D224 11-18-23 0700-1600 R

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Western Governors University *

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D2224

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Health Science

Date

Dec 6, 2023

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docx

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3

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Pt D Date: 11-18-23 Time: 0700-1600 Sphere of Care: Wellness/Disease Prevention Preceptor: Pamela Smith Location: Fresenius Kidney Care Waxahachie A3: Activity Description: During this day I spent time assisting my preceptor in setting up patients on their sessions for hemodialysis. Assessments of the patients were completed as they came in and set up on the machines. This takes approximately 15 minutes per patient. On a typical day, there may be 12 patients in the first shift coming in based on their chair times. When a task was available, such as moving a patient, assisting a patient up in the chair, providing water to the patient, or any other needs I was available to assist as allowed in my capacity. I continued to follow my preceptor as she went around to each of the patients and started them up on HD. Ensuring that they were stable. She would speak with each patient to discuss with them their diets and to see what it is that they are eating to ensure that they are eating a healthy diet. Being on HD they are limited to the type of foods that they are allowed to eat. So, they must maintain their diet to meet the needs of their chronic kidney disease and any other disease they have. This can be very challenging, so diets and ideas are provided to the patients to help them fully understand what they can eat. They are instructed to eat small amounts of any of the foods so that if they do happen to eat something that is high in potassium or phosphorus. Then it won’t affect them in a negative way. Patients are advised to wear masks when they are in a crowded area and to wash their hands often. They are reminded especially if they have a permacath that they need to keep that site clean and free from moisture. If the dressing does get wet, then they need to change it and keep it clean. There was one patient that runs longer than anyone else there, this is either due to his obesity or due to his diet. He typically is fluid overloaded and has a large lunch box which is loaded with snacks. My nurse tells him he needs to limit what he takes in, but he says he isn’t eating that much. However, based on the edema noted on him and the snacks he brings one would beg to differ. Attempts are made by the nurse to spend time with him to educate him on his diet and what it is doing to him both his kidneys and because of his diabetes but the patient doesn’t really want to hear it. After 20 minutes the nurse moves on and states she will try again later. But states that it’s the same thing every week. This patient, when he started HD, first tried peritoneal dialysis and was not successful with it. He then had to switch to traditional HD and was able to tolerate this. The patient is hoping to be able to get onto a transplant list but to do that he must first be below 300 pounds. This patient is over 350 pounds
currently. He is aware of the struggle and states he will take any advice that anyone can provide him with in losing weight. Then within the last year, this patient was found to have cancer in his nasal area of the left side of the face. This caused swelling of the eye and he was fearful of losing his eye. This did not happen, but now he is also dealing with chemotherapy, HD treatment, and being diabetic. This patient is very vulnerable when it comes to illness and must be reinforced to maintain a healthy standard of living. As the morning group of patients starts to finish the nurse continues to check vital signs every 30 minutes and complete their charting. She then gets them off the HD machine and dresses their HD site either by holding pressure and applying a dressing or by flushing the line and capping the permacath. As these patients finish the afternoon set of patients starts to arrive there are also 12 in this group and they will be staggered and placed on the HD machine according to how their access is set up. Each patient is given the time to discuss new findings and be educated on new medications. The patients are educated on falls, washing of hands, and keeping their access sites clean and free from moisture. Also, follow-up questions are asked to ensure that they have seen the doctor recently and see if they have any questions for them. A5: Activity Relation to Sphere of Care: Today we discussed with patients about eating a healthy diet and maintaining enough protein. Not to have too much potassium. When eating protein, it would need to come from plant-based sources such as tofu, beans, peas, and lentils. We also discussed that having chronic kidney disease puts a strain on their organs and this in turn can put them at risk for infection. The best way to avoid infection is to wash their hands. Instructions on how to properly wash hands were provided and how to use hand sanitizer. It was advised to all patients that if they had not gotten or received their flu vaccine they should. Also, it was strongly advised to get the most current Covid-19 vaccine. They should also ask their doctors about any other vaccinations that are age appropriate for them. It was discussed with patients about the fluid content of food and to limit them based on this because if they eat too much of the food. This too can cause them to be overloaded.
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