lprutean

According to the National Institute of Aging, the Alzheimer's Disease is " an irreversible, progressive brain disease that slowly destroys memory and thinking skills and, eventually even the ability to carry out the simplest tasks of daily living. In most people with Alzheimer's, symptoms first appear after age 60. Alzheimer's disease is the most common cause of dementia among older people." (National Institute on Aging) How many Americans have Alzheimer's disease?"Estimates vary, but experts suggest that as many as 5 million Americans age 65 and older have Alzheimer's disease. Unless the disease can be effectively treated or prevented, the number of people with it will increase significantly if current population trends continue. That's because the risk of Alzheimer's increases with age, and the U.S. population is aging. The number of people with Alzheimer's doubles for every 5-year interval beyond age 65." (nia.nih.gov) During nursing school and later during my nursing career, I had learned about AD, aging process, brain function deterioration and signs and symptoms of the disease. Occasionally, I was assigned to take care of patients affected by AD. But in the last ten years, as a pediatric nurse, I did not have many chances to be exposed to such patients. So, in my practice, over the years, my knowledge about AD faded, especially due to lack of exposure and lack of continued education classes in the geriatric field. Taking care of pediatric patients, my awareness about AD remained dormant. The only older people I was very close to, were my parents, getting older, but still independent in most aspects of their lives. Our close daily relationship, either over the phone or visits, stopped me from noticing the slow, but progressing change in personality and in ability to perform daily activities. Once in a while, my mother complained about not remembering things, having difficulties performing house work. I attributed all of them to normal aging process, and I did not take it seriously. I did not see the early stage of AD. "Memory problems, are typically one of the first signs of Alzheimer's disease." I reassured her that we all forget sometimes and that is OK. My father brought to my attention that mom became lately very slow , and spent more and more time getting dressed, or getting ready for an appointment, at the point of being late all the time. He expressed his frustrations, but day by day he started to take away some of her house chores and tried to balance their lives at his best abilities. One of the changes that startled me, was the changes in my mom's vocabulary. She started to use in a regular daily conversation words from her native language, archaic words that she never used before. When I asked her what does that word mean, she looked at me very surprised. Sometimes during our conversation she did not remember facts and tried to change the subject, tried to make up an answer, or to admit very embarrassed that she did not remember. At that time, caught in a busy life, between work and school, I did not see the gravity of her condition. Every day she lost some of her abilities to take care of others and herself. One day she flooded the bathroom because she forgot the water was running, or forgot to turn off the stove and burned the food. Than I stepped in and I started to realize that she needs more help, and I was happy to spend more time with her and do laundry, cook or take her shopping. And I did still considered that her age was number one in her decline. These were already signs of mild Alzheimer,s disease as per National Institute on Aging One winter, at Christmas time, my son came home and spent time with his grandparents. He noticed that something was wrong with grandmother, and asked me about it. He had not seen her in a few months, and was scared to see how much she changed. Mother was always a very nice, calm person with a lot of patience. Now, she started to have episodes when she became very agitated and aggressive. I was very surprised and my son suggested to take her to a neurologist. At her first visit she was able to answered all the questions , but still, after examining her the doctor diagnosed her with initial symptoms of AD. He prescribed medications to keep her calm and also to increase her cognitive functions. Every three months we followed up and I was able to see the changes compared to the last visit. I became more and more aware about the worsening of her symptoms. On a daily basis I did not see a lot of changes. Mom, like other patients with AD, was trying to hide her symptoms and inability to function from friends and family. She was able to keep the appearances and hide her forgetfulness, memory loss, inability to perform her daily routine. After reading books, articles and other specialty literature, I was able to see clearly more and more signs and symptoms of AD, the pattern of the disease and the decline of her health. As the symptoms worsened, mom stopped recognizing one by one the family members, her home, her husband. She had days when she packed her clothes and some food to go "home to her kids". Her ability to perform the daily tasks was less and less and she needed more help every day. I was happy to help, but, at the same time, very sad about her deterioration. Today my mother continues to live a life, what I call "happy and comfortable". She does not recognize any of her children, but she knows we are the people taking care of her. It keeps me happy to see her smiling when I come home from work, to see her pleased after a watching cartoons, or resting. It is very hard for me to accept her condition and her limitations. I do not know how much she remembers, or her thoughts, since sometimes she cannot express herself, or find the right words. But it is very rewarding when she gives me a kiss or a hug, or thanks me for caring for her. "People with severe Alzheimer's Disease cannot communicate and are completely dependent on others for their care." The AD had built a wall between her and the reality; she is trapped in her own limited world, but sometimes a window opens and she reconnects with me. There are days when I stand in front of that window ready to interact with her, when she can, with a bath, a massage, a good meal that she still enjoys. She spends her days playing with toys. The day is a very happy for both of us, when she calls my name.

Introduction to DialysisPatient Educationby Lidia Pruteanu Kidney The kidneys are very important organs with multiple functions in the human body. People have usually two kidneys with some exceptions, located in the back of the abdominal cavity, above the waistline, on both sides of the spinal column. They are red dark, and have a bean-shaped , are about the size of a fist, and weigh about five ounces. They are protected by the rib cage and pads of fat. Kidney Functions The main function of the kidney is to : - filter the waist from the blood -remove excess of fluid from the body -keep the fluids and electrolytes in balance - control of Blood Pressure - maintain acid-base balance - produce hormones to keep the bones healthy and to help the bone marrow to produce red blood cells. Types of Kidney disease 1. Acute kidney failure ( AKF) is a sudden loss of kidney function due to different causes: an acute illness , accident, toxins, trauma, formation of kidney stones. Usually this stage reversible. 2. Chronic kidney (CKD) is a slow and progressive decrease of kidney function, usualy irreversible, leading to a permanent loss of function. CKD has a number of causes : - diabetes - high blood pressure - polycystic kidney - glomerular disease - systemic lupus erythematosus - birth defects - drugs - cancer - kidney infection - sickle cell disease - AIDS When Kidney Fail Usually when 75-80 % of renal function is lost, kidneys are not longer able to maintain a healthy life .Progressive decreasing of renal function may be managed conservatively with diet, fluid control, and medications till GFR reaches 10-15 % of normal. When kidney fails the patient needs dialysis treatment or renal transplant to sustain life. Treatments for kidney failure The dialysis treatment cleans the blood from toxins, removes the waste and excess of water from the body, controls the blood pressure keeps certain blood levels in normal range. Dialysis is a way to replace some of the kidney function, but cannot improve or cure the kidney failure. Dialysis is necessary to maintain health till kidney transplant occurs. Types of treatment 1. Hemodialysis 2. Peritoneal dialysis 3. Transplantation 1.Hemodialysis can be done is the dialysis centers, at home, ( home dialysis ), nocturnal dialysis( in center about 8 hours 3-7 nights per week) or short daily home dialysis. ( 2-3 hours treatments 5-7 days per week) In case of Acute Renal Failure a 24 hours slow treatment ( CRRT) is being done in the hospital, in acute units , ICU.. 2.PD treatment is done at home by the patient him/herself or a family member who was fully trained by a dialysis nurse , about 2 weeks, to perform the treatment . The dialysis nurse and nephrologist will be available 24/7 for emergencies, and also the Baxter help desk wil assist patient with the PD machine and will provide technical support. Patient needs a PD catheter which is surgically placed in the peritoneal cavity, a soft, plastic tube through which a special dialysis solution is placed to fill the abdomen. During dwelling time ( 2-3 hours) the the waste products and excess of fluid is being removed from the patient,s blood through the small capillaries and then drained. The three steps of PD treatment are : - drain - fill - dwell The cycle has to be repeated 4-5 times per day . Peritoneal treatment can be done manually ( Continuous Ambulatory Peritoneal Dialysis ) CAPD, or via a dialysis machine ( automated peritoneal dialysis APD) 3.Kidney transplantation gives patient one healthy kidney from a donor and a lifestyle that is closest to normal. The kidney donor could be a life donor , blood related , a family member , a non-blood related , a friend, a spouse, or a deceased donor. A transplant is not a cure for kidney disease ,it is another form of treatment. The transplant may last up to 17-20 years or more or may not work at all from the beginning.. The most common problem after transplantation is rejection of the new kidney by the body, as the body fights against the "foreign " object ( kidney). The solution to rejection is to put patient on anti rejection medications which will decreased the ability of the immune system to fight. After the transplant, the patient has to be followed on a regular basis by a neurologist, who is constantly going to adjust the medications accordingly to the antibodies level. Also the patient have to be on a special diet ,, but with very few restrictions. Dialysis Access In order to have a dialysis treatment , the patient needs a vascular access . They are three types of access, surgically created : 1. tunneled cuffed catheter 2. arteriovenous graft 3. arteriovenous fistula The tunneled cuffed catheter is a soft plastic tube introduced through the skin into a large vein, usually internal jugular vein, subclavian vein or femoral vein, which leads directly in the heart . The catheter has two ports : one to bring the blood out of the blood stream into the extracorporeal circuit of the dialysis machine, and the second one to return the clean blood to the patient. Only a small amount of blood is out of the body at any time ( 100-250 ML) The blood goes through a special filter ( dialyser) where it gets cleaned. The treatment usually is 3-4 hours three time a week . The nephrologist determines the time,the blood flow, the type of filter and the dialysis solution according to the patients needs. 2. An arteriovenous graft is a special plastic tube used to connect an artery and a vein , to create an artificial vessel, which will hold a larger amount of blood than a regular vein . A graft is created for patients who are not a good candidate for fistula, due to the anatomy and conditions of their own vessels.. 3. An arteriovenous fistula is surgically created from a native artery and vein . Through surgery the patient,s own artery and vein is connected to create a bigger vessel with a strong blood flow.Most common type of fistula links the radial artery and the cephalic vein in the forearm. The fistula can be created using the brachial artery and cephalic vein in the upper arm. The fistula need 1-2 month to mature . When ready the surgeon will give permission to use it for treatment . The vascular access is the life line of the patient and needs to be protected from infections or clotting. The catheter needs to be kept covered with a dry and clean dressing all the time. No showers or swimming are permitted. Only the qualified personnel, or the dialysis nurse is permitted to change the dressing, to assess the exit site, and to access the catheter. The graft and fistula needs to be assessed by the dialysis nurse or technician before each cannulation , and checked daily for thrill and bruit by the patient. In case the access stopped working the patient needs to notify the dialysis unit and to be referred to a vascular surgeon for evaluation and declotting . Dialysis team In the dialysis center a comprehensive dialysis team oversees the patients treatment , manages the disease process, helps provide a quality care, educates the patient and family members regarding treatment goals to maintain a stated of wellness. The members of the dialysis team are: - the medical director- nephrologist - clinical manager - dialysis nurse - social worker - renal dietitian - psychologist The most important member of the dialysis team are the patients themselves, as they know themselves the best. Good outcome for patients requires a close relationship based on trust,and respect for knowledge , good communication and collaboration , active participation in own care.References: Larry E. Lancaster, MSN, EdD, RN (1995). Core Curriculum for Nephrology Nursing, ANNA( Third Edition). New Jersey: Pitman

Introductin to DialysisPatient Educationby Lidia Pruteanu Kidney The kidneys are very important organs with many functions in the human body. People have two kidneys located in the back of the abdominal cavity, just above the waist, on both sides of the spinal column. They are red dark, bean-shaped organs, about the size of a fist, and weighs about five ounces. They are protected by the rib cage and pads of fat. Kidney Functions The main function of the kidney is to : - filter the waist from the blood -remove excess of fluid -keep the fluids and electrolytes in balance - control of Blood Pressure - maintain acid-base balance - produce hormones to help the bones to stay strong and to help the body to produce red blood cells. Types of Kidney disease 1. Acute kidney failure ( AKF)is a sudden loss of kidney function due to an illness , injury, toxins, trauma, kidney stones. Usually this reversible. 2. Chronic kidney (CKD) is a slow onset irreversible, permanent loss of kidney function. CKD has a number of causes : - diabetes - high blood pressure - polycystic kidney - glomerular disease - systemic lupus erythematosus - birth defects - drugs - cancer - kidney infection - sickle cell disease - AIDS When Kidney Fail When 75-80 % of renal function is lost, kidneys are not longer able to maintain a healthy life . Renal failure may be managed conservatively with diet, fluid control, and medications till GFR decreased to 10-15 % of normal. When kidney fails the patient needs dialysis treatment or renal transplant to sustain life. Treatments for kidney failure The dialysis treatment cleans the blood , removes the waste and excess of water from the body, controls the blood pressure keeps certain blood levels in normal range. Dialysis is a way to replace some of the kidney function, but cannot improve or cure the kidney failure. Dialysis is necessary to maintain health till kidney transplant occurs. Types of treatment 1. Hemodialysis 2. Peritoneal dialysis 3. Transplantation 1.Hemodialysis can be done is the dialysis centers, at home, ( home dialysis ), nocturnal dialysis( in center about 8 hours 3-7 nights per week) or short daily home dialysis. ( 2-3 hours treatments 5-7 days per week) In case of Acute Renal Failure a 24 hours slow treatment ( CRRT) is being done in the hospital. 2.PD treatment is done at home by the patient him/herself or a family member who was fully trained by a dialysis nurse to perform the treatment . Patient needs a PD catheter which is surgically placed in the peritoneal cavity, a soft, plastic tube through which a special dialysis solution is placed to fill the abdomen. During dwelling time ( 2-3 hours) the the waste products and excess of fluid is being removed from the patient,s blood through the small capillaries and then drained. The three steps of PD treatment are : - drain - fill - dwell The cycle has to be repeated 4-5 times per day . Peritoneal treatment can be done manually ( Continuous Ambulatory Peritoneal Dialysis ) CAPD, or via a dialysis machine ( automated peritoneal dialysis APD) 3.Kidney transplantation gives patient one healthy kidney from a donor and a lifestyle that is closest to normal. The kidney donor could be a life donor , blood related , a family member , a non-blood related , a friend, a spouse, or a deceased donor. A transplant is not a cure for kidney disease ,it is another form of treatment. The transplant may last up to 20 years or more or may not work at all. The most common problem after transplantation is rejection of the new kidney by the body, as the body fights against the "foreign " object ( kidney). The solution to rejection is to put patient on anti rejection medications which will decreased the ability of the immune system to fight. After transplant, the patient has to be followed on a regular basis by a neurologist, who is constantly going to adjust the medications accordingly to the antibodies level. Also the patient have to be on a special diet ,, but with very few restrictions. Dialysis Access In order to have a dialysis treatment , the patient needs a vascular access . They are three types of access, surgically created : 1. tunneled cuffed catheter 2. arteriovenous graft 3. arteriovenous fistula The tunneled cuffed catheter is a soft plastic tube placed through the skin into a large vein, usually internal jugular vein, subclavian vein or femoral vein, which leads directly in the heart . The catheter has two ports : one to carry the blood out of the blood stream into the tubing of the dialysis machine, and the second one to return the clean blood to the patient. Only a small amount of blood is out of the body at any time ( 100-250 ML) The blood passes through a special filter ( dialyser) where it gets cleaned. The treatment usually is 3-4 hours three time a week . The nephrologist determines the time,the blood flow, the type of filter and the dialysis solution according to the patients needs. 2. An arteriovenous graft is a special plastic tube used to connect an artery and a vein , to create an artificial vessel.. A graft is created for patients who are not a good candidate for fistula. 3. An arteriovenous fistula is surgically created from a native artery and vein . Through surgery the patient,s own artery and vein is linked to create a bigger vessel with a strong blood flow.Most common type of fistula links the radial artery and the cephalic vein in the forearm. The fistula can be created using the brachial artery and cephalic vein in the upper arm. The fistula need 1-2 month to mature . When ready the surgeon will give permission to use it for treatment . The vascular access is the life line of the patient and needs to be protected from infections or clotting. The catheter needs to be kept covered with a dry and clean dressing all the time. No showers or swimming are permitted. Only the qualified personnel, or the dialysis nurse is permitted to change the dressing, to assess the exit site, and to access the catheter. The graft and fistula needs to be assessed by the dialysis nurse or technician before each cannulation , and checked daily for thrill and bruit by the patient. In case the access stopped working the patient needs to notify the dialysis unit and to be referred to a vascular surgeon for evaluation and declotting . Dialysis team In the dialysis center a comprehensive dialysis team oversees the patients treatment , manages the disease process, helps provide a quality care, educates the patient and family members regarding treatment goals to maintain a stated of wellness. The members of the dialysis team are: - the medical director- nephrologist - clinical manager - dialysis nurse - social worker - renal dietitian - psychologist The most important member of the dialysis team are the patients themselves, as they know themselves the best. Good outcome for patients requires a close relationship based on trust,and respect for knowledge , good communication and collaboration , active participation in own care.