Nursing pathway - If you've just walked through the door you should go to the Core Pathway first. This section is for any nurse who cares for renal patients including students, registered nurses and some clinical support workers. You will find the Textbook should have a useful introduction to each topic.
Nursing syllabus by topic:
- Acute renal failure
- General nephrology ward
- Outpatient haemodialysis
- Home haemodialysis
- Peritoneal dialysis
- Primary care
- Renal outpatients
- Prescribing
- Advanced roles
Acute renal failure (AKI)
Read about acute renal failure and its management (Edren Textbook). What are the risks? What do people die of?
Below are further links to general nursing issues in acute renal failure and intensive monitoring (high dependency units and intensive care settings; HDU and ICU)
Monitoring
- haemodynamic monitoring (link to follow ...)
- central venous pressure (link to follow ...)
- arterial lines (link to follow ...)
Assessment of fluid status and prescription of fluids
- Because patients have no or very limited ability to control excretion, careful monitoring and prescription of fluid balance is critical. In many patients, output = insensible losses only, and you can't afford to overshoot by much.
- Fluid compartments and fluid prescription - general teaching resource on fluid balance (EdRen textbook)
Renal replacement therapy (RRT) in ARF
- RRT for ARF (Edren handbook)
- RRT for AKI (Renal Association guidelines)
- Anticoagulation (Edren handbook needs this page! To follow ...)
Pharmacology and prescribing
- General prescribing issues in renal failure (Edren handbook)
- Management of patient controlled analgesia (link to follow ...)
Nutrition
Critically important in ARF
- Prevent hyperkalaemia and sodium overload
- Prevent malnutrition and wasting
Early intervention is essential. See Nutrition in AKI (guideline 10) from Renal Association guidelines.
Tissue viability
- Links ...
General nephrology ward
Many of the issues are general nursing issues, not specifically renal. The particularly renal issues relate to
- Fluid balance - see AKI section above
- Vascular access - assessment, protection,
- Management of intravascular catheters
- Haemodialysis
- Peritoneal dialysis
- Conservative care (patient info link from Edren. Others to follow)
- Social care and rehabilitation of patients
- recovering from ARF
- on longterm RRT with comorbid disease
Remember that some patients have more renal experience than many of the staff.
Outpatient maintenance haemodialysis
(Yvonne) - see Haemodialysis pathway
Home haemodialysis
(Johnny)
Peritoneal dialysis
See PD pathway
Primary care
See CKD
Renal outpatients
Renal outpatients (not including those already on RRT) fall into three groups
- Assessment of new problems; diagnosis and management of active diseases
- Management of patients with CKD to prevent progression
- Preparation of patients for ESRD
Prescribing for the patient with renal disease
(Lorna)
- General issues with drug excretion and prescribing
- Fluid therapy in renal disease
- Reference sources
Advanced roles
These are going to end up as discrete pathways but for now are just listed.
- Anaemia
- Vascular access
- Predialysis care
- Conservative care
- Transplant assessment and follow up
Documents
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