~ Make a Difference ~Become a Nephrology Nurse

• Incidence (rate of occurrence)–220 per million in 1992

–334 per million in 2000

• Prevalence (number of cases)–20 million stages 1-5

–Stage 5 ~ 350,000

Chronic Kidney Disease (CKD)

Stages of CKD

The Importance of the Kidneys

• Regulation of Homeostasis– Extracellular volume and osmolality– Electrolyte balance– Excretion of metabolic wastes, free radicals and drugs– Regulation of acid-base balance– Renin-Angiotensin System

• Bone mineralization• Produces calcitriol (form of Vit. D) to increase Calcium absorption• Regulates calcium and phosphorus

• Production and release of hormones– ADH and aldosterone – Control regulation of reabsorption of

water, sodium– Erythropoietin – stimulate RBC production

• Insulin Degradation

Fluid and Electrolyte Imbalances

• Hyperkalemia– Low excretion

• Hyponatremia– Fluid retention

• Hypocalcemia– Low excretion of

phosphorus– Decreased level of

vitamin D

• Hyperphosphatemia– Low excretion

• Hypermagnesium– Low excretion

Physical Findings in CKD

Commonly Used Medications

• Vitamins

• Phosphate Binding Agents

• PTH Suppression Agents

• ESA Products

• Iron Therapy

• Antihypertensive Agents

Commonly Used Medications

• Vitamins

• Phosphate Binding Agents

• PTH Suppression Agents

• ESA Products

• Iron Therapy

• Antihypertensive Agents

General Principles of DialysisGeneral Principles of Dialysis

• Diffusion

• Osmosis

• Ultrafiltration

• Diffusion

• Osmosis

• Ultrafiltration

What Exactly Is a Nephrology Nurse ?

• Work in many settings• Care for patients in

different stages of CKD

• Care for patients using different modalities of treatment

• Many different areas for the nurse to explore within nephrology

Where Do I Start ?

• Most nurses do begin working in hemodialysis settings

• Practice areas include:– Hemodialysis– Peritoneal Dialysis– Transplant– Acute Care– Pediatrics

Hemodialysis• Patients: Come to a center three

times a week to have procedure performed by a trained dialysis nurse.

• Nurses:– Assess patients– Initiate hemodialysis treatments– Monitor vital signs during

treatments– Provide medications– Function collaboratively – Provide education

• Hours Worked in Hemodialysis– 12 hour days in an outpatient setting– Rare Sundays in outpatient clinics

Vascular Access- Catheter

Vascular AccessFistula and Graft

Peritoneal Dialysis

• Patients:

– Usually taught how to perform PD at home

– Visit center monthly for evaluation

• Nurses:

– Perform calls with patients to “triage” problems

– Meet monthly with patients• Assess

• Review medications

• Provide supplies

• Review with physician

Peritoneal Dialysis

• Three Phases:• Fill – 1.5-2L dialysate

Infuses over 10-15 minutes

• Dwell – Remains in

abdomen for 4-6 hrs• Drain – Fluid and

endogenous end-products removed via diffusion and osmosis.

Transplant

• Patient

– Surgical procedure

– Need a donor

• Nurse

– Works in a clinic-type setting

– Sees patients monthly

– Reviews medications, labs

– Educates

Acute Care

• Patient

– In the hospital may have a condition that is “recoverable” (acute) or chronic (long term) –and just beginning on dialysis

• Nurses– May work in a dialysis area

– May perform the procedure at the bedside in ICU or a CC setting

– Often work 12 hr days; may take “call”

Pediatrics

• Patients

– Can be newborns without developed kidneys

– Can have different diseases that cause kidneys to fail

• Nurses– Often work 12 hr shifts

– Education to Mom & Dad

– Family support

– May teach family to perform at home; or come to center

Where Can I Grow ?

• Management/Administration• Advanced Practice• Transplant Coordinator/Organ recovery coordinator• Office nurse• Pharmaceutical/ Corporate/Sales representative• Nurse Researcher• Quality Management• Nurse Educator• Government Oversight Positions• University settings

Administration

• Nurse Managers/Administrators– Meet state and federal regulations– Staff unit – Insure safety of all patients and

staff– Meet annual requirements for

education and physicals of staff– Perform quality improvement

activities– Meet with Medical Director of the

facility monthly– Annual evaluations of staff

members– Fiscal responsibilities of unit –

including budgets, raises, purchasing of supplies Susie VanBuskirkSusie VanBuskirk

Advanced Practice

• Advanced Practice Nurses (APN)– Work closely with the physician

regarding pt care– “Round” weekly on outpatients– Write prescriptions for medications– Collaborate with other medical

specialties– Order tests, lab procedures– Participate in quality improvement

projects– See patients in clinic or CKD

settings– Educate patients on disease process,

medications, treatment modalities…

Debra CastnerDebra Castner

Membership in ANNA

• Publications

• Educational Meetings

• Opportunities to interact with other dialysis nurses –in your specialty – across the US !

• Become certified

A Focus for Everyone …

• Opportunity for Members to get involved• Acute Care • Administration• Advanced Practice• Chronic Kidney Disease• Hemodialysis• Transplantation• Peritoneal Dialysis• Pediatric Nephrology

Become Certified: The Mark of a Leader

Questions ?

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Thank You for your time…..