Utopia Health Career Center

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1 Utopia Health Career Center Magda Castaneda RN, BSN, CNN, HTC Coordinator / Instructor BONENT Approved Program Florida Board of Nursing CE Provider # Property of Utopia Health Career Center, LLC. Distribution prohibited with out permission

2 Introduction This Webinar is good for 3 contact hours and we will cover: What is dialysis and a brief history. Normal Kidney Functions. Causes of Kidney Failure. The person with Kidney Failure

3 Normal Kidney Function Renal Anatomy - Two Kidneys. - About the size of a fist and weighs 5 ounces. - Located on the back of the body, just above the waist. - Protected by pads of fat and the rib cage. Property of Utopia Health Career Center, LLC. Distribution prohibited with out permission

4 Kidney Property of Utopia Health Career Center, LLC. Distribution prohibited with out permission

5 Nephrons (Kidney cells) The kidney has million of Nephrons. Start in the renal cortex and extend into the medulla. Eliminate excess water and waste and keep what the body needs. Glomerulus and a tubule. Property of Utopia Health Career Center, LLC. Distribution prohibited with out permission

6 Glomeruli Glomerulus: ball of capillaries in a sac called Bowman s capsule. Semipermeable membrane. (Filter) Coffe maker. (small cells pass through and big cells stay). Blood cells and proteins do not pass healthy glomerulus walls. Property of Utopia Health Career Center, LLC. Distribution prohibited with out permission

7 Property of Utopia Health Career Center, LLC. Distribution prohibited with out permission Nephron & Tubule System Pressure (forces water outside of the blood) Tubular system Chemicals and water needed pass back into the blood. Waste and extra water empty into the calyces 1%.

8 Property of Utopia Health Career Center, LLC. Distribution prohibited with out permission

9 Functions of the Kidney Homeostasis Keep the right balance of chemicals and fluid in the body. Create hormones, controls blood pressure, controls acid/base balance. Property of Utopia Health Career Center, LLC. Distribution prohibited with out permission

10 Types of kidney disease Acute Kidney failure (AKF) - Sudden loss of kidney function. - Illness, injury or toxin. - May last for a couple of days, weeks or months. - It could be reversible, but they have higher risk of chronic kidney disease later on. Property of Utopia Health Career Center, LLC. Distribution prohibited with out permission

11 Chronic Kidney Disease (CKD) Kidneys can function with 50% of their Nephrons. CKD is a long, slow process of Nephron loss. Screening for CKD Urine test and blood pressure check. Blood Creatinine check may find CKD early. Property of Utopia Health Career Center, LLC. Distribution prohibited with out permission

12 How to slow the loss of kidney function? Keep blood sugar in target. Keep blood pressure in target. Avoid pain pills called NSAIDS (non-steroidal anti-inflamatories) Eg. Naproxen and Ibuprofen Quit smoking Caution with X-rays and dye tests. Property of Utopia Health Career Center, LLC. Distribution prohibited with out permission

13 Chronic Kidney Disease Stages The stages of CKD (Chronic Kidney Disease) are mainly based on measured or estimated GFR (Glomerular Filtration Rate). There are five stages but kidney function is normal in Stage 1, and minimally reduced in Stage 2. Property of Utopia Health Career Center, LLC. Distribution prohibited with out permission

14 Chronic Kidney Disease Stages Stage 1 GFR 90+ Normal kidney function but urine findings or structural abnormalities (kidney damage) or genetic trait point to kidney disease. Treatment: Observation and control on Blood Pressure. Property of Utopia Health Career Center, LLC. Distribution prohibited with out permission

15 Stage 2 GRF Mildly reduced kidney function, and other findings (as for stage 1) point to kidney disease. Could have anemia. Treatment: Observation, control of blood pressure and risk factors. Property of Utopia Health Career Center, LLC. Distribution prohibited with out permission

16 Stage 3 GFR Moderately reduced kidney function. Symptoms: anemia, fatigue, swelling. Treatment: Observation, control of blood pressure and risk factors. Diet and medications. (Epogen or Procrit). Property of Utopia Health Career Center, LLC. Distribution prohibited with out permission

17 Stage 4 - GFR Severely reduced kidney function. Symptoms: anemia, fatigue, swelling, calcium and phosphorus imbalances. Treatment: Planning for endstage renal failure. Vein mapping for AVF or AVG, choosing dialysis unit, medication, diet. Property of Utopia Health Career Center, LLC. Distribution prohibited with out permission

18 Stage 5 - GFR <15 End Stage Renal Disease (ESRD) Very Severe Symptoms. Patient should start on Dialysis or receive a Transplant in order to live. Treatment: Dialysis or Transplant. Property of Utopia Health Career Center, LLC. Distribution prohibited with out permission

19 Most common causes of Renal Failure ( ) Diabetes High Blood Pressure Glomerular Diseases Property of Utopia Health Career Center, LLC. Distribution prohibited without permission.

20 Diabetes Type I: immune system kills cells that make insulin in the pancreas. Type II: pancreas does not make enough insulin or the body can t use what it does make. Type II: #1 cause of kidney failure in US. Property of Utopia Health Career Center, LLC. Distribution prohibited without permission.

21 Diabetes Harms the heart, blood vessels and nerves. Blidness and limb loss. African americans, hispanics and native americans. Lifestyle changes: Losing 5% of body weight, 30 mins of exercise 5 times a week. Reduces the onset of Diabetes type II by 34%. Property of Utopia Health Career Center, LLC. Distribution prohibited without permission.

22 High Blood Pressure Number two cause of kidney failure in US. Harms blood vessels that lead to the kidney. Tx: Diet, low salt, medication. Complication due to: No symptoms, No treatment. No medication. Property of Utopia Health Career Center, LLC. Distribution prohibited without permission.

23 Glomerular Disease Glomerulonephritis: inflamation of the glomeruli. Glomerulosclerosis: hardening of the glomeruli. Property of Utopia Health Career Center, LLC. Distribution prohibited without permission.

24 Polycystic Kidney Disease (PKD) Genetic disease. Fluid filled cysts that grow in the kidney. Can also be present in the liver and brain. Property of Utopia Health Career Center, LLC. Distribution prohibited without permission.

25 Polycystic Kidney Disease Property of Utopia Health Career Center, LLC. Distribution prohibited without permission.

26 Other Causes Birth defects Frequent large kidney stones Systemic lupus erythematosus (SLE) Use of street drugs Kidney infections Cancer HIV/AIDS Sickle cell disease Property of Utopia Health Career Center, LLC. Distribution prohibited without permission.

27 As a technician, you can have a chance each day to help patients feel their best and this can lead to a rewarding career.

28 Overview of Dialysis When Kidneys fail, patients need dialysis or a kidney transplant. Renal failure is irreversible. The nephrons (kidney cells) do not regenerate. Dialysis filters wastes and excess water out of the blood. Medications, Diet and fluid limitations are also ordered.

29 Types of Dialysis HEMODIALYSIS (HD) A vascular access is needed: Aretriovenous Fistula (avf), Areriovenous Graft (avg) or a Central vein catheter (cvc). Through one line the Blood flows out of the patient to a dialyzer (artificial kidney). The blood is cleaned is cleaned in the filter and then goes back into the patient through the other line. A fluid called dialysate is also needed to help carry the extra fluid and waste down the drain. The dialysis machine sets the rate of the blood flow, has safety alarms, mixes and delivers dialysate.

30 HEMODIALYSIS Types of Hemodialysis: 1. Standard in center Hemodialysis. 3/week about 4hrs 2. Nocturnal in center Hemodialysis. 3/week about 8 hrs 3. Standard home hemodialysis. 3/week or every other day about 4-6hrs 4. Short daily home hemodialysis. 5 or 6/week about hrs 5. Nocturnal home hemodialysis. 3 7 nights about 8 hrs

31 PERITONEAL DIALYSIS (PD) Peritoneal dialysis is a home treatment. Peritoneum tiny blood vessels. Filter to clean the blood. Access is through a catheter placed through the wall of the abdomen. The abdomen gets full of sterile dialysate. Excess fluid and waste flow out of the tiny vessels into the dialysate. After the dialysate dwells for a few hours it is drained out and new dialysate is then placed again. Exchange.

32 Peritoneal Dialysis Happens 7/week. Can be manual or using a cycler.

33 Payment for Dialysis and Transplant Before 1973, hospitals had Life and Death committees that chose which patients would receive dialysis. How were they chosen? Age. How mature and educated they were. Whether they could pay for their care. How much they might give back to society if they lived. High costs treatments. Insurance company called dialysis experimental and did not pay for it.

34 1972 Congress was convinced! 1973 Law Medicare End Stage Disease Program. Medicare to patients who have worked enough to qualify for Social Security. Medicare pays 80% of dialysis or transplant. Private health insurances, Medicaid, State programs or the patients pays the rest. End stage renal disease (ESRD) is the only disease with its own Medicare program. Conditions for coverage rules by Medicare. * Dialysis is still very costly today.

35 Patients that do not have Medicare when they start dialysis have to wait for three full months before they qualify for it. If the patient starts in a home program Medicare starts paying from day 1. Patient with private insurance stay with their insurance as primary for 30 months, Medicare is secondary. After 30 months Medicare becomes primary. Medicare has a fixed rate for dialysis treatments with different tiers that can increase dialysis center revenue.

36 Quality in Dialysis ESRD Networks: 18 networks nationwide. Promote rehabilitation. Collect and report data about dialysis. Do quallity improvement projects. Handle patient grievances. Help clinics deal with conflicts. Provide resources to staff and patients. Dialysis clinics are required by law to work with the networks.

37 Guidelines for Dialysis Care Improve outcomes. Renal Physicians Association (RPA) National Kidney Foundation (NKF) Dialysis Outcomes and Practice Patterns study (DOPPS)

38 ESRD Quality Initiative Dialysis Facility Compare Fistula Firts Breakthrough Initiative ESRD Conditions for Coverage CAHPS In-center Hemodialysis Survey ESRD Clinical Performance Measures Consolidated Renal Operations in a Web-enabled Network (CROWNWeb) Quality Incentive Program (QIP)

39 Quality Standards for Dialysis State surveyors inspections. (Condition for coverage). Dialysis standards: The Joint commission (TJC) The Association for advancement of Medical Instrumentation (AAMI) The food and drug Administration (FDA) The united states data system (USRDS)

40 Continuos Quality Improvement in Dialysis (CQI) Clinical anemia, access doses Technical water treatment, dialyzer reuse Organizational staff schedules, patient safety

41 Finally, Dialysis Technician Professionalism More direct contact with patients than other staff members. You should: Know the field and the job. (Expert). High quality work. High ethics. Good work morale and motivation. Respect patients and colleagues.

42 Questions Property of Utopia Health Career Center, LLC. Distribution prohibited with out permission