EG HEALTHCARE, INC.

DIALYSIS TRAINING CENTER METROPOLITAN HOSPITAL RENAL CENTER

The Factors for Choosing a Dialyzer for HD Patients

Group II Batch 36 Renal Forces

The Factors for Choosing a Dialyzer for HD Patients In Partial Fulfillment Of The Requirements in Advanced Dialysis Management Training Course

Submitted by Group II: Mary Rose Adaban James Adam Ado Mirriam Cacho Maria Kriselda Grospe Denmark Pedraza Michelle Poreno Fe Angeline Salazar Judith Anne Silvestre

Submitted to: EG HEALTHCARE, INC. DIALYSIS TRAINING CENTER MS. DIVINA GRACIA V. PASCUA, RN, RRN Training Coordinator

December 2, 2011

Approval Sheet
This case study entitled, The Factors for Choosing a Dialyzer for HD Patients prepared and submitted by Batch 36: Renal Forces -Group II, in partial fulfillment of the requirements for the EG Healthcare Dialysis Training has been examined and recommended for acceptance and approval for oral examination. __________________________________ _________ MS. DIVINA GRACIA PASCUA, RN, RRN Research Adviser

Approved by the committee on oral examination with the grade of ____________ ______________________________ Name Chair

__________________________________ ___________________________________ Name Member Name Member

Accepted and approved in partial fulfillment of the requirement for the degree EG Healthcare Dialysis Training for Nurses. ___________________________________ MS. DIVINA GRACIA PASCUA, RN, RRN EG Healthcare Coordinator

Acknowledgment
The researchers would like to express their whole hearted appreciation to all the people who made the entire course of this research study bearable and memorable, who have manifested their support, patience and assistance in putting together this research study. The researchers would like to show gratitude first and foremost, Mr. Jesson V. Butcon PhD., RN., their research adviser, who is overwhelmingly optimistic and gave his expert advices throughout this study, for his encouragement that inspired them to have a fervent desire in finishing their research and who willingly shared his knowledge and guidance in the completion of the study and to have definite grasp onto their research endeavor. To the panelists, chair Josefina E. Florendo MAN., RN., Melanie C. Tapnio MAN., RN., and Forra M. Joloya MAN., RN., for their constructive criticisms that enhanced the substance of this study and for their guidance in the significant initial steps in learning the language of research. Thank you.

To the beloved coordinators of Institute of Nursing, the researchers are of much gratitude for their kind consideration in handing the fundamental data which serves as one of the keys used for the study. To the administration and the level coordinators of the Institute of Nursing who warmly welcomes this research study. The researchers are definitely thankful to the ever supportive and hard working Dean of the Institute of Nursing, Mrs. Glenda S. Arquiza, PhD., RN., for the extreme support a mentor can always share to her juvenile and determined students. To the mainly important characters and considerate respondents who despite busy hours finds time to entertain and took the greatest part in this study , the group of nursing students who meekly participated in the research, a parcel of gratitude. To the family and acquaintances of the researchers, the debt of appreciation they are indebted and could certainly not repay and who continuously extends their moral and financial support and for the understanding they have given. Beyond each and every one, to Almighty God; for showering his blessing and understanding that lightens the burden of this undertaking where in He is the source of a persons knowledge, strenght and wisdom. A hand works on its best with others encouragement and support.

Dedication

WHAT LIES BEHIND US AND WHAT LIES BEFORE US ARE TINY MATTERS COMPARED TO WHAT LIES WITHIN US.

~Oliver Wendell Holmes

Half of all good work is the thought put into it before action.

~ BSNo46-Group 184

Name of Institution: Address: Title: Researchers:

BATCH 36: RENAL FORCES GROUP II

EG HEALTHCARE, INC. DIALYSIS TRAINING CENTER METROPOLITAN HOSPITAL RENAL CENTER The Factors for Choosing Dialyzers for HD Patients Mary Rose Adaban James Adam Ado Mirriam Cacho Maria Kriselda Grospe Denmark Pedraza Michelle Poreno Fe Angeline Salazar Judith Anne Silvestre Nurse

Profession:

_____________________________________________________________________________

Abstract

Table of Contents Title Page Acknowledgement Dedication Abstract CHAPTER I: Introduction Background of Study-------------------------------------------------------------------Statement of Problem------------------------------------------------------------------Significance of Study-------------------------------------------------------------------Scope and Limitations Study------------------------------------------------------CHAPTER II: Review of Literature Definition Terms--------------------------------------------------------------------------CHAPTER III: Research Design and Methodology Research Design------------------------------------------------------------------------------Participants Setting----------------------------------------------------------------------

the the the of the

of

and

Instrument------------------------------------------------------------------------------------Methods of Collection-----------------------------------------------------------------Data Processing Analysis-----------------------------------------------------------------Ethical Consideration------------------------------------------------------------------------CHAPTER IV: Results Discussion----------------------------------------------------------Data &

and

CHAPTER V: Summary of Findings, Conclusions and Recommendations Findings---------------------------------------------------------------------------------------Conclusions-----------------------------------------------------------------------------------Recommendations---------------------------------------------------------------------------Bibliography................................................................................... .............................. Appendices Appendix Appendix Appendix of Nursing Appendix Appendix A: Transaction of Focus Group Discussion B: Sample letter to the Level Coordinators C: Sample letter of Request to the Participants of Institute D: Data Gathering Questions E: Curriculum Vitae

TABLE OF CONTENTS TITLE I. Introduction II. Review of Literature/Studies PAGE

III.Biographic Data a. Patients Profile A b. Patients Profile B IV. Nursing Care Plans

V. Health Teachings/Recommendations

I. INTRODUCTION
BACKGROUND OF THE STUDY
While healthy kidneys have numerous functions in the body, the most well-known job is to produce urine. When kidney function goes below 10% to 15% kidneys are no longer capable to filter the blood and make urine. This causes toxins to build up in the body along with excess fluid. Fortunately, we live in a time when there are treatments and medicines that can replace the functions of the kidneys and keep our body alive. One type of renal replacement therapy, a

treatment that replaces kidney function is hemodialysis. A procedure can help you carry on an active life despite failing kidneys.

Dialysis patients are all too familiar with the routine of their treatments particularly hemodialysis; go to the clinic, get weighed, have their vital signs taken, get stuck with awful needles, unless the patient has a catheter access (subclavian access, intrajugular access, femoral access), have tubes connected from their access to the dialyzer and then sit on the chair or lie on bed until it is time to go home. The dialysis machine mixes and monitors the dialysate, it filters a patient's blood to remove excess water and waste. Blood is drawn through a specially created vein in the forearm, which is called an arterio-venous (AV) fistula. From the AV fistula, blood is taken to the dialysis machine through the blood lines. The dialysis machine itself can be thought of as an artificial kidney. Inside, it consists of more plastic tubing that carries the removed blood to the dialyser, a bundle of hollow fibers that forms a semipermeable membrane for filtering out impurities.
In the dialyser, blood is diffused with a saline solution called dialysate, and the dialysate is in turn diffused with blood. Once the filtration process is complete, the cleansed blood is returned to the patient. Most patients using dialysis due to kidney impairment or failure use a dialysis machine at a special dialysis clinic. Most sessions take about four hours, and typically patients visit the clinic one to three times per week.

The choice of dialyzer affects the dialysis process more than any other single component of the dialysis system. Understanding the characteristic of the dialyser is important to provide adequate dialysis treatment to your patient.
Ideal Dialyzer Characteristics of Ideal Hemodialyzer

1. High clearance of small and middle weight and urimic toxin 2. Negligible loss of vital solutes e.g. amino acid, low molecular weight proteins 3. Adequate ultrafiltration range 4. Minimal back filtration at low ultrafiltration rates 5. Low blood compartment volume 6. Non toxic and non thrombogenic materials of construction 7. Good washback characteristics 8. High reliability 9. Low cost 10. Potentially reusable without adverse effects

*Each devices therefore represents the manufacturers solution to meet ideal requirements. Types of Dialyzer Membrane material Biocompatibility Solute removal - Clearance Diffusion Convection Absorption Dialyzer Membrane Cellulose based membrane Synthetic membrane

Biocompatibility the choice of membrane material affects how blood will react when in contact with the membrane. Reactions to bioincompatibility: Mild or unnoticed Severe Anaphylactic shock Indicators of bio-incompatiblity Compliment Activation Increase in circulating C3a level Decrease in WBC Hypocoagulation

II. Review of Literature/Studies

III.BIOGRAPHIC DATA Patients Name: Mr. MAM

Age: 20 Sex: Male Status: Single Religion: Iglesia ni Cristo Occupation: College Student Nationality: Filipino Living with: Family Date of Birth: September 24, 1990 Address: San Jose Rodriguez Rizal Blood Type: O+ Height: Weight: 60.6 kg Chief Complaint: Intermittent Fever Date of Admission: October 9, 2011 Hospital: Salve Regina Regional Hospital Final Diagnosis: End Stage Renal Disease Secondary to Chronic Glomerulonephritis Attending Physician: Attending Nephrologist: Dr. Micahel delaCruz, M.D.

APPENDIX E CURRICULUM VITAE

Name: Nickname: Address: Date of Birth: Age: Place of Birth: Citizenship: Contact #: E-mail Address: EDUCATIONAL BACKGROUND Elementary: Highschool: College: Course: License #: AWARDS AND ACHIEVEMENTS

PROFESSIONAL MEMBERSHIP

Hobbies and Interests: Motto:

Name: Judith Anne Silvestre y dela Cruz Nickname: Jhudzee, Jhudz, Dith Address: 19-A Long Road Gordon Heights, Olongapo City, Zambales Date of Birth: January 20, 1989 Age: 22 Place of Birth: San Marcelino, Zambales Citizenship: Filipino Contact #: (047) 2242629 / +630153733533 or +639184569314 E-mail Address: Judithanne14@yahoo.com , Judithannecs28@gmail.com EDUCATIONAL BACKGROUND Elementary: St. Anne Academy, Olongapo City Attended 1996-2002, Class of 2002 Highschool: St. Joseph-College Olongapo City Attended 2002-2006, Class of 2006 College: Far Eastern University-Manila Attended 2006-2010, Class of 2010 Course: Bachelor of Science in Nursing Student #: 2006-537481 AWARDS AND ACHIEVEMENTS Leadership Award (2002) Loyalty Award (1996-2002) Grade 6: 2nd Honorable Mention (2001-2002) 1st year highschool top 1, Best in Conduct, Best in Attendance (2001-2002) PROFESSIONAL MEMBERSHIP Children of Mary (2000-2002) Legion of Mary (2000-2002) St. Anne Parish Choir (1999-2002) Spirit Committee (2009-2010) RCYCC Disaster Committee (2009-2010) PNA Membership (September 14, 2011) Hobbies and Interests:

Music is my life, thats why I love to dance as well as to sing. I enjoy watching movies and DVDs, netsurfing, texting, chatting and hanging around with my friends or malling with my Mom. I so much like violet or lavander, pink, black and white; Hello Kitty and I am a pet lover. So much to say, but Im proud to be a graduate of TAMARAW NURSE! Motto: "Never stop dreaming unless you're ready to wake up and make it a reality."