Contemporary Renal Replacement Therapy (CNA573)

UNIVERSITY
Name of the Student
Task
Reflection on Haemodialysis assessment
Tutor

Introduction
Haemodialysis is a process of blood purification; it entails the removal of waste products in
the blood. Clinical practice is of the essence in hemodialysis nursing world. Having basic and
competent understandings of various nursing practice diagnosis is essential in the
management of the dialysis process, (Nistor, 2015). This reflection offers my assessment
skills on key areas in health care nursing practice touching on hypotension, cramps, vomiting,
headaches, vomiting, A-V Access surveillance and anticoagulant free dialysis assessment.
Hypotension management
Hypotension can occur during hospital admission or developed during the patient's
hospitalization or at times caused by iatrogenic complications. Non-traumatic conditions
occurring out of hospitals are associated with increased hospital mortality, while those
developing in emergency care settings or during acutely decompensated heart failure, COPD
and community-acquired occurrence is associated with high mortality. Its occurrence happens
at below normal blood pressures ranges of 120/80mmHg, (Dasgupta, Farrington, Simon,
Davies, Davenport & Mitra, 2016 pp. 325). Main causes can be attributed to a decrease in
cardiac output, dilation of blood vessels low blood volume, nervous system impairment, and
other medications. Intradialytic hypotension is a common hemodialysis type occurring. It
leads to a rapid reduction in the volume of blood due to the ultrafiltration process ad
reduction in extracellular osmolarity process. Its management entails usage of midodrine, and
vasopressin analogous. Further, usages of new classes of drugs such as adenosine receptor
antagonists have been used selectively to manage the state, (Kuipers et al., 2016 p. 21.
Cramps
Cramps are more observed among patients needing high ultrafiltration rates. Cramps during
dialysis are related to a reduction in muscle perfusion which occurs in response pt
hypovolemia. Vasoconstrictive responses occur which can shut the blood in the central
pathways which can promote muscle cramps. Further changes occurring in intra and
extracellular potassium balance and calcium ionization often can disturb neuromuscular
transmission casing cramps. Further, they can be linked to intra dialectic cramps which
ascertain the presence of dialytic treatment linked to cramps. Its management treatment can
be undertaken using physical manoeuvres to smoothen muscles. Moreover, usage of dialysate
of sodium, potassium, and calcium can be affected. Reassessing dry weight and patient
counseling can be effective in the reduction of interdialytic weight gain and usage of
bicarbonate dialysis, (Flythe et al., 2018).
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Vomiting, headaches, and vomiting
Vomiting and nausea are often associated with kidney. Low blood pressure and excess weight
gain are the most often associated causes. The symptoms are commonly associated with a
kidney condition, coupled with low blood pressure and weight gain can have contributing
effects. Nausea and vomiting can have effects of discontinuation of dialysis treatment
process. Medication management of nausea and vomiting entails regulation of fluid removal
levels and further prescription of anti-nausea medication, (Singh et al., 2016 pp. 803-805).
Further, the dialysis process, may at times induce severe headaches which often result in
large quantity shifts in electrolyte and water balance, (Goksan, Karaali-Savrun, Ertan &
Savrun, 2004 ). They can result from low blood pressure. Management is offered through
over the counter drugs. Over the counter drugs such as acetaminophen can be used to
minimize headaches.
A-V access surveillance
Haemodialysis vascular access often referred to as lifeline is critical to a lifeline. Functional
arteriovenous access offers a lifeline access for hemodialysis is crucial as it provides enough
blood for adequate dialysis. Common causes of AV failure are linked to stenosis and
development of thrombosis. Stenosis assessment can be detected using various techniques
which often calls close monitoring. Clinical observation, flow measurement, pressure
determination, and recirculation measurement is crucial in the assessment of stenosis.
Further, stenosis can be accessed through direct visualization though none invasive
techniques such as venography or color duplex imaging, (Inston et al., 2017 pp. 4-7).
Managing access and patency of diagnosing accuracy of A-V access depends on timely
interventions. Related linked to vascular access is often the common causes of hemodialysis
hospitalizations among dialysis patients. Thus, prevention of complication development can
be effective in reducing morbidity, mortality and reducing associated complications which
reduces the health care system.
A-V access assessment can be undertaken using physical examination process which is the
cornerstone of clinical monitoring. Elements of access can include inspection of arm,
shoulder, face, neck, and breast, palpation assessment and auscultation. Physical assessment
of vascular access is often a simple method which can be performed readily. Access flow
measurement can be further implemented; this can measure significant stenosis which
assesses monthly blood flow access. Further assessment of venous pressure monitoring can
be undertaken using a dialysis machine using a pressure transducer at the beginning of
hemodialysis, (Khawaja et al., 2016 pp. 104-107).
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