1. ~ Make a Difference ~ Become a Nephrology Nurse

2. Incidence (rate of occurrence) –220 per million in 1992 –334 per million in 2000 Prevalence (number of cases) –20 million stages 1-5 –Stage 5 ~ 350,000 Chronic Kidney Disease (CKD)

3. Stages of CKD

4. The Importance of the Kidneys Regulation of Homeostasis –Extracellular volume and osmolality –Electrolyte balance –Excretion of metabolic wastes, free radicals and drugs –Regulation of acid-base balance –Renin-Angiotensin System Bone mineralization Produces calcitriol (form of Vit. D) to increase Calcium absorption Regulates calcium and phosphorus Production and release of hormones –ADH and aldosterone – Control regulation of reabsorption of water, sodium –Erythropoietin – stimulate RBC production Insulin Degradation

5. Fluid and Electrolyte Imbalances Hyperkalemia –Low excretion Hyponatremia –Fluid retention Hypocalcemia –Low excretion of phosphorus –Decreased level of vitamin D Hyperphosphatemia –Low excretion Hypermagnesium –Low excretion

6. Physical Findings in CKD

7. Commonly Used Medications Vitamins Phosphate Binding Agents PTH Suppression Agents ESA Products Iron Therapy Antihypertensive Agents

8. Commonly Used Medications Vitamins Phosphate Binding Agents PTH Suppression Agents ESA Products Iron Therapy Antihypertensive Agents

9. General Principles of Dialysis Diffusion Osmosis Ultrafiltration Diffusion Osmosis Ultrafiltration

10. What Exactly Is a Nephrology Nurse ? Work in many settings Care for patients in different stages of CKD Care for patients using different modalities of treatment Many different areas for the nurse to explore within nephrology

11. Where Do I Start ? Most nurses do begin working in hemodialysis settings Practice areas include: –Hemodialysis –Peritoneal Dialysis –Transplant –Acute Care –Pediatrics

12. Hemodialysis Patients: Come to a center three times a week to have procedure performed by a trained dialysis nurse. Nurses: –Assess patients –Initiate hemodialysis treatments –Monitor vital signs during treatments –Provide medications –Function collaboratively –Provide education Hours Worked in Hemodialysis –12 hour days in an outpatient setting –Rare Sundays in outpatient clinics

13. Vascular Access - Catheter

14. Vascular Access Fistula and Graft

15. Peritoneal Dialysis Patients: –Usually taught how to perform PD at home –Visit center monthly for evaluation Nurses: –Perform calls with patients to “triage” problems –Meet monthly with patients Assess Review medications Provide supplies Review with physician

16. Peritoneal Dialysis Three Phases: Fill – 1.5-2L dialysate Infuses over 10-15 minutes Dwell – Remains in abdomen for 4-6 hrs Drain – Fluid and endogenous end- products removed via diffusion and osmosis.

17. Transplant Patient –Surgical procedure –Need a donor Nurse –Works in a clinic-type setting –Sees patients monthly –Reviews medications, labs –Educates

18. Acute Care Patient –In the hospital may have a condition that is “recoverable” (acute) or chronic (long term) –and just beginning on dialysis Nurses –May work in a dialysis area –May perform the procedure at the bedside in ICU or a CC setting –Often work 12 hr days; may take “call”

19. Pediatrics Patients –Can be newborns without developed kidneys –Can have different diseases that cause kidneys to fail Nurses –Often work 12 hr shifts –Education to Mom & Dad –Family support –May teach family to perform at home; or come to center

20. Where Can I Grow ? Management/Administration Advanced Practice Transplant Coordinator/Organ recovery coordinator Office nurse Pharmaceutical/ Corporate/Sales representative Nurse Researcher Quality Management Nurse Educator Government Oversight Positions University settings

21. Administration Nurse Managers/Administrators –Meet state and federal regulations –Staff unit –Insure safety of all patients and staff –Meet annual requirements for education and physicals of staff –Perform quality improvement activities –Meet with Medical Director of the facility monthly –Annual evaluations of staff members –Fiscal responsibilities of unit – including budgets, raises, purchasing of supplies Susie VanBuskirk

22. Advanced Practice Advanced Practice Nurses (APN) –Work closely with the physician regarding pt care –“Round” weekly on outpatients –Write prescriptions for medications –Collaborate with other medical specialties –Order tests, lab procedures –Participate in quality improvement projects –See patients in clinic or CKD settings –Educate patients on disease process, medications, treatment modalities… Debra Castner

24. Membership in ANNA Publications Educational Meetings Opportunities to interact with other dialysis nurses –in your specialty – across the US ! Become certified

25. A Focus for Everyone … Opportunity for Members to get involved Acute Care Administration Advanced Practice Chronic Kidney Disease Hemodialysis Transplantation Peritoneal Dialysis Pediatric Nephrology

26. Become Certified: The Mark of a Leader

27. Questions ? Thank You for your time…..