Before commencement of dialysis assess and question the patient taking particular note of any changes since last session:
- skin state
- any oedema
- sign of bruising/bleeding
- overall well-being including change in general health since last sessions
- whether the patient has complaints or signs and symptoms of infection
- document whether healthcare has been sought elsewhere since previous dialysis session and chase any correspondance telating to this
Review informations from previous dialysis session:
- Note pre and post dialysis observations
- Note any recorded dialysis variances
Pre-dialysis observations will be performed and recorded:
- Seated blood pressure. Ensure seated for at least 5 minutes and correct cuff size.
- Pulse rate
- Respiratory rate
Patients wishing to perform their own observations should be appropriately trained and deemed competent as per self-competency documentation.
To ensure patients are treated safely and appropriately it is vital that a thorough assessment of the patients and their observations is performed before dialysis is commenced. This allows early identification of arising medical problems and appropriate delivery of dialysis.
Once patient’s dialysis machine and station are sufficiently ready for the patients to be able to settle down and be seated comfortably, a nurse will call patients from the waiting area. Any special isolation or machine preparation needs to be checked and as ready as possible, before hand to ensure patients are dialysed safely and in the correct cohort.
For those patients that have arterio-venous fistula/graft, the patients will be asked to wash the relevant limb, along with their hands, with soap and water, before entering their dialysis station area. Assistance will be provided if required. Patients dialysing via a kidney dialysis catheteter will be asked to wash their hands.
All patients should also be weighed before entering their dialysis area. Again they will encouraged to perform this aspect of their care themselves with help given as required.
For those that can weight themselves and carry out and record their observations and those self-caring, encourage those that can do so. Ensure patients are aware of where and how to document the observations.
It still possible to travel for work or personal pleasure if you are receiving haemodialysis. Dialysis may make it difficult, but not impossible. Holidays and trips will need careful planning to book into another dialysis clinic.
When starting dialysis it should be possible to continue working. The benefits of keeping a job include earning an income, maintaining self-esteem and friendships. The challenge when working on dialysis is balancing work and dialysis with the rest of life. Dialysing at home makes it easier to schedule treatments around personal commitments.
Just as your medication and other treatment can alter over time, your diet may also need to be reviewed. Suggested changes to your diet are based on your blood test results. You could be asked to limit your salt, protein, phosphate, potassium or fluid intake but only if these are causing problems. More hours on dialysis usually means less diet restriction. Your diet will be designed with your special needs in mind.
Kidney failure can reduce your appetite. You may have difficulty eating enogh food to keep you healthy, and malnutition can become a problem.
On your dialysis days you will need to set aside a total of 6-8 hours for the treatment and travel. Activities are limited during dialysis. You can read, chat, play games, watch TV, write, use a laptop or sleep, but you cannot get up and move around.
On your dialysis days you can carry on with your usual life activities. You can work, attend social functions and carry on your usual role with your family. Intimate relationships can continue. Exercise is encouraged to promote a healthy heart. It can vary how healthy you fell between dialysis sessions, but most people feel better than before they started dialysis.