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/clinical/pted/hffy/renal/5043.hffy

20170126

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UWHC,UWMF,

Clinical Hub,Patient Education,Health and Nutrition Facts For You,Renal

Dialysis Program - Patient and Family Guidelines (5043)

Dialysis Program - Patient and Family Guidelines (5043) - Clinical Hub, Patient Education, Health and Nutrition Facts For You, Renal

5043








University of Wisconsin
Hospital and Clinics

Dialysis Program

for Patient and Family


1
Have You Met. . .
Date:

Your Dialysis Doctor ___________________

Your Primary Nurse ____________________

Your Dietician _________________________

Your Social Worker _____________________

A Financial Counselor ___________________

A Surgeon for graft or fistula placement___________________




Have You Received. . .


The University of Wisconsin Hospital and Clinics Dialysis Program
Health Facts for You

List of Contacts

Information on Advance Directives

Hemodialysis Access Health Facts for You

Kidney disease options education








2
Welcome to the University of Wisconsin Hospital and Clinics Dialysis Program.
At UWHC, we know that living with the demand of dialysis is tough. We are here
to help you and your loved ones cope with renal disease. Our goal is to work with
you to provide the very best care. Please talk with us about your questions and
concerns.

Information to Get You Started

What is Hemodialysis?

Hemodialysis means “cleaning the blood”. Blood is moved through a machine with
a special filter called a dialyzer. The dialyzer removes wastes and extra fluids. The
clean blood is then returned to your body. Taking out the harmful wastes, extra
salt, and fluids helps control your blood pressure and keeps the proper balance of
chemicals like potassium and sodium in your body.

How Does the Dialyzer Clean my Blood?

The dialyzer is a large tube that has thousands of small fibers which your blood
passes through. Dialysis solution, the cleaning fluid, is pumped around these fibers.
The fibers allow wastes and extra fluids to pass from your blood into the fluid that
carries them away. The dialyzer is sometimes called the artificial kidney.

Where Is Hemodialysis Done?

Hemodialysis can be done in a hospital, a dialysis center, or even at your home.
You and your doctor will decide which place is best for you based on your needs.

How Long Are Hemodialysis Treatments?

The treatments usually take about 3-4 hours and are done 3 times a week. The
treatment time depends on:
ξ How much your kidneys are working.
ξ How much fluid weight you gain between treatments.
ξ How much you weigh.
ξ How much waste you have in your blood.


3
Will the Treatments Make Me Feel Sick?

Symptoms like cramps, headaches, nausea or feeling dizzy can occur but are not
common. If you have these symptoms let your care team know how you are feeling
so they can help you. You can help yourself by keeping to your diet and fluid
limits. Going over your limits will increase the amount of fluid that must be
removed during treatment. Taking away the extra fluids is one of the things that
may make you feel sick during treatment so it is helpful to keep to your fluid limits
in between treatments.

Will Hemodialysis Change my Lifestyle?

You will need time to get used to dialysis and your treatment schedule. The social
worker will be here also to talk to you and help you adjust to the changes. Once
you get used to your treatment you should feel a lot better and have more energy for
things you enjoyed before.




4
Your Rights and Responsibilities


Patients who understand and get involved in their health care program get more out
of it. We want you to know that you are at the center of the health care team. Your
ideas and concerns about your health are important. We want you to be part of
making decisions that affect you.

You and Your Doctors and Nurses

A good relationship with your doctors and nurses is key to your health. Be sure to
talk with them about your questions and concerns. They want to give you the best
care and need to know how the treatment is affecting you.

Equal Treatment

UWHC patients and families are given the same respect and treatment regardless of
race, creed, color, religion, financial status, gender or limitations.

Your Privacy and Comfort

Meeting your privacy and comfort needs is important to us. Your needs may be
very different from that of the next person. Be sure to let us know how we can best
meet your needs. Also, since we are a teaching hospital, you may meet doctors and
others in-training. If you have any questions about this, please talk with your
doctor or nurse.

Confidentiality

Information you share with your doctors and nurses is confidential. That means it
remains private. If another doctor sent you to UWHC, he or she will get a report
about your care. Your record will not be shown to anyone else without your written
consent unless ordered by a court of law. You may read your record at any time. It
is best to schedule a visit with your doctor to review the chart together. The doctor
can help to answer any questions you may have. A small fee is charged for copies
of the record.


5

Your Right to Refuse Treatment

You may wish to refuse treatment. Your doctors and nurses will respect your
wishes. You may even choose to leave against your doctor's advice. However, in
this case, your doctor and the hospital cannot be blamed for any harm that results.
If you are unsure about your care or have questions or concerns before you leave,
it's best to talk with your doctor about any risks you might be taking. On the other
hand, if you have been discharged from UWHC and do not feel ready to leave,
please talk with us about your concerns. Your doctor will consider your thoughts
and talk with you about options.

Getting Involved in Research Studies

UWHC aims to provide top quality health care to patients and families. It is also a
teaching and research hospital. You may be asked to be part of a research study.
These studies help us provide even better care to you and others in the future. Yet
be assured that you will not be involved in research without knowing it. And, you
have a right to refuse to get involved in any studies.

Your Responsibilities As A Patient

Be honest and direct with your doctors and nurses. If you do not understand your
illness or treatment, please ask us about it. Your caregivers will talk with you about
caring for yourself. You will need to follow the plan that is set up for you. If your
health changes or you’re having trouble following the plan, let us know.

A Few More Suggestions

A hospital and clinics setting can be confusing. We may overlook something that
matters a great deal to you. Here are some helpful hints to help you cope as best
you can.
ξ If you don't understand something about your care, ask us to explain it.
ξ If you don't feel up to seeing other people, ask us to limit your visitors.
ξ If you have not yet met someone who is caring for you, ask him or her to come
meet with you.
ξ If you don’t want us to share information with family, please let us know.



6
Family Visiting


Family members and friends are important to people who get dialysis. We want
your family and friends to feel welcome and to feel free to ask questions about your
illness and treatment. Since we also need to provide a safe place for your treatment,
here are a few basic rules for visitors.

▪ Family members and friends are asked to stay in the waiting room until the
dialysis is started. Having guests at the chair-side during “put-on” can be
unsafe.

▪ Once the patient has been on dialysis, family members and friends may visit.
They can remain at the patient’s chair-side for the remainder of the treatment.

▪ During “take-off”, family and friends are again asked to return to the waiting
room.

▪ In case of a problem in the dialysis unit, visitors are asked to return to the
waiting room.

▪ In certain cases, a visitor may be allowed to be present during “put-on” and
“take off”. If the family member stays during this time, the nurses will explain
and discuss safe ways to remain present. Some times wearing special clothing,
masks and/or glasses may be needed.



7
In Case of Emergency


In an emergency, your safety is our first concern. In case of a fire, a tornado, or
other emergency, we have a plan to respond quickly and carefully.

In case of a fire, your nurse will disconnect you from the dialysis machine at once.
If you know how to help, please do so. Turn off the machine power, clamp and
secure the needles, and disconnect the blood lines. If the fire is nearby, a nurse will
take or direct you to the nearest, safe exit. If the fire is outside of your area, please
wait for further instructions.

When a tornado has been sighted, a tornado warning is sounded. This means you
must take cover right away. Your nurse will move you away from any windows.
Pillows and blankets will be placed over your head to protect you from flying
objects.

All of these things are done for your safety. No matter what the emergency, we are
here to help you. And, we need your help. Please stay calm and listen closely. The
quicker all of us respond, the safer for everyone.




8
The Grievance Procedure


The goal of the dialysis team is to provide you with the very best care possible. We
would like for you to give us suggestions and voice your concerns. We want to
know what you think of the care we provide. After all, you are the only one who
can tell us if we are meeting your needs.

Please review the patients’ rights and responsibilities statement. If you have
concerns about your care, your schedule, or any other issues, please discusses the
concern with your social worker, nurse, or doctor. If you don’t feel at ease with
those options, you can contact the manager of the dialysis unit at (608) 270-5626 or
the manager of the inpatient dialysis unit at(608) 263-8748

If you feel that your concerns have not been heard, you have the right to file a
grievance. You can do this without fear or worry that problems will result. Contact
the Dialysis Medical Director at (608) 270-5687, who will work with you to resolve
the issue with a result you can accept.

If you feel as though you would like to speak to someone outside the unit, you may
contact UW Hospital’s Patient Relations Staff at (608) 263-8009. Patient Relations
staff is there to be a support for patients. The Patient Relations staff will be happy
to help you address and resolve your concerns, whatever they may be.

Another choice for you in voicing your concerns is to seek help from an outside
agency. The Renal Network 11 serves this function, as delegated by the Health
Care Financing Administration (HCFA). They can be contacted directly at
1-800-973-3773. Renal Network 11 staff will help you with any concerns about
your dialysis treatments.

Please feel free to use any or all of these options to get your needs met. Your health
is important to us and we want to work together with you so that you can be as
healthy as you can be. With that as our shared goal, we will help you find your way
as best we can.



9
Guidelines for Travel to and from Your Treatments


Here are a few basic tips that may make going to and from dialysis easier for you.
Before you begin the trip, be sure to have these supplies with you: an emesis basin,
Band-Aids, 4x4 gauze pads, broth, crackers, soda, and drinking water.

1. When going to dialysis, watch for:

ξ Shortness of breath - Sit as upright as you can. If you have oxygen use it at 2
liters.

ξ Nausea and vomiting - Again, sit as upright as you can and use an emesis
basin.

In both cases, let the dialysis staff know about these things when you arrive.

2. When returning from dialysis, watch for:

ξ Bleeding at the needle sites - if bleeding occurs, place firm direct pressure
on the site for 15 minutes. Do not remove pressure during the 15 minutes.
Check the site. If needed, replace the 4x4 gauze pads until the bleeding
stops. If the bleeding continues, press on the site for another 15 minutes. If
bleeding continues, have someone take you either to an emergency room or
return to the dialysis center. Remove the dressing over needle sites 4-6 hours
after the bleeding stops, so that it won’t stick to the scab.

ξ Low blood pressure -You may notice signs that occur as your blood
pressure is going down. Often, this is shakiness, blurred vision, dizziness,
feeling lightheaded, or nausea. Lay as flat as you can. Take water or broth
or eat salty snack foods like pretzels or corn chips. Your driver may need to
go to a local drive through or mini-mart to get some salty food. If you
become unresponsive, your driver should take you to the nearest Emergency
Room. If you (the patient) are driving yourself, pull over and drink some
broth or water. If these stops are not nearby and/or you feel unsafe, pull over
right away and do not drive. Put on your flashing lights to signal for help
and call 911.

ξ Nausea and vomiting - Sit up and use an emesis basin. When able, drink
clear soda or water.



10
Daily Medicine: See your Pharmacist for further instructions.

Type/Name

Purpose

Method Given
Calcium Supplements
Calcium Carbonate
TUMS
Your Dose: __________
To increase blood calcium level and
decrease blood phosphorus level.
By mouth with meals

Do not take with iron supplements.
Phosphorus Binders
Calcium Carbonate
Tums
Phoslo
Benagel
Renvela
Your Dose: _______________
To lower blood phosphate level and
prevent bone, heart and blood vessel
disease

By mouth with meals

Multivitamin
Nephrocap
Your Dose:__________

To supplement elemental and trace
vitamins

By mouth after dialysis

Epoietin or Darbepoetin
Your Dose: ____________

To increase Red Blood Cells
(Hematocrit)

Intervenously with dialysis or
subcutaneously

Iron
Iron Sulfate
Ferrlecit
Nulecit
Your Dose:____________

To increase iron stores in the body to
help Epoetin to work and raise red
blood cells (Hematocrit)

By mouth or Iron Sucrose intravenously
with dialysis

Do not take with calcium supplements.

Stool Softeners
Docusate
Sorbital
Metamucil
Miralax
Your Dose:___________

To soften stool and prevent constipation

By mouth




11


Monthly Lab Tests

Blood Test


Normal Value
for Dialysis

Too High
Cause/Side Effects/What to Do

Too Low
Cause/Side Effects/What to Do

Potassium
(K+)

3.5 – 5.5

Cause: Eating too many fruits and
vegetables, gastrointestinal bleeding.
Side Effects: Tiredness, irregular
heartbeat, muscle weakness, tingling,
death
What to do: Decrease the amount of
fruits and vegetables in your diet
especially bananas, tomatoes, potatoes,
oranges. Notify dialysis staff for
bloody or tarry stool. Inform dialysis
staff of symptoms so a K+ can be sent
to the lab.

Cause: Not eating enough fruits
and vegetables, lasix, vomiting,
diarrhea.
Side Effects: Muscle weakness,
shaking, irregular heart rate,
tingling, death.
What to do: Increase fruits and
vegetables in your diet i.e., one
banana, tomatoes, potatoes.
Change or stop lasix (if still
taking this medicine). Treat
vomiting or diarrhea per doctor's
recommendation.

Calcium
(CA+)

8.2 – 10.1

Cause: Taking too many calcium
supplements (i.e. TUMS, Elemental
Calcium) or vitamin supplements or
hormonal imbalance.
Side Effects: Calcium deposits in
tissues, arteries, or heart.
What to do: Decrease the number of
calcium supplements you are taking.

Cause: Not taking enough
calcium supplements.
Side Effects: Bone disease,
tingling in fingers, and may cause
abdominal cramps.
What to do: Increase the number
of calcium supplements



12

Monthly Lab Tests

Blood Test


Normal Value
for Dialysis

Too High
Cause/Side Effects/What to Do

Too Low
Cause/Side Effects/What to Do

Phosphorus
(PO4)

3.5 – 5.5

Cause: Not taking binders with meals.
Eating too much beans, nuts, milk,
processed lunch meats, or hotdogs,
"dark" sodas.
Side Effects: itching, easily broken
bones, hardening of blood vessels
which can cause a heart attack,
problems breathing, and painful joints.
What to do: Take binders with meals,
avoid or decrease the amount of
processed lunch meats and hotdogs,
beans, nuts and "dark" caramelized
soda you eat or drink.

Cause: Taking too many calcium
supplements.
Side Effects:
What to do: Decrease the
amount of calcium supplements
you take after checking with your
nurse or doctor. Eat/drink more
beans, nuts, milk, processed
lunch meat or hot dogs.








Hemoglobin


10 – 12 grams

Cause: EPO or Darbepoetin dose too
high, recent blood transfusion.
Side Effect:
What to do: EPO or Darbepoetin dose
may be held or decreased.





Cause: Not enough red blood
cells being made in the body or
blood loss, ulcer.
Side Effects: Shortness of breath,
tiredness, pallor or chest pain.
What to do: Increase EPO or
Darbepoetin dose, may get a
blood transfusion or intervenous
iron.



13

Monthly Lab Tests

Blood Test


Normal Value
for Dialysis

Too High
Cause/Side Effects/What to Do

Too Low
Cause/Side Effects/What to Do

Albumin

>4.0

Cause: Rare to be too high.
Side Effects: None
What to do:N/A

Cause: Not eating enough
proteins and/or calories. Recent
infection.
Side Effects: Swelling in ankles,
muscle weakness, and/or
breakdown, increase chance of
infection.
What to do: Increase the amount
of protein/calories you are eating.
Use protein supplement.




14

Monthly Lab Tests

Blood Test


Normal Value
for Dialysis

Too High
Cause/Side Effects/What to Do

Too Low
Cause/Side Effects/What to Do

Urea
Reduction
Ratio (URR)
KT/V

>70%


>1.4

Cause: Receiving adequate dialysis.
Side Effect: None
What to do: Continue with present
treatment, medications and diet.

Cause: Inadequate dialysis due
to slow blood flow speed of
dialysis machine, missed or
shortened dialysis treatments,
dialysis filter clotting, or dialysis
AV fistula or catheter not
working properly.
Side Effect: Nausea, itching.
Other blood tests (i.e. K+, CA+,
PO4) are increased and all those
side effects can be present.
What to do: Show up for every
dialysis treatment, stay for the
whole treatment, may need to
increase your treatment time.
May need a new dialysis access
to allow better blood flows.
+





Your health care team may have given you this information as part of your care. If so, please use it and call if you have any questions. If this information was not given to you as part of
your care, please check with your doctor. This is not medical advice. This is not to be used for diagnosis or treatment of any medical condition. Because each person’s health needs are
different, you should talk with your doctor or others on your health care team when using this information. If you have an emergency, please call 911. Copyright © 1/2017. University of
Wisconsin Hospitals and Clinics Authority. All rights reserved. Produced by the Department of Nursing. HF#5043



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