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Renal Nursing

A Practical Approach

Renal Nursing by Bobbee Terrill
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Overview of Renal Nursing

Patients with end stage renal disease (ESRD) are unique among those who live with chronic illness. These patients rely on the regular use of a 'life support' therapy without which they will die. The term 'life support' is understood by the general public to mean the short term reliance on some form of life sustaining therapy. The implication of this is that once the patient has been treated, they will be 'well' and able to resume a normal life. For patients with end stage renal disease it means much more than this. It means lifelong reliance on technology.

While many patients are able to resume their usual daily activities, some are not able to do so, and for this group there is the additional problem of multiple medications, frequent hospital visits, the threat of invasive procedures and many unwanted lifestyle intrusions and limitations. There may be fewer intrusions for those with renal disease that has not reached end stage and for those who live with a functioning transplant, a return to near normal life is possible. However, difficulties remain for both these groups. The former wonder if/when they will have to commence dialysis. The latter wonder what will happen if their transplant fails.

This book began two years ago with a suggestion from Ausmed Publications, an Australian publishing company, that I write a book dealing with renal disease, its consequences and its treatment from an Australian nursing perspective. After a difficult conception, prolonged gestation period and an equally difficult birth, this is that book. It deals primarily with chronic renal disease, however a discussion of the development and treatment of acute renal failure, and the provision of additional extracorporeal therapies are included. Emphasis is placed on the care of patients prior to commencing dialysis, and includes the care of those who decline treatment, or who wish to withdraw from treatment.

The book is divided into seven sections, each of which deals with different aspects of the nursing management of people with renal disease. Section one is divided into six chapters and examines the development of renal disease, its diagnosis, consequences, and management strategies.

Sections two, three, five and six detail the use of the renal replacement therapies of haemodialysis, peritoneal dialysis, and transplantation for people with end stage renal disease. The importance of patient education, understanding, and participation in treatment decisions are referred to throughout these sections.

The use of haemofiltration, primarily as a treatment for renal failure in the acute setting, is discussed in the first chapter of section four. Plasma exchange and haemoperfusion are addressed in chapter two.

I am delighted to include in the book, a section devoted to the care of children with renal disease. This section was co-written by a nursing colleague, who specialises in the care of paediatric dialysis patients, and myself.

Section seven addresses the increasingly frequent use of complementary therapies by the general population and the possible effects of such therapies, especially those involving herbal and dietary supplementation, on people with renal disease. It contains a list of known, or suspected, interactions between conventional medications and herbal remedies, as well as reference to the contribution of some forms of herbal remedies as a cause of renal failure.

Bobbee Terrill
RN, FRCNA, MNStud.

Ausmed Publications; September 2004
402 pages; ISBN 9781597340243
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Title: Renal Nursing
Author: Bobbee Terrill