Subject Description Form Subject Code

SN5402

Subject Title

Renal Nursing I (Haemodialysis and Therapeutic Renal Replacement Therapy)

Credit Value

3

Level

5

Pre-requisite / Co-requisite/ Exclusion

Nil

Objectives

This subject develops the knowledge base on the care of patients with renal impairment. It equips students with the problem-solving and clinical strategies necessary for nephrology care practice. The subject strengthens students’ ability to demonstrate comprehensive knowledge of the implications and effects of evidence-based interventions for patients with compromised renal function. (PILO 1, 2, 3 & 5) This subject enables the student to acquire competencies in nephrology care as an advanced practice nurse. (PILO 1, 2, 3, 4 & 5) This subject also enables the student to demonstrate advanced nephrology nursing care for patients with acute or chronic renal disorder, including up-todate management with compromised kidney function. (PILO 1, 2, 3, 4, 5, 6, 7 & 8)

Intended Learning Outcomes

Upon completion of the subject, students will be able to: a. demonstrate an understanding of the nephrology problem in Hong Kong. (PILO 1, 2, 3 & 5) b. appraise the role of the Advanced Practice Nurse in nephrology nursing. (PILO 1, 2, 3 & 5) c. introduce the comprehensive and nephrology-focused health assessment. (PILO 1, 2, 3 & 5) d. apply knowledge of the pathophysiology, epidemiology and psychology of renal disease in the clinical management of patients with compromised kidney function. (PILO 1, 2, 3, 4 & 5) e. demonstrate effective clinical care, training and counselling for patients with acute or chronic kidney disorder and their families. (PILO 1, 2, 3, 4, 5 & 6) f. provide care for patients indicated for haemodialysis and care of vascular access; demonstrate an understanding of various renal dialysis treatments and the nursing management of their complications. (PILO 1, 2, 3, 4, 5 & 6) g. acquire knowledge of water treatment systems for blood purification / renal dialysis. (PILO 1, 2, 3 & 5) h. provide renal nursing care to patients requiring continuous renal replacement therapy and other forms of renal replacement therapy. (PILO 1, 2, 3 & 5) i. develop sound clinical judgment and prioritize nursing interventions based on clinical assessments. (PILO 4, 6, 7 & 8) j. critically evaluate the clinical outcomes of nephrology care (PILO 6, 7 & 8) k. apply evidence-based practice in nephrology nursing (PILO 1, 2, 3, 4, 5, 6, 125

7 & 8) Subject Synopsis/ Indicative Syllabus

I.

Core Renal Disorders

• • •

• •

Applied Renal Anatomy & Physiology Electrolyte & Acid-base Balance Renal Diseases (Medical) Renal Diseases (1)  Nephrotic and nephritic syndrome  Primary and secondary glomerulonephritis  Systemic lupus erythematosus/lupus nephritis, syndrome, vasculitis, amyloidosis, etc. Renal Diseases (2)  Hypertensive and diabetic nephropathy  Vascular diseases  Urinary tract infection  Tubulo-interstitial diseases and? toxic nephropathies Renal Diseases (3) (Surgical Aspect)  Obstructive uropathy  Neoplasms  Cystic & developmental diseases Acute Kidney Injury Chronic Renal Failure

II.

Haemodialysis (HD)

•

Principles of Haemodialysis  Dialysate  Blood lines  Machine Nursing Management of Patients with Haemodialysis Nursing Management for Patients with Vascular Access  Cannulation technique and button-hole cannulation  Strategies supporting patient’s choice of vascular access  Prediction and strategies for vascular complications: stenosis, thrombosis and infection  Quality improvement strategies for vascular access in haemodialysis: surveillance, infection control and education (patient and healthcare professional) Anticoagulation in Dialysis  Prevention of bleeding in dialysis patients Complications of Haemodialysis & Management thereof Recent Advances in Haemodialysis Treatment - Special Dialysis Mode Water Treatment Systems Self-care Haemodialysis Dialyser Re-use Nocturnal Home Haemodialysis (NHHD)  Advantages of NHHD  Nursing implications: inclusion of patient, training, safety measures, support, environmental protection  Barriers and challenges Assessment of Adequacy of Haemodialysis: Nurses’ Approach

• •

• • • • • • •

•

III. Continuous Renal Replacement Therapy (CRRT) 126

Goodpasture’s

• • •

Plasmapheresis Haemoperfusion Haemofiltration and Haemodiafiltration

IV. Others: • • • • • • Teaching/Learning Methodology

Renal Services in Hong Kong Roles and Responsibilities of Renal Nurses Layout of Renal / Dialysis Unit Infection Control in Renal Unit Adequacy of Dialysis: Haemodialysis and Peritoneal Dialysis Pharmacological Aspects of Renal Diseases (End-stage Renal Failure)

Lecture Lectures are delivered to provide students with relevant and up-to-date knowledge related to acute kidney injury, kidney function impairment, common renal disorders, renal services in Hong Kong, different renal replacement therapies, and recent developments in renal replacement therapies. Seminar The seminars involve the presentation of renal problems and nephrology practice. Students will be guided to constructively criticize their peers’ performance and evaluate their own work.

Assessment Methods in Alignment with Intended Learning Outcomes

Specific assessment methods/tasks

% weighting

Intended subject learning outcomes to be assessed (Please tick as appropriate) a

1. Examination

50%

2. Seminar presentation and written report

50%

Total

100%

b

c

d

e

f

g

      

h

i

j

k 

          

Examination Exams are used to assess students’ comprehension and application of the role of advanced practice nurse for critical care practice. Additionally, students’ abilities in the diagnosis and management of patients with cardiac and pulmonary system alterations will be examined and evaluated (PILO 1, 2, 3, 5 & 6). Seminar Presentation and Written Report Seminar Presentation is used to assess students’ understanding to incorporate nephrology care practices related to hospital-based and community-based settings. Students will be divided into groups and participate in the presentation. This provides a good opportunity for students to develop team spirit and communication skills. Written Report is used to assess students’ ability in comprehending the topic they have presented in the seminar. The knowledge of related areas and students’ ability to synthesize, analyse and evaluate will be improved; the task 127

also gives an overview of students’ written communication ability (PILO 1, 2, 3, 4, 5 & 6).

Student Study Effort Expected

Class contact: 

Lecture

26 Hrs.



Tutorial / Laboratory

13 Hrs.

Other student study effort: 

Pre-reading

20 Hrs.



Preparation of students’ seminars

22 Hrs.



Preparation of examination

20 Hrs.



Writing assignment

20 Hrs.

Total student study effort Reading List and References

121 Hrs.

Indicative reading list 1. Daugirdas, J.T., Blake, P.G. & Ing, T.S. (2007) Handbook of dialysis (4th Ed.) Philadelphia: Lippincott, Williams & Wilkins 2. Levy, J., Morgan, J. & Brown, E. (2001). Oxford Handbook of Dialysis. United Kingdom: Oxford. 3. Lancaster, L.E. (1995). Core Curriculum for Nephrology Nursing. (3rd ed.) USA American Nephrology Nurses’ Association. Others Allen, R., Nissenson, R.N., & Dominick, E.G. (Editors) (1995). Clinical Dialysis. 3rd ed., Appleton & Lange. Burrows-Hudson, S. (1999). Standards and Guidelines Of Clinical Practice for Nephrology Nursing. USA, Nephrology Nursing Journal. Chiu, M.C. & Yu, E.C.L. (1989). Paediatric Nephrology Handbook. Hong Kong: Abbott. Clinical nephrology nursing practice manual. European core curriculum of postbasic course in nephrology nursing (2nd ed.) EDTNA/ERCA Daugirdas, J.T. & Todd, S.I. (1999). Handbook of Dialysis (3rd ed.) USA: Little Brown Gabriel, R. (1981). Renal Medicine (3rd ed.) London: Balliere Tindall Guter, S.C. (1993). Review of Haemodialysis for Nurses and Dialysis Personnel. St. Louis: Mosby Henderson, L.W. & Thuma, R.S. (1994) Quality Assurance in Dialysis. Dordrecht: Kluwer Academic Publishers Jacobs, C., Kjellstrand, C.M., Koch, K.M. & Winchester, J.F. (1996). Replacement of Renal Function by Dialysis (4th ed.). Dordrecht: Kluwer 128

Academic Publishers. Ledebo, L. (1990). Acetate VS Bianburate in Everyday Dialysis Sweden: Gambro A-B. Pennsylvania (1984) Renal & Urological Nursing Springhouse. Molzahn, A.E. & Butera, E. (2006). Contemporary nephrology nursing: principles and practice (2nd ed.). ANNA Parker, J. (1998). Contemporary Nephrology Nursing. New Jersey: ANNA Stokes, R.A. (1991). Competency-Based Orientation Manual for Haemolysis Nursing. USA: Pergamon Pres Thompson, F.D. & Woodhouse, C.R.J. (1987). Disorder of the Kidney and Urinary Tract. Great Britain: Amold Journals • Journal of American Nephrology Nurse’s Association, Pitman: New Jersey • Journal of European Dialysis and Transplant Nurses Association/European Renal Care Association: Luzern, Switzerland. • Journal of Critical Care Nurse • Journal of Advanced Nursing • The Lancet • Journal of Kidney Disease • Journal of Nephrology • Journal of Clinical Nursing Website http://www.ecglibrary.com/ecghome.html http://www.renal.org http://hdcn.org/com

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