WAYS OF KNOWING
Knowledge that is objective and observable (facts, evidence based)
Includes logical reasoning and problem solving
Empirical knowing
"Why people need nursing" - need for nursing occurs when there are health related limitations for knowing, deciding, and producing care
Theory of self care deficit
Treatment that involves a dialysis machine an a special filter called an artificial kidney to clean your blood
Hemodialysis
You are teaching the patient starting hemodialysis. Which statement, if made by the patient, indicates the need for further teaching?
A) "To protect my fistula I shouldn't wear tight fitting clothing on that side"
B) "If I see any redness or swelling on the site I should call my doctor"
C) "I shouldn't sleep on my side with the graft but it's ok to take a blood pressure on that arm"
D) "I need to wait to take my medications until after my dialysis treatment"
C - It is not ok to take a blood pressure on the side with the dialysis site. The patient should also be taught to avoid tight fitting clothes, blood draws, iv insertions, carrying bags/pocketbooks, or sleeping on the affected side. Redness and swelling are signs of infection that should be reported to the doctor. Because hemodialysis can cause medication accumulation and toxicity patients are advised to take daily medications after dialysis treatment.
Pattern of knowing about self and other. It develops when nurses intuitively understand and connect with clients as unique human beings.
Personal knowing.
Starts in the final stage of dying, then continues until death and into family bereavement and care of the body. It is provided across all settings across the continuum of care to relieve suffering and improve the quality of living until death.
End of life care
defined as the presence of kidney damage (usually detected as urinary albumin excretion of ≥30 mg/day or equivalent) or decreased kidney function (defined as estimated glomerular filtration rate [eGFR] <60 mL/min/1.73 m2) for three or more months
Chronic Kidney Disease
The kidneys are responsible for performing all of the following functions EXCEPT:
A) Activating vitamin D
B) Secreting Renin
C) Maintaining cortisol production
D) secreting erythropoietin
C - The adrenal glands are responsible for maintaining cortisol production
Referred to as the "art" of nursing. This knowledge links the humanistic components of care with its scientific application.
Aesthetic knowing.
Uses palliative care principals (i.e., dignity, hope, comfort, quality of life, relief of suffering) with people facing chronic, life-limiting conditions at all stages, not just at the end of life. It reinforces personal autonomy, the right for persons to be actively involved in their own care and a greater sense of control for individuals and families
The palliative approach
This substance can build up in your body when the kidneys are not functioning properly, causing fluid retention.
Sodium
Which patient below is NOT at risk for developing chronic kidney disease?
A) A 58 year old female with uncontrolled hypertension.
B) A 69 year old male with diabetes mellitus.
C) A 45 year old female with polycystic ovarian disease.
D) A 78 year old female with an intrarenal injury.
C - A 45 year old female with polycystic ovarian disease is not at risk for developing chronic kidney disease.
Refers to the moral aspects of nursing care. This was of knowing encompasses knowledge of what is right and wrong.
Ethical knowing.
initiating communication that reflects people’s values and health-care wishes;
honouring the values and health-care wishes of persons and supporting families;
advocating for and supporting persons in their experience of living and dying;
providing comprehensive, coordinated, compassionate and holistic care to persons and their families;
attending to pain and other symptom relief and to psychosocial, grief and bereavement support to maximize a person’s quality of life and death;
providing a compassionate and therapeutic presence to persons and families, including support for grief and bereavement, throughout the dying process;
advocating for resources that support persons and families in choosing their preferred environment for a peaceful and dignified death
The role of the palliative nurse
checking the patients' vital signs and talking with them to assess their condition
teaching patients about their disease and its treatment and answering any questions
overseeing the dialysis treatment from start to finish
making sure patients are given the correct medications ordered by their doctors
evaluating patients' reaction to the dialysis treatment and medications
reviewing the patients' lab work, home medications and activities and letting the doctors know about changes in their patients' conditions
helping patients follow-up with their transplant center
supporting the entire care team in delivering quality care in a considerate, respectful manner
Role of the dialysis nurse
Your patient had surgery to form an arteriovenous fistula for hemodialysis. Which information is important for providing care for the patient?
A) The patient feels best immediately after the dialysis treatment
B) Taking a blood pressure reading on the affected arm can cause clotting of the fistula
C) Using a stethoscope for auscultating the fistula is contraindicated
D) The patient shouldn’t feel pain during initiation of dialysis
B - Pressure on the fistula or the extremity can decrease blood flow and precipitate clotting, so avoid taking blood pressure on the affected arm.
This way of knowing includes the nurses awareness of social problems and inequities. It involves critical reflection and action.
Emancipatory knowing.
A client is receiving palliative care for CKD. The primary purpose(s) of her receiving palliative care is (are) to (select all that apply)
A) Improve her quality of life.
B) Assess her coping ability with disease.
C) Have time to teach patient and family about disease.
D) Focus on reducing the severity of disease symptoms.
E) Provide care that the family is unwilling or unable to give.
A, D
Treatment that uses the lining of your abdomen (belly area) and a cleaning solution called dialysate to clean your blood
Peritoneal Dialysis
A client is experiencing complications with her diagnosis and is now switching treatment methods. She explains to her nurse that she has been experiencing mixed feelings trough this entire process. Which complementary/alternative therapy is best for the nurse to suggest.
A) Aromatherapy
B) Imagery
C) Massage
D) Journaling
D - journaling allows and opportunity for the client to record those thoughts and feelings, providing an opportunity for self reflection.