Managing Fluid, Diet and Medications

Managing Fluid, Diet and Medications This lesson covers: Fluid and body weight Managing your diet Understanding your medications It is important that you feel comfortable with the information and procedures you are learning during your training. Everyone has different ways of learning. Your nurse will guide you through the information you need to know so you can take care of yourself at home. PATIENT FIRST PART 1

Part 1 Fluid and body weight... Page 3 Your nurse or dietitian will provide specific fluid and diet instructions for you to follow. Part 2 Managing your diet... Page 11 Part 3 Understanding your medications... Page 21 Your doctor will determine what medications you should be taking based in your lab results and how well you are feeling. Together with dialysis, diet, and fluid control, your medications can help improve your quality of life. Fluid and body weight Healthy kidneys balance the fluids in your body by removing excess water from your blood. When your kidneys are not working, 4 things affect the amount of fluid in your body: The amount of fluid you take in by drinking and eating The amount of urine output you still have The amount of fluid that is removed by dialysis The amount of salt that is removed Fluid weight is made up of the liquid part of your tissues and blood. Fluid weight can increase quickly if you drink more than your kidneys or dialysis can remove. Body weight is made up of bones, tissue, muscles, and fat. Body weight stays the same from day to day, unless you are eating too much and then body weight increases gradually over time. Fluid and body weight make up your total body weight. This lesson will provide some of the key points you need to know about fluid and diet management. Your nurse or dietitian will provide specific fluid and diet instructions for you to follow. 2 PART 1 3

What you should do each day Now that your kidneys no longer balance the fluids in your body, it is important to understand how you can check your fluid weight each day. Each day, you should: Weigh yourself Check your blood pressure Look for signs of swelling in your tissues Notice how you feel To check your fluid weight each day you need to: Weigh yourself Weigh yourself at the same time every day with the same scale and similar clothes and shoes. Record your weight each day. Rapid weight gain or loss may mean you have too much or too little fluid in your body. Check your blood pressure Check your blood pressure (BP) as taught in your training. Record the reading each day. Increased BP may mean you have too much sodium and fluid in your body. Decreased BP may mean you have too little sodium and fluid in your body. Notes Notes 4 PART 1 PART 1 5

Look for signs of swelling in your tissues Look in the mirror, especially in the morning, to check the area around your eyes and face for puffiness. Check your hands, ankles, and feet for swelling. Record your observations each day. Puffiness around the eyes or swelling of the feet and ankles may mean you have too much fluid in your body. Notice how you feel Check for these symptoms: You may have an increase in weight or blood pressure You may feel tired You may be short of breath You may have swelling in your hands and/or feet These symptoms may mean you have too much fluid. Check for these symptoms: You may feel dizzy You may be weak You may feel unusually tired These symptoms may mean you have too little fluid. How to balance the fluids in your body PD, along with control of salt and fluid intake, can help balance the fluids in your body. To balance your fluids, it is important to: Pay attention to your weight Look for swelling Use correct strength dialysis solutions Check your blood pressure every day Pay attention to your salt and fluid intake Based on your prescription for PD, your nurse will help you plan which type of PD solution to use for each exchange. Points to Ponder How confident do you feel in choosing your PD solutions? 1 2 3 4 5 6 7 8 9 10 n o t u n s u r e s o m e w h a t v e r y c o n f i d e n t c o n f i d e n t c o n f i d e n t 6 PART 1 PART 1 7

My personalized action plan for understanding my medications is: Something I want to do Achievable Action specific Chapter review 1) Your total body weight is made up of fluid weight and body weight. My goal is: 2) Recording your weight, blood pressure, and how you feel each day is not necessary. To meet my goal, I will: 3) Different strengths of solutions remove different amounts of fluid. Times per week/day: Things I know will interfere with my plan: How I m going to deal with this: I will report back to: when: My confidence level that I can reach this goal is: 1 2 3 4 5 6 7 8 9 10 n o t u n s u r e s o m e w h a t v e r y c o n f i d e n t c o n f i d e n t c o n f i d e n t Answers: 1) True, 2) False, 3) True 8 PART 1 PART 1 9

Guide to new terms: Managing your diet Arteries Blood pressure Body weight Fluid weight Total body weight Strength The vessels that carry blood away from the heart through the body. The force of your blood pushing against the inner walls of your arteries. Two types of pressures are measured, systolic and diastolic. The measurement of the bones, tissue, muscles and fat. The measurement of the liquid part of your tissues and blood. The fluid weight and body weight. Used to refer to the concentration or percentage of dextrose in your dialysis solution. Tips for eating well on PD PD gives you the opportunity to choose from a wide variety of foods. Your dietitian will work with you on your diet plan. The following are tips for helping you have a more normal diet with fewer limitations. Foods your body needs: High-protein foods High-fiber foods Foods you should limit or avoid to stay healthy: Foods high in fluid content Foods high in sodium or salt High-potassium foods High-phosphorus foods High-carbohydrate foods Notes Points to Ponder What do you find most difficult about the food restrictions? Problem solve ways to overcome these challenges. What does healthy eating mean for you? 10 PART 1 PART 2 11

Tips for eating well on PD foods my body needs Eating well starts with a balanced diet that includes protein and fiber foods. You will be instructed on how much protein and fiber you should eat each day. Protein is needed to keep the body healthy and help to fight off illness. Your body loses some protein during PD exchange. When you eat enough protein, you may: Have more energy Have fewer infections Feel better Enjoy life Albumin is a protein in your blood used to measure how well you are eating. Be sure to keep track of what you are eating. Your doctor may prescribe a PD solution called NUTRINEAL as one of your PD exchanges. NUTRINEAL is a PD solution that provides dialysis and nutritional therapy in one bag by the addition of amino acids. Your nurse will instruct you when to use NUTRINEAL if it has been ordered for you. High-fiber foods Eating well starts with a balanced diet that includes protein and fiber foods. You will be instructed on how much protein and fiber you should eat each day. Eating high-fiber foods will help prevent constipation. Some high-fiber foods contain phosphorus, which you will need to limit. Check with your dietitian for a list of high-fiber foods that you can enjoy. Tips for eating well on PD foods to limit or avoid Foods high in fluid content Not all fluid and waste products are removed with dialysis. Use these tips, along with your diet plan, to help you choose what to eat: Some foods contain hidden fluids You may need to limit the amount you eat Knowing your daily fluid allowance will help you decide which of these foods you can have each day 12 PART 2 PART 2 13

Foods high in sodium or salt Some foods contain a high quantity of sodium or salt. Salty food will make you thirsty and you may drink more than you should. This causes fluid weight gain, increased blood pressure, and swelling in your body tissues. Too much sodium holds water in your body. High-potassium foods Some foods are high in potassium. High levels of potassium in your blood can cause muscle weakness and affect your heart. This can be VERY dangerous. Your dietitian will provide you with a guide to eating well. High-phosphorus foods Some foods contain a high quantity of phosphorus. High levels of phosphorus in your blood can cause your bones to become brittle and weak and can accelerate blood vessel disease. Your doctor may prescribe a medication, called a phosphate binder, to help keep your phosphorus level down. You must take these binders as directed every day. High-carbohydrate foods Some foods contain a high quantity of carbohydrates and calories. You must balance the amount of calories you get from your food. There are also calories in the PD solution. Speak to your dietitian about the amount of calories you need each day. 14 PART 2 PART 2 15

Key points to remember Perform your dialysis daily, as prescribed Record your weight, blood pressure, and how you feel every day Use different strengths of PD solutions depending on what your body needs Eat the amount of protein foods recommended by your dietitian such as poultry, fish, and lean meat daily Follow the diet instructions provided by your nurse and dietitian My personalized action plan for managing my diet is: Something I want to do Achievable Action specific My goal is: Take all of your medications, as ordered See the members of your healthcare team your doctor, nurse, dietitian, and social worker regularly Know your laboratory results and review them each month with your nurse To meet my goal, I will: Times per week/day: Things I know will interfere with my plan: How I m going to deal with this: Notes I will report back to: when: My confidence level that I can reach this goal is: 1 2 3 4 5 6 7 8 9 10 n o t u n s u r e s o m e w h a t v e r y c o n f i d e n t c o n f i d e n t c o n f i d e n t 16 PART 2 PART 2 17

Chapter review Guide to new terms: 1) Albumin is a protein in your blood used to measure how well you are eating. Albumin A protein in your blood used to measure how well you are eating. Calcium A mineral found in bones, teeth and body tissues. Calcium strengthens the bones. 2) Some foods to limit or avoid are those high in salt. Calories Carbohydrate Fiber Phosphate binder Give us energy. A source of energy that is essential for normal body function. There are simple carbohydrates or sugars and complex carbohydrates or starches and fiber. A nondigestible type of complex carbohydrate. Certain fibers may also help reduce blood cholesterol. Binds the phosphorus in food in the intestines, so that it can be eliminated in the bowel movement. Notes Answers: 1) True, 2) True 18 PART 2 PART 2 19

Guide to new terms: Phosphorus Potassium Protein Saliva Sodium A mineral found in most foods. It works with calcium to build strong bones, and with other chemicals as a source of energy. When kidneys begin to fail, phosphorus remains in the body and can damage the bones and blood vessels. A mineral that is important for the muscles and nerves to work the right way. If your body does not get enough potassium, your muscles will not work correctly and you will feel tired. Too much potassium can cause an irregular heartbeat as well as other heart-related problems, which can be VERY dangerous. An essential nutrient that becomes a component of many parts of the body, including muscles, bone, skin, and blood. The watery substance found in your mouth that helps with your digestion. A salt. It is found in almost all foods. Excessive amounts in the diet can increase thirst, cause fluid retention, shortness of breath and high blood pressure. Understanding your medications Guidelines for taking medications All medication should be taken with the careful guidance of your doctor and nurse. This is especially important since your kidneys no longer work as they used to. Your doctor will prescribe the medications and dose you need. Your doctor will prescribe medication using either the generic name or the brand name. Always read the label on your medications and be sure that the medication you receive is what the doctor prescribed. Continually take your medications as prescribed. Never take any over-the-counter or prescription medication that you have not discussed with your doctor or your nurse. 20 PART 2 PART 3 21

The common medications your doctor may prescribe, and why medications are important Phosphate binders Phosphorus in your body comes from the food you eat. Healthy kidneys normally remove extra phosphorus from the body through the urine. When your kidneys no longer remove phosphorus it remains in the blood. High levels of phosphorus in your blood can cause your bones to become brittle and weak. It can also cause blood vessel damage. Phosphate binders bind to the phosphorus in the food in the intestines so that it can be eliminated in the bowel movement. To be most effective, binders are most often taken with food (meals or snacks) Take your binders as directed by your doctor There are many different types of phosphate binders Your doctor will prescribe the one that is best for you Vitamin D Vitamin D is a substance produced with the help of the kidneys. Vitamin D works with the calcium in your body to help keep your bones healthy. It may also help your blood vessels stay healthy. When your kidneys fail, the active form of Vitamin D is in short supply to work with calcium to keep your bones strong. You may need to take extra Vitamin D to keep your bones and blood vessels strong and healthy. Your nurse will instruct you how to take your Vitamin D. Iron Iron works in your body to help make red blood cells. You may need to take extra iron to increase the amount of iron in your blood. Your nurse will instruct you how to take your iron medication. You must take iron exactly as prescribed to get the full benefit of the medication. Iron pills are best absorbed when taken on an empty stomach. If you experience stomach upset, check with your doctor or nurse for suggestions that will help relieve your symptoms Iron should not be taken at the same time as phosphate binders or antacids. My prescribed phosphate binder is 22 PART 3 PART 3 23

Stool softeners and laxatives You may need a stool softener to help promote soft, easier bowel movements. Your doctor will prescribe the best type of stool softener for you to take and how often to take it. Stool softeners do not prevent constipation. If you should become constipated, contact your nurse Your doctor may prescribe an additional medication called a laxative Erythropoietin When your kidneys no longer make enough erythropoietin, your body does not make enough red blood cells. Lack of red blood cells leads to anemia. Anemia makes you feel tired and have less energy. Erythropoietin, commonly referred to as EPO, is a drug that will help you make more red blood cells. It is given by injection. You may be given EPO by your nurse or you may be trained to give yourself EPO at home. Insulin If you are diabetic, your doctor may prescribe insulin. Insulin is a drug used by many people who have diabetes to help maintain their blood sugar level. You may take your insulin as an injection or it may be added into your solution bag. Your nurse will instruct you how to take your insulin. Heparin Heparin is an anticlotting drug. Heparin can reduce fibrin that may block your catheter. If prescribed by your doctor, your nurse will instruct you how to add heparin to your solution bag. Points to Ponder Do you have a current list of your medications? 24 PART 3 PART 3 25

Antibiotics Antibiotics fight infections. If you should develop peritonitis or an exit site infection, you will need antibiotics. Your doctor will prescribe the antibiotic that is best for your particular type of infection. Sometimes antibiotics are put directly into your solution bag. Your nurse will instruct you how to add antibiotics to the solution bag. If you are prescribed antibiotics, it is important to take them as directed until they are gone. Blood pressure medication Blood pressure or antihypertensive medications help reduce high pressure. Key points to remember Be sure that the label on the medication bottle is exactly what your doctor has prescribed Take all of your medications exactly as directed by your doctor Check with your doctor or nurse before taking any over-the-counter medication Take antibiotics as directed, until they are gone Some medications may be put into your solution bag Keep a list of all your medications, dosages, and any drug allergies with you at all times You may also wear a medic-alert bracelet to identify your medications and allergies Your doctor will prescribe the type and dose of medication(s) to help control your blood pressure. Points to Ponder Do you have an accurate blood pressure scale at home? Do you have a validated blood pressure cuff? What is your target blood pressure? 26 PART 3 PART 3 27

My personalized action plan for understanding my medication is: Something I want to do Achievable Action specific My goal is: Chapter review 1) To be most effective, phosphate binders should be taken at the same time as your meals. 2) When you buy medications over-the-counter, you do not need to consult your doctor. To meet my goal, I will: Times per week/day: 3) Follow the instructions of your doctor or nurse when taking your medications. Things I know will interfere with my plan: How I m going to deal with this: 4) Immediately notify the pharmacist and contact your nurse if the name of the drug displayed on the label is different than what your doctor has prescribed. I will report back to: when: My confidence level that I can reach this goal is: 1 2 3 4 5 6 7 8 9 10 n o t u n s u r e s o m e w h a t v e r y c o n f i d e n t c o n f i d e n t c o n f i d e n t Answers: 1)True, 2) False, 3) True, 4) True 28 PART 3 PART 3 29

Guide to new terms: Guide to new terms: Anemia A condition that occurs when there are too few red blood cells in the blood. Generic Medication not protected by trademark, such as acetaminophen. Antacid Brand Diabetes Dose Erythropoietin A medication that neutralizes or corrects acidity, especially in the digestive tract. Medication made by a company with a trade name, such as Tylenol. A disease that causes high blood sugar. Diabetes can cause kidney disease. The amount of a medication to be taken at one time. A hormone normally produced by the kidneys to help the blood make red blood cells. Laxatives Over-the-Counter Peritonitis Prescription Red blood cells Medications that relieve constipation. Medication sold without a prescription, such as Tylenol. An infection of the peritoneum. A doctor s written directions for the type and use of a medication or treatment. Cells that bring oxygen to the tissues and are responsible for the red colour of the blood. Fibrin A stringy substance, often described as cotton-like fibers, that can block your catheter. Notes 30 PART 3 PART 3 31

Sources High Blood Pressure and Your Kidneys, National Kidney Foundation Public Education, 1997 Edition Diet Guide for the CAPD Patient, American Kidney Fund. Eating to Lower Your High Blood Cholesterol, U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, Public Health Service, National Institutes of Health. Measures of Health, A Transplant Patient s Guide to Vital Signs and Lab Tests, Roche Laboratories, 1997. Thomas-Hawkins C, Zazworsky D. Self-Management of Chronic Kidney Disease. AJN. 2005; 105(10):40-48. Adapted from the Self-Management Support Patient Planning Worksheet by the organization Improving Chronic Illness (ICIC). Stein, Andy, and Janet Wild. Kidney Failure Explained: Everything you always wanted to know about dialysis and kidney transplants but were afraid to ask. London, England: Class Publishing, 1999. Thank you to those centres who helped put this material together. Note to the nurse: This booklet for Managing Fluid, Diet, and Medications provides you with a guide to basic patient training and is part of the Patient First Educational Series. It is not intended to be the practice of medicine, nor does it replace sound medical/ clinical judgement. Please use the space designated by notes to individualize this guide for each patient. Provided by Baxter Corporation as a service to healthcare professionals and their patients. PART 1 Baxter Corporation Mississauga, Ontario L5N 0C2 www.baxter.ca Baxter is a trademark of Baxter International Inc. PD-PF-03 1/12