Care and mobility considerations
Kidney Dialysis Patients
Introduction
All family members are affected, patients and families must learn to incorporate new treatments and changes to their lifestyles. This change to lifestyle can lead to behavioural and psychological illness.
There are limitations to travel and holidays. Some patients continue to work. Working however is often difficult due to the treatment restrictions and a person’s lack of general well being.
Renal patients are required to restrict their dietary and fluid intake, and fluid restriction can be 500mls per day. Dietary restrictions are dependant on a person’s individual blood results. Examples of restricted foods are fruit, chocolate, coffee, dairy products, alcohol.
There is normally a requirement for transport to and from the Hospital. This can be provided by Patient transport Ambulance service, which results in long waiting times for patients before and after dialysis treatment. Some patients will be able to drive their own cars following treatment this is dependant on their general well being.
Haemodialysis
Haemodialysis is a very robust treatment, which makes the patient feel very tired. This is because of huge fluxes in their metabolism. Haemodialysis takes place in a dialysis suite situated either in hospital or in the patient’s own home.
During haemodialysis the person is immobile and dependent on others for his/her needs, and requires monitoring for indications of the effectiveness of the treatment and signs of any complications. Changes in blood pressure are usually recorded regularly throughout the period of haemodialysis.
Because of rapid changes which can occur in blood pressure and in the movements of salts and/or water into and out of the body during dialysis, and the risks of danger these may pose, there is a reasonable need for continual supervision during the periods of haemodialysis.
Peritoneal Dialysis
In a person who is otherwise physically and mentally well, attention or supervision would not normally be necessary. However, many patients who undergo CAPD and APD are elderly. Most people with CAPD increasingly require the input of helpers. They may basically be independent, but in many situations, help is required from family members.
The requirement for dialysis will reduce a person’s physical independence.
In the many cases complicated by extremes of age, blindness, mental impairment, or severe physical weakness preventing the lifting of the bags of fluid it is unlikely that the affected individual will be able to complete the process without a great deal of help. In these cases, the complicating condition as well as the dialysis will have an effect on the overall care and mobility needs.
The occurrence of the following disabilities in those undergoing CAPD or APD will likely require assistance from another one or more times a day:
(i) Severe physical frailty from any cause (e.g. anaemia, which is common in renal failure); help will be needed with the lifting of the bags, which are heavy.
(ii) Blindness: the bags must be checked to make sure they are clear. Clouding may be a sign of infection or fibrin formation. The latter can block the connecting tubes and is dealt with by an injection of heparin into the bag.
(iii) Loss of manual dexterity: the changes of the bags needs considerable manual dexterity and must be carried out under meticulous aseptic (germ free) conditions. The function of the hands is very important. Persons with moderate to severe arthritis of the hands (e.g. rheumatoid arthritis) may well not be able to perform the actions without the assistance of another person.
(iv) Extremes of age: the very young and the very old may well need assistance with the changing of the bags.
Night attention is not normally needed on account of dialysis alone as the dialysing fluid is left in the abdominal cavity overnight, changes taking place during the day.
Mobility Considerations
Those doing well on dialysis should be able to walk, but around 50% of patients will not be able to walk 100 metres.
All these cases will need to be assessed on their merits.
Chronic Kidney Disease Patients
Some patients may not even know that they have the condition or may not have extensive needs arising as a result of the condition. Others will experience significant and disabling weakness and fatigue.
If chronic kidney disease progresses to end- stage renal failure, treatment requiring dialysis or transplantation will be necessary to sustain life, and the care and mobility needs will be that of a person undergoing dialysis or who has had a transplant.
Unsuccessful Kidney Transplant Patients
If a person has chronic graft rejection, there will be a slow decline in renal function more than 3 months after transplantation, not responding to treatment. It will be obvious after a three month period post- transplant whether further treatment in the form of dialysis is needed.
These patients will experience significant and disabling weakness and fatigue.
A return to dialysis will be needed while a new transplant is awaited, however a new transplant may not be forthcoming for a considerable time.
The treatment can vary between haemodialysis, peritoneal dialysis, and transplant, and each method of treatment can be revisited more than once.
The care and mobility needs of the individual therefore will be dependant on what sort of treatment the person is having at the time.
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Amended April 2008
