Renal Nursing by Thomas Nicola

Renal Nursing by Thomas Nicola

Author:Thomas, Nicola
Language: eng
Format: epub
ISBN: 9781118410745
Publisher: John Wiley & Sons, Inc.
Published: 2013-11-05T16:00:00+00:00


Special Care on Haemodialysis

Diabetes mellitus

Diabetes is the leading cause of established renal failure in the Western world, and approximately 20–30% of those with type 1 or type 2 diabetes will develop overt kidney damage (Atkins 2005). The prevention of established renal failure in those with diabetes has been discussed in Chapter 6; many renal programmes in the United Kingdom have up to 25% of their dialysis population with diabetes as their underlying renal disease (Gilga et al. 2011).

The following points should be considered when caring for those with diabetes on dialysis:

Care of those with diabetes and renal disease should be through joint renal–diabetes management, for example joint clinics.

Those with diabetes should continue to attend specialist diabetes centres or specialist practice nurse clinics for annual review, to monitor complications of retinopathy, neuropathy and cardiac disease.

Glucose monitoring should be individualised according to patient requirements – tight glycaemic control is preferable to avoid further complications of diabetes. Insulin requirements may either be reduced (dialysis reverses insulin resistance) or increased (dialysis may reverse anorexia and may increase dietary intake). Dialysate should contain glucose to avoid hypoglycaemia.

Glycated haemoglobin (HbA1c) should be between 6.5% (48 mmol/mol) and 7.5% (58 mmol/mol).

Tight blood pressure control is recommended (<130/80 mmHg), although it is recognised that hypotension on dialysis may be common. Sodium profiling may be helpful.

Treatment guidelines for antidiabetic therapy rarely consider safe and efficacious management of patients with CKD, so drug therapy has to be considered carefully (Hamilton 2012).

Good nutrition is important as patients may suffer gastroparesis and subsequent nausea and vomiting.

Dialysis nurses should carry out foot examination at least once per month as foot lesions are the most commonly mismanaged problem (Meaney 2012). Patient teaching on foot care is vital.



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