Search

ANNA's Administration SPN created this proposal as a clinical practice project to re-evaluate how training and education are provided to individuals working in the dialysis setting. This article describes an education initiative based on the escape room methodology to provide a fresh approach on dialysis curriculum. Keywords: Education, escape room, nurse competency, dialysis curriculum., NCPD 1.2 contact hours The medical landscape is always evolving, demanding constant education and adaptation from health care providers to offer the highest standard of care. Within the past decade, [...]

Keywords: Mentoring, nursing, leader, preceptor, professional commitment., Review of: Johnson, W.B., & Ridley, C.R. (2018). The elements of mentoring: 75 practices of master mentors (3rd ed.). St. Martin's Press. This book review discusses the art and science [...]

The CDC recommends that all hemodialysis (HD) patients be vaccinated against hepatitis B virus (HBV). In 1999, only 39 of our 134 (29%) HD patients had received HBV vaccine. Since the vaccine is indicated for all HD patients, this presented a drug-related problem (DRP): indication without treatment. In response, nurses and pharmacists initiated a proactive HBV vaccination program. Methods: An immunization protocol based on then current CDC recommendations was developed. HBV vaccine (40 mcg IM; at 0, 1 and 6 months) was administered to consenting HD patients. Anti-hepatitis B surface antibody (anti-HBs) titers were monitored and booster doses were given per the protocol. Results: By August 2001, all consenting HD patients (n = 110) had received ≥ 1 dose of HBV vaccine and 90 (81.8%) had either received a full course (≥ 3 doses) or had received ≥ 1 dose and developed a positive anti-HBs titer (≥ 10 mIU/mL). Of these 90 patients, 52 (58%) developed a positive anti-HBs titer, 33 (37%) responded to ≤ 3 doses, and 19 (21%) following a booster. The DRP was significantly improved. Conclusion: Given CDC guidelines, HBV vaccine should be offered to all HD patients. This initiative demonstrates that with concerted effort all consenting HD patients can receive HBV vaccination, thereby addressing an important DRP., In 1974, the incidence of hepatitis B virus (HBV) infection was 6.2% among hemodialysis (HD) patients and 5.2% among HD staff in the United States (Snydman, Bregman, & Bryan, 1977). [...]

Renal transplantation is the preferred therapy for children with end stage renal disease. A functioning renal allograft can dramatically improve a child's quality of life. Advances in immunosuppressive therapy and clinical practice approaches have significantly improved graft survival rates allowing children to attain near normal growth and development. Accurate assessment and appropriate nursing care enhances long-term survival of these young patients., Objectives: After reading this article, the reader will be able to: 1. Describe the postoperative nursing care of the pediatric renal transplant recipient. 2. Identify immunosuppressive medications used after transplantation [...]

Introduction: Paricalcitol (Z) is vitamin D analog purported to have less effects on serum calcium (Ca) than calcitriol. Methods: We report experience with Z in 7 hemodialysis patients with high parathyroid hormone (PTH) and Ca levels. Based on prior experience with calcitriol, small increases in Z doses were being made for these patients in an attempt to reduce PTH and avoid hypercalcemia. Eventually, hypercalcemia necessitated that Z and Ca-containing P binders be discontinued. Z was restarted 4 weeks later at higher doses based upon the manufacturer's dosing recommendations. Results: Mean ([+ or -] SD) Ca, P, and PTH levels prior to holding Z, prior to restarting Z (4 weeks later), and 3 months after restarting Z are shown (table). Z held 4 wks later 3 mos later Z dose (mcg) 3.4 + 1.5 6.1 + 2.0 10 + 1.5 Ca (mg/dl) 11.2 + 0.3 10.4 + 0.3 11.0 + 0.6 P (mg/dl) 6.1 + 1.6 6.5 + 0.7 6.5 + 1.6 PTH (pg/ml) 734 + 426 897 + 514 582 + 215 Conclusion: Hypercalcemia occurred with low and high Z doses. Larger doses more effectively reduced PTH. PTFI-mediated bone resorption likely contributed to the high Ca levels seen in these patients. Z dosing should be aggressive to effectively reduce PTH and minimize PTH--related effects on bone and Ca.

This is a time of great change and challenge in the workplace. Organizational skills are no longer a luxury -- they are a necessity. Time management skills add support in [...]