1. SUBMITTED BY: Kawerdeep singh

2. Hemodialysis is removal of certain elements from the blood by virtue of the difference in rates of their diffusion through a semipermeable membrane while being circulated outside the body; the process involves both diffusion and ultrafiltration.

3.  http://www.youtube.com/watch?v=IQKQ4eo KfTg http://www.youtube.com/watch?v=IQKQ4eo KfTg

4.  Metabolic acidosis : Metabolic Acidosis or a change of the blood pH to acidic. Usually, this condition can be treated by neutralizing the acidic blood with sodium bicarbonate. However, dialysis may be needed in cases where this is impractical or if there is a risk of fluid overload.  Electrolyte Imbalance : Electrolyte imbalance such as severe hyperkalemia, where the blood level of potassium is raised.

5.  Acute poisoning : where the harmful substance can be removed by dialysis. Lithium, a drug used to treat mood disorders and the pain reliever aspirin are two examples of drugs that can be removed using dialysis.  Uremia : Certain complications of the condition uremia, where urea and other waste material builds up in the blood. Such complications include pericarditis (inflammation of the pericardium in the heart), encephalopathy or a disease affecting brain function and gastrointestinal tract bleeding.

6. Chronic or long-term illness: Renal failure where symptoms are manifesting. In the case of a lowered glomerular filtration rate (GFR) that has dropped to less than 10-15 mls/min/1.73m2, although in diabetics, dialysis is started before this stage is reached. In cases of low GFR where medication is unable to control fluid overload and rising levels of serum potassium or phosphorus. (Dr Mandal, MD, 2014)

7. The nurses responsibilities include: Checking the patient’s vital signs and talking with them to assess their condition. Teaching patients about their disease and its treatment and answering any questions. Overseeing the dialysis treatment from start to finish. Making sure patients are given the correct medications ordered by their doctors.

8. Evaluating patient’s reaction to the dialysis treatment and medications. Reviewing the patient’s lab work, home medications and activities and letting the doctors know about changes in their patient’s conditions. Helping patients to follow-up. Supporting the entire care team in delivering quality care in a considerate, respectful manner. (Helmut, Susanne, & Rainald, 2002, p. xx)

9.  People need dialysis when they develop end stage kidney failure --usually by the time they lose about 85 to 90 percent of their kidney function and have a GFR of <15.  Most of times, dialysis is done for 4 hours a day. It is done for 3 times a week.

10.  Most people who require hemodialysis have a variety of health problems. Hemodialysis prolongs life for many people, but life expectancy for people who need it is still less than that of the general population.  While hemodialysis treatment can be efficient at replacing some of the kidney's lost functions, you may experience some of the related conditions, although not everyone experiences all of these issues. Your dialysis team can help you deal with them.

11.  Low blood pressure (hypotension).  Muscle cramps  Itching  Sleep problems  Anemia  Bone diseases  High blood pressure (hypertension)  Fluid overload

12.  Inflammation of the membrane surrounding the heart (pericarditis).  High potassium levels (hyperkalemia)  Access site complications  Amyloidosis  Depression(Cabral & Santos, 2012, p. xx)

13.  RISK FOR INJURY :  Monitor internal AV shunt patency at frequent intervals:Palpate for distal thrill.  Notify physician and/or initiate declotting procedure if there is evidence of loss of shunt patency.  Evaluate reports of pain, numbness/tingling; note extremity swelling distal to access.

14.  DEFICIENT FLUID VOLUME :  Measure all sources of Intake and Output and keep it in record.  Weight daily before/after dialysis run.  Monitor BP, pulse, and hemodynamic pressures if available during dialysis.

15.  EXCESS FLUID VOLUME:  Measure all sources of Intake and Output. Weigh routinely.  Monitor BP, pulse.  Note presence of peripheral/sacral edema, respiratory rates, dyspnea, orthopnea, distended neck veins, ECG changes indicative of ventricular hypertrophy.

16.  Dr Mandal, A. (2014, January 14). Indications for Dialysis. Retrieved from http://www.news- medical.net/health/Indications-for- Dialysis.aspx  Helmut, S., Susanne, M., & Rainald, F. (2002). Daily hemodialysis and the outcome of acute renal failure. The new England journal of medicine, 305-10. Retrieved from http://search.proquest.com.proxy.library.nia garac.on.ca:8080/docview/223941278/fullte xt?accountid=39476 http://search.proquest.com.proxy.library.nia garac.on.ca:8080/docview/223941278/fullte xt?accountid=39476

17.  Cabral, Y. F., & Santos, M. C. (2012). Hemodialysis: Indications, procedures and complications. Hauppauge] New York: Nova Biomedical, Nova Science Publishers, Inc  http://nurseslabs.com/3-hemodialysis- nursing-care-plans/ http://nurseslabs.com/3-hemodialysis- nursing-care-plans/