Nursing Care

This week we will look at the nursing care of individuals with CKD.  The American Nephrology Nurses Association (ANNA) has created a wonderful set of modules about CKD care.  I have summarized the modules here, however I encourage you to go to their site yourself and have a more in-depth look.

The role of the nurse varies according to the stage of the disease that the patient has progressed to:

Stage 5

Transplant

Care Setting hospital

•    Patient education on immunosuppressive medication - these medications must be taken for life.   Tell patients they will have an increased risk of infection, and what they can do to stay healthy   

•    The nurse must also watch for complications from surgery such as leakage or bleeding from the surgical site, signs of infection, or a sudden change in blood pressure could mean the patient's body is rejecting the new kidney

RRT (Renal Replacement Therapy)

Care Settings include home health, rehabilitation hospital, extended care facility, long-term care facility, dialysis clinic; some hospitals have dialysis services

•    Check weight before and after dialysis

•    Maintaining good vascular access, meaning the site where the needles are inserted are free of infection and blood is flowing to and from them

•    Medication management and education - since dialysis basically is clearing the system, it is important that medication (especially blood pressure medication) be given after dialysis treatment has finished 

•    Weekly/Monthly lab draws (never draw from arm that has the fistula)

•    Connect patient with resources for transportation to and from dialysis appointments

No Therapy 

•    Patient and family will be counseled on end-of-life care

•    Plan should be in place for when the patient decides to stop using dialysis

Stages 3 & 4 Moderate to Severe

Care Settings general and family practice, for stage 4 nephrologist, many of these patients are older, and quite ill with other diseases in addition to CKD

•    Help patient manage co-morbid illnesses, including high blood pressure and diabetes

•    Promote self-management (i.e. lifestyle modifications, medication adherence, smoking cessation) 

•    Slow progression

•    Patient education on how to avoid complications, and when to call for help

•    Prepare patient RRT – go over dialysis options, transportation, vein mapping, access referral

Stages 1 & 2

Care Settings general and family practice

•    Heart disease risk reduction (lifestyle modification, medications)

•    Patient education on how to monitor BG and BP at home, and on the importance of getting kidney function labs drawn annually

•    Education on drugs to avoid (antifungals, NSAIDS)

•    Emphasis on self-management.  The patient is ultimately in control of their health!!  Progression is slow so there are many opportunities to maintain health at this stage. 

•    Monitor response to therapy

CKD in Children

•    Nurses would perform all the same care for children as they do for adults.  However, children with CKD are also at a high risk for slowed growth, both physically and cognitively.

•    Nurses working with children may need to be more creative in their approach to building a relationship with the patient, they may find themselves using play as a tool with which to provide care

That should give you a pretty good idea of what the nurse does at the various stages of CKD.  Before you go check out this message from one of my favorite CKD patients, Ms. Sheila Shaw!