DEFINITION
An assessment of condition of the patient prior to commencing haemodialysis treatment. The assessment include physical, social, and psychological aspects to detect and manage any immediate identifiable problems for further action and to enable the planning of an individualized treatment in line with their dialysis prescription.
PURPOSE
1. To ensure safe and effective treatment is planned according to the patient’s dialysis prescription.
2. To identify any issues that require further action and follow up to ensure that the patient receives individualized therapy and thus maintain optimum quality of care.
CONDITIONS
1. Applies to all Registered Nursing Personnel working in Dialysis Centres in Oman
2. This procedure can be performed by a dialysis nurse undertaking nephrology / dialysis training program, provided he / she is closely supervised by an experienced dialysis nurse at all times.
3. Hand washing should be performed according to policy and procedure on antiseptic hand washing.
EQUIPMENT
1. Stethoscope
2. Blood Pressure apparatus
3. Weighing scale
4. Thermometer
5. Patient’s file
PROCEDURE
| SN | Nursing Action | Rational |
| 01 | Impression of general condition General inquiry to the patient about health and well being since last dialysis treatment and situation on the day of treatment. | Vital information about the patient can be learned as soon as he/she arrives for treatment. More extensive assessment is required before the patient is commenced on dialysis therapy. |
| SN | Nursing Action | Rational |
| Objective assessment of the visual picture of the patient, walking easily, general demeanor, or any other signs of potential complications e.g. dyspnoea, muscle weakness, etc. | Any patient’s complaint may require immediate action before dialysis therapy can be commenced. | |
| 02 | Weight Weigh patient, ensuring that he/she is in the same clothes etc. as for previous dialysis treatments. Assigned staff should check the weight of the patient. Document findings and interpret information obtained. If any abnormalities detected, inform the physician for further action. | It is necessary to compare pre- dialysis weight with that at the end of the previous dialysis to assess the weight gained and to be able to plan dialysis treatment in the light of expected dry weight and the information gained from the patient as per step one. Further action may be necessary if there are abnormalities detected which may result in a change in dialysis prescription. |
| 03 | Check and record Vital Signs Blood pressure Pulse: rate, rhythm, and volume Temperature Volume status * Presence, absence of oedema * Neck vein distension * Skin turgor Ask the patient whether they had due medication . Observe general condition observing for complications such hypotension. | Vital signs and fluid status of the patient should be in the normal range. If there is deviation from the normal range, the physician should be informed and further action taken which may include revision of dialysis prescription. Further action may be necessary if there are abnormalities detected which may result in a change in dialysis prescription . |
| 04 | Review Review laboratory reports for recent biochemical and haematological data. Interpret data and note findings for further action. Review previous dialysis treatment records for notes, remarks, and action to be taken. | It is essential that all data is reviewed to ensure that patient safety is maintained. It is essential to maintain accurate and complete records of data obtained to allow monitoring of treatment response, detection, and management of complications. |
| SN | Nursing Action | Rational |
| 04 ctn’ | Review General review of all findings to ensure that dialysis treatment can be planned according to the individual requirements. | If any abnormality is detected, a member of the team should take appropriate action. Required patient education should be noted for further planning. |
| 05 | Assessment of vascular access Question the patient about the vascular access since last dialysis treatment. Observe overall appearance for any signs of infection . Carefully observe the temporary access site for signs of infection. Palpate fistula / site for bruit, thrill, volume and any signs of pain or oozing etc. | It is essential that potential complications will be eliminated before dialysis treatment is commenced. It is important to maintain accurate and complete records of data obtained to allow monitoring of treatment response and the detection and management of any complications. To ensure that the fistula is working. |
| 06 | Documentation of findings The results of the assessment and the treatment goals should be recorded and signed by the nurse undertaking the assessment Any notes or instructions for this or a subsequent dialysis treatment must be clearly identified. Patient’s complaints also should be recorded . | There has to be accountability for the delivery of dialysis treatment and evidence of the therapy management to achieve the goals of the dialysis prescription. It is necessary to ensure that there is continuity of care from one dialysis treatment to the next to maintain patient safety and well being. |