolithiasis :types , causes, most prone regions, diets for recovery and further prevention and treatment.
use artificial kidney to remove waste products and excess water from the patient’s blood
Three primary methods are used to gain access to the blood
Nursing Management of Hemodialysis
use artificial kidney to remove waste products and excess water from the patient’s blood
Three primary methods are used to gain access to the blood
Nursing Management of Hemodialysis
Hemodialysis is a treatment to filter wastes and water from your blood; In hemodialysis, the blood is cleaned outside the body using a dialysis machine and then sent back into the body.
Hemodialysis is a treatment to filter wastes and water from your blood, as your kidneys did when they were healthy. Hemodialysis helps control blood pressure and balance important minerals, such as potassium, sodium, and calcium, in your blood.
Hemodialysis is one way to treat advanced kidney failure and can help you carry on an active life despite failing kidneys.
Mechanism of Hemodialysis:
Hemodialysis is a procedure by which waste products and excess water are removed from a patient’s blood. This is done by directly removing blood from the patient’s circulation, passing it through the dialysis filter, and then returning it directly back into the circulation.
Apparatus needed:
Dialyzer or dialysis filter
Dialysate (dialysis solution)
Tubing for transport of blood and dialysate
Machine that powers and monitors the filtration
Hemodialysis has 5 main steps which are as follows:
1.Two sets of tubing are connected to the patient’s dialysis access:
Connected directly to central venous catheter
Two needles inserted into AVF/AVG and taped down
2. Azotemic blood pumped from patient into dialysis filter
3. Dialysis filter removes toxins primarily through diffusion:
Dialysis filter is a plastic cylinder filled with thousands of tiny individual tubes composed of the filtering material.
Blood flows through the inside of the tiny tubes in one direction.
Dialysis fluid (dialysate) flows on the outside of the tiny tubes (but still within the single plastic cylinder that contains them) in the opposite direction.
The opposing directions of blood and dialysate result in maximal concentration gradients that drive the diffusion of toxins:
Known as “countercurrent” mechanism
Also results in correction of electrolyte/acid–base abnormalities via diffusion.
4. Dialysis filter removes excess water from the blood through ultrafiltration.
Suction force is applied by the dialysis machine across the dialysis filter.
Water is pulled from the blood side into the dialysate side.
5. Clean blood and waste-filled dialysate exit the dialysis filter.
Clean blood is pumped back into the patient’s Circulation.
Waste-filled dialysate is disposed of (including the excess water from the patient’s body that was removed during ultrafiltration).
Chronic dialysis
3–4 hours each session
3 times a week (Monday/Wednesday/Friday or Tuesday/Thursday/Saturday)
Acute dialysis:
Treatment duration and daily schedule are
Variable.
Priscriptions: The nephrologist may control many variables within the dialysis procedure:
Duration of treatment
Ultrafiltration goal
Anticoagulation
Electrolyte composition of the dialysate
Speed of blood flow and dialysate flow
Presented by: Mohammadsaleh Moallem
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.
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
Approach to patient with upper GIT bleeding
Approach to patient with upper GIT bleeding
Approach to patient with upper GIT bleeding
Approach to patient with upper GIT bleeding
The Gram stain is a fundamental technique in microbiology used to classify bacteria based on their cell wall structure. It provides a quick and simple method to distinguish between Gram-positive and Gram-negative bacteria, which have different susceptibilities to antibiotics
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
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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
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
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2. dialysis is the process of removing
excess water, solutes and toxins from
the blood in those whose native kidneys
have lost the ability to perform these
functions in a natural way. This is
referred to as renal replacement therapy
3. Dialysis may be used in those with rapidly
developing loss of kidney function, called acute
kidney injury (previously called acute renal
failure); or slowly worsening kidney function,
called Stage 5 chronic kidney disease, (previously
called chronic kidney failureand end-stage renal
disease and end-stage kidney disease).
Dialysis is used as a temporary measure in either
acute kidney injury or in those awaiting kidney
transplant and as a permanent measure
4. Dialysis works on the principles of
the diffusion of solutes and ultrafiltration of
fluid across a semi-permeable membrane.
Diffusion is a property of substances in water
tend to move from an area of high
concentration to an area of low concentration.
Blood flows by one side of a semi-permeable
membrane, and a dialysate, or special dialysis
fluid, flows by the opposite side.
5. A semipermeable membrane is a thin layer of material
that contains holes of various sizes, or pores. Smaller
solutes and fluid pass through the membrane, but the
membrane blocks the passage of larger substances (for
example, red blood cells, large proteins).
This replicates the filtering process that takes place in
the kidneys when the blood enters the kidneys and the
larger substances are separated from the smaller ones
in the glomerulus.
Dialysate
Composed of sterile water, electrolytes/chemicals and
dextrose
Dextrose concentration determines osmotic pressure
in PD exchange
6. Acute indications
Indications for dialysis in the patient with acute kidney
injury are summarized with the vowel mnemonic of
"AEIOU":[17]
Acidemia from metabolic acidosis in situations in which
correction with sodium bicarbonate is impractical or may
result in fluid overload.
Electrolyte abnormality, such as severe hyperkalemia,
especially when combined with AKI.
Intoxication, that is, acute poisoning with a dialyzable
substance.
Overload of fluid not expected to respond to treatment
with diuretics
Uremia complications, such
as pericarditis, encephalopathy, or gastrointestinal
bleeding.
7. Chronic indications
Chronic dialysis may be indicated when a patient
has symptomatic kidney failure and low glomerular
filtration rate (GFR < 15 mL/min
8. There are three primary and two secondary
types of dialysis:
hemodialysis (primary),
peritoneal dialysis (primary),
hemofiltration (primary),
hemodiafiltration (secondary)
intestinal dialysis (secondary).
9. Hemodialysis
In hemodialysis, the patient's blood is pumped
through the blood compartment of a dialyzer,
exposing it to a partially permeable membrane.
The dialyzer is composed of thousands of tiny
hollow synthetic fibers.
The fiber wall acts as the semipermeable
membrane.
Blood flows through the fibers, dialysis solution
flows around the outside of the fibers, and water
and wastes move between these two solutions.
The cleansed blood is then returned via the
circuit back to the body..
10. Ultrafiltration occurs by increasing the
hydrostatic pressure across the dialyzer
membrane This usually is done by applying a
negative pressure to the dialysate compartment
of the dialyzer.
This pressure gradient causes water and
dissolved solutes to move from blood to
dialysate and allows the removal of several
litres of excess fluid during a typical 4-hour
treatment
11. Dialysis machine and a dialyser clean
the blood
Blood and dialysis fluids do not mix
Can take up to 3-6 hours
Usually 3 times per week
Either inpatient or outpatient by trained
staff
12.
13.
14. Peritoneal dialysis
In peritoneal dialysis, a sterile solution
containing glucose (called dialysate) is run
through a tube into the peritoneal cavity,
the abdominalbody cavity around the intestine,
where the peritoneal membrane acts as a
partially permeable membrane.
This exchange is repeated 4–5 times per day
15. Instillation of dialysis fluids into the
peritoneal space via a surgically-inserted
catheter
Most catheters are silicone
Fluid is removed to take out toxins
Most common types include:
Chronic ambulatory
Continuous cyclical
Chronic intermittent
16.
17. Hemofiltration
Hemofiltration is a similar treatment to
hemodialysis, but it makes use of a different
principle. The blood is pumped through a dialyzer
or "hemofilter" as in dialysis, but no dialysate is
used.
A pressure gradient is applied; as a result, water
moves across the very permeable membrane
rapidly, "dragging" along with it many dissolved
substances, including ones with large molecular
weights, which are not cleared as well by
hemodialysis.
18. Hemodiafiltration
Hemodiafiltration is a combination of
hemodialysis and hemofiltration, thus
used to purify the blood from toxins
when the kidney is not working normally
and also used to treat acute kidney
injury (AKI).
19. Intestinal dialysis
In intestinal dialysis, the diet is supplemented
with soluble fibres such as acacia fibre, which
is digested by bacteria in the colon.
This bacterial growth increases the amount of
nitrogen that is eliminated in fecal waste.
20. Hemodialysis Vascular Access
Provides location for easy access to patient’s
blood for dialysis
Higher flows rate of bood
cannulation can lead to stenosis or
thrombosis
Early detection of stenosis can lead to
intervention before thrombosis occurs
21. AV Fistula
Vein cross-cut, attached end-to-side to artery
High-pressure flow dilates and thickens vein
Best alternative:
Lowest infectious risk
Longest lasting with least thromboses
Drawbacks
Takes 2-4 months to mature
Only about 50% ever mature
22. AV Graft
Tube made of biocompatible material (gortex)
attached end-to-side to artery and vein
Often required in patients with vascular disease,
occluded distal veins
Advantages
Ready to use when swelling resolves (~2
weeks)
Able to use in most patients
Disadvantages
High stenosis/thrombosis rate
Moderate infectious risk
23.
24. Catheter
Intra juguar vein is most common site ,
Some times femoral vein
Tunnelled under skin to reduce communication
from skin flora with blood
Advantages
Ready for use immediately
Disadvantages
High infectious risk
High thrombosis risk
A/W increased mortality
Can be a sign of poor pre-dialysis care or
extensive vascular disease
25.
26. Complications of heamodialysis
• Infection
• Nutritional Deficiencies
• Low Blood Pressure
• Muscle Cramps
• Clotting Issues
• Movement Issues
• Dry and Itching Skin
27. Complications related to vascular Access in
Hemodialysis
1. Infection
2. Catheter clotting
3. Central venous thrombosis
4. Stenosis or thrombosis
5. Ischemia of the affected limb
6. Development of an aneurysm
28. Peritoneal Dialysis (PD ) complication
Patients may experience both psychological and physical
problems like
• Body image -- catheter outside , size and shape of
abdomen
• Fluid overload
• Dehydration
• Discomfort- uncomfortable when fluid in full or blotted
– backache , shoulder pain
• Poor drainage : a. Constipation b. Catheter displacement
• Leaks
Tunnel infection
• Peritonitis
• Back pain
29. Nursing considerations Hemodialysis:
Nursing interventions for H D
1. Explain procedure to client
2. Cannulating & connecting to HD machine
3. Monitor hemodynamic status continuously
4. Monitor acid-base balance
5. Monitor electrolytes
6. Insure sterility of system
7. Maintain a closed system
8. Discuss diet and restrictions on: a. Protein intake b.
Sodium intake c. Potassium intake d. Fluid intake
30. Pre-dialysis care
Weight: Determines amount of fluid to be
removed during dialysis •
Vital signs: BP for hypo and hypertension;
temperature for sepsis; respiration for fluid
overload •
Potassium level: Determines potassium level in
dialysate (in the chronic setting, this is done
monthly unless the patient is symptomatic
31. Review Medications
• Hold drugs that pass through the dialysis
membrane, such as piperacillin, folic acid, and
other water-soluble vitamins.
• Hold antihypertensive drugs, especially if
systolic pressure is below 100, per physician
order
• Review need for blood products
32. Check access site
• Assess fistula or graft for infection
• Assess circulation in distal portion of
extremity
• Auscultate for bruit
• Palpate for thrill
• No IV or blood draws in that arm
• No BP in arm
33. During dialysis
Watch for
• Hypotension
• Muscle cramps
• Nausea and vomiting
• Headache
• Itching
• Less commonly: disequilibrium syndrome,
hypersensitivity reaction, arrhythmia, cardiac
tamponade, seizures, air embolism
34. Post-Dialysis care
• Monitor BP; report hypotension or
hypertension
• Watch for bleeding
• Check weight and compare (weight loss should
be close to fluid removal goal set during
treatment)
• Document unusual findings • Assess access site
for bruit, thrill, exudate, signs of infection,
bleeding • Give missed meds, if indicated