Table of Contents

 

 

 

 

Foreword

viii

 

Preface

ix

 

Acknowledgments

x

 

Contributors

xi

1

Nephrology Nursing Scope of Practice

1

 

Definition of Nephrology Nursing

1

 

Scope of Practice for Nephrology Nursing

1

 

Overview of the Scope of Practice for Nephrology Nursing

2

 

General Nephrology Nursing Practice

3

 

Advanced Practice in Nephrology Nursing

3

 

Theoretical Foundations of Nursing

4

 

Nursing Theories

4

 

Evolution of Nephrology Nursing

6

 

Nephrology Nursing Process

6

 

Differentiated Areas of Nephrology Nursing Practice

7

 

Education and Professional Development

9

 

Continuing Education

9

 

Professional Organization

10

 

Certification

10

 

Health Policy Involvement

11

 

Practice Issues

11

 

Ethics

12

 

Trends and Opportunities

13

 

Evidence-Based Practice and Research

13

 

Technology

13

 

Future of Nephrology Nursing

13

2

Nephrology Nursing Standards of Practice

15

 

Standards

15

 

Definitions and Concepts Related to Competence

15

 

Competence and Competency in Nephrology Nursing Practice

16

 

Standards of Nephrology Nursing Practice

16

1

Assessment

16

2

Diagnosis

18

3

Outcomes Identification

19

4

Planning

20

5

Implementation

21

5a

Coordination of Care

22

5b

Health Teaching and Health Promotion

23

5c

Consultation

24

5d

Prescriptive Authority and Treatment

24

6

Evaluation

25

 

Standards of Professional Performance

27

7

Ethics

27

8

Education

28

9

Evidence-Based Practice and Research

29

10

Quality of Practice

30

11

Communication

31

12

Leadership

32

13

Collaboration

33

14

Professional Practice Evaluation

34

15

Resource Utilization

35

16

Environmental Health

36

3

How to Use the Standards in Practice

37

 

Performance Appraisal Action Plan

38

 

Individual Development Plan (IDP)

40

 

Employee Performance Review Form

42

 

Policy and Procedure Development

46

 

Position Description

52

 

Competency Skills Checklist

54

4

Nephrology Nursing Process of Care

57

 

Introduction

57

 

Chronic Kidney Disease, Stages 1-4

59

 

Anemia

59

 

Chronic Kidney Disease - Mineral and Bone Disorder

62

 

Dyslipidemia and Reduction of Cardiovascular Disease Risk Factors

64

 

Fluid Balance and Congestive Heart Failure

67

 

Glycemic Control

69

 

Hypertension

71

 

Nutrition and Metabolic Control

74

 

Preparation for Replacement Therapy

76

 

Nephrology Nursing Care

79

 

Anemia

79

 

Bowel Function

82

 

Chronic Kidney Disease - Mineral and Bone Disorder

83

 

Coping

86

 

Dyslipidemia and Reduction of Cardiovascular Disease Risk Factors

89

 

Electrolyte Balance

91

 

Family Process

92

 

Fluid Balance and Congestive Heart Failure

93

 

Integrity of Skin and Mucous Membranes

97

 

Nutrition and Metabolic Control

98

 

Rehabilitation

100

 

Residual Kidney Function

104

 

Sexuality - Adult

106

 

Sexuality - Adolescent

107

 

Self-Concept and Self-Management

108

 

Sleep

110

 

Infection Control

115

 

Bacterial Infection

115

 

Hepatitis B

117

 

Hepatitis C

119

 

Tuberculosis

120

 

Hemodialysis

123

 

Vascular Access

123

 

Adequacy

128

 

Treatment and Equipment-Related Complications

132

 

Patient Management

139

 

Peritoneal Dialysis

145

 

Catheter Implantation

145

 

Acute Peritoneal Dialysis

146

 

Dialysis Prescription and Adequacy

149

 

Prevention and Treatment of Complications

151

 

Bleeding

151

 

Hyperglycemia

152

 

Catheter Malfunction

153

 

Infectious Complications

155

 

Self-Care and Home Dialysis

159

 

Evaluation and Education

159

 

Dialysis Training

161

 

Ongoing Monitoring

164

 

Apheresis and Therapeutic Plasma Exchange

167

 

Pretreatment Patient Education

167

 

Patient Assessment

168

 

Equipment Assessment

171

 

Initiation of Treatment

171

 

Anticoagulation

172

 

Intratherapy Monitoring

174

 

Fluid Management

176

 

Acid/Base and Electrolyte Balance

177

 

Complications

178

 

Blood Leak

178

 

Air Embolus

179

 

Hemolysis

180

 

Termination of Treatment

181

 

Continuous Renal Replacement Therapy

183

I

Pretherapy

184

 

Pretreatment Assessment

184

 

Preparation for Therapy Initiation

188

II

Intratherapy Considerations

189

 

Initiation of Therapy

189

 

Intratherapy Monitoring

190

 

Anticoagulation

192

 

Fluid Management

193

 

Acid/Base and Electrolyte Balance

194

 

Metabolic Stability

195

 

Nutrition

196

 

Complications

196

 

Infection

196

 

Hyperglycemia

197

 

Hypothermia

198

 

Blood Leak

198

 

Minimal Interruption of Therapy

199

 

Termination of Therapy

199

III

Post Therapy Considerations for Quality of Care

200

 

Post Treatment

200

 

Elements of a CRRT Monitoring Tool

201

 

Kidney and Pancreas Transplantation

203

I

Deceased Donor

203

 

Approaching and Educating the Family

203

 

Physiologic Maintenance

204

II

Living Donor

205

 

Education and Evaluation

205

 

Evaluation Studies

207

 

Perioperative Education and Discharge Planning

208

III

Recipient

210

 

Education and Evaluation

210

 

Perioperative Education and Discharge Planning

211

IV

Postoperative Care of Donor and Recipient

214

 

Pulmonary Care

214

 

Fluid Management

215

 

Bowel Function

217

 

Urinary Tract Function

218

 

Operative Site Care

219

 

Comfort Management

220

 

Allograft Dysfunction

221

 

Palliative Care and End-Of-Life Care

225

5

How to Use Nephrology Nursing Process of Care

229

 

Teaching Plan

230

 

Performance Criteria

232

 

AKI Scenario

234

6

References

237

7

Glossary

243

8

Appendixes

247

 

Position Statements

 

A

Delegation of Nursing Care Activities

248

B

Advanced Practice in Nephrology Nursing

251

C

Certification in Nephrology Nursing

253

D

ANNA Health Policy Statement

255

 

Publications

 

E

Principles and Elements of a Healthful Practice/Work Environment

261

F

Reference Card from the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure

262