Current Search:   Montoya, Vicki (x)

View All Items

  • CSV Spreadsheet
(1 - 2 of 2)
NURSING INTERVENTIONS FOR INTRADIALTYIC HYPOTENSION: USING BLOOD VOLUME MONITORING GUIDED ULTRAFILTRATION
Title
NURSING INTERVENTIONS FOR INTRADIALTYIC HYPOTENSION: USING BLOOD VOLUME MONITORING GUIDED ULTRAFILTRATION.
Creator
Cedeno, Suzette S, Montoya, Vicki, Desmarais, Paul, University of Central Florida
Abstract / Description
Background: Intradialytic hypotension is a potential complication experienced by patients with end-stage renal disease who receive hemodialysis. This complication occurs during the dialysis treatment in 15-30% of all treatments. The multiple comorbidities that exist in hemodialysis patients predispose them to recurrent intradialytic hypotension episodes. Recurrent intradialytic hypotensive episodes can result in negative short-term and long-term clinical consequences. Short-term consequences...
Show moreBackground: Intradialytic hypotension is a potential complication experienced by patients with end-stage renal disease who receive hemodialysis. This complication occurs during the dialysis treatment in 15-30% of all treatments. The multiple comorbidities that exist in hemodialysis patients predispose them to recurrent intradialytic hypotension episodes. Recurrent intradialytic hypotensive episodes can result in negative short-term and long-term clinical consequences. Short-term consequences include complications such as ischemic events (e.g., heart attacks, strokes), clotting of patient dialysis access, or heart rhythm abnormalities. Long-term consequences include end-organ damage, increased cardiovascular morbidity, and a higher mortality rate. Problem Statement: Available nursing interventions used to treat intradialytic hypotension such as decreased dialysis fluid temperature, changes in the calcium and sodium concentrations in the dialysis fluid and oral medication have limited success. Another existing technological intervention called blood volume monitoring shows greater potential success but is currently underutilized. Purpose: The purpose of this literature review is to synthesize current literature on blood volume monitoring technology used to prevent intradialytic hypotension in hemodialysis patients. Methods: A literature review was conducted analyzing pertinent research articles published in the last ten years, in addition to seminal articles. Seventeen articles were retrieved and analyzed that met criteria. Results: Fourteen of the seventeen research studies reached a consensus on the successful use of blood volume monitoring to decrease intradialytic hypotension and the related symptoms. Conclusion: Results of the literature review support the use of blood volume monitoring technology as an effective nursing intervention to prevent intradialytic hypotension in hemodialysis patients.
Show less
Date Issued
2019
Identifier
CFH2000519, ucf:45670
Format
Document (PDF)
PURL
http://purl.flvc.org/ucf/fd/CFH2000519
Improving Chronic Kidney Disease Care with Group Visits
Title
Improving Chronic Kidney Disease Care with Group Visits.
Creator
Montoya, Vicki, Sole, Mary, Norris, Anne, Wink, Diane, Abbott, Lionel, University of Central Florida
Abstract / Description
First year death rates remain unacceptable high for the end-stage renal disease (ESRD) population. New effective methods are vital to improve first year morbidity and mortality outcomes for the population transitioning from Stage 4 chronic kidney disease (CKD) to ESRD)/Stage 5 CKD. Based on current methods, evidence-based recommendations made by nephrology providers are frequently not heeded by patients in Stage 4 CKD. Low levels of patient knowledge, self-efficacy, and a poor ability to self...
Show moreFirst year death rates remain unacceptable high for the end-stage renal disease (ESRD) population. New effective methods are vital to improve first year morbidity and mortality outcomes for the population transitioning from Stage 4 chronic kidney disease (CKD) to ESRD)/Stage 5 CKD. Based on current methods, evidence-based recommendations made by nephrology providers are frequently not heeded by patients in Stage 4 CKD. Low levels of patient knowledge, self-efficacy, and a poor ability to self-manage CKD negatively influence a patient's ability to follow provider recommendations. The group visit (GV) intervention has demonstrated improvements in disease-related outcomes through increased levels of patient knowledge, self-efficacy, and disease self-management for other chronic diseasses such as diabetes and congestive heart failure (CHF). No data are available for the use of GVs in CKD.The purpose of the study was to develop and test a nurse practitioner-facilitated chronic CKD GV model versus usual nephrology care for Stage 4 CKD patients (knowledge, self-efficacy/self-management, physiological data, and satisfaction). As classified by the National Kidney Foundation's (NKF) staging system, Stage 4 CKD is considered severe kidney disease, with a decrease in the functional capacity of the kidney as determined by a glomerular filtration rate (GFR) of 15-30 ml/min. It is common for patients with Stage 4 CKD to progress to Stage 5 CKD/end-stage renal disease (ESRD), requiring dialysis or transplantation to survive.Preliminary instrumentation and feasibility studies were conducted prior to a pilot study of a CKD GV model. The development and validation of the Stage 4 CKD Knowledge Instrument was completed with 59 Stage 4 patients. Findings supported reliability (Kuder-Richardson-20 [KR] = .89) and content validity (I-CVI = .97, S-CVI= 1.0) Feasibility of the CKD GV model was assessed with a single group, pretest-posttest design using a convenience sample of eight Stage 4 patients. Results demonstrated an improvement in knowledge of CKD from a median of 69% to 86% (p =.012). No improvements were noted in self-efficacy scores (p = .230). GV satisfaction ranged from very good to excellent. Feasibility was supported by a high retention rate (100%). No barriers to participant recruitment or GV implementation were encountered.The pilot study used a two-group, repeated measures experimental design, with a sample of 30 Stage 4 CKD patients from two office locations of an outpatient nephrology practice. Patients were randomized to the GV intervention or to usual nephrology care. CKD-knowledge, self-efficacy, and self-management scores were collected at baseline, six months, and nine months. Physiological data were measured at baseline, six months, and nine months. GV satisfaction was obtained after the completion of GVs (six months). Nephrology practice satisfaction was obtained from by both groups at nine months. MANOVA for repeated measures was calculated for data collected at the three time points.Twenty-six of 30 patients completed the study, with four patients ineligible to complete the study due to progression to ESRD and dialysis initiation. GV attendance was 92%. CKD knowledge was statistically improved for both groups (F(1.498, 34.446) = 6.363, P = .008). While not statistically significant, a favorable upward trend in the mean scores for the subscales of self-management (communication, partnership in care, and self-care) was demonstrated in the GV patients, with a lack of improvement found in the usual care group for these subscales. Self-efficacy scores revealed a non-significant improvement in mean scores for the GV patients during the GVs, not seen with usual care patients. GV satisfaction was again high with the vast majority of patients requesting use of GVs in their future nephrology care. Current methods of intervention in the Stage 4 CKD population have made little impact on reducing first-year ESRD mortality and morbidity rates. Opportunities to intervene in the poor outcomes begin in the predialysis care of Stage 4 patients. Based on the documented success of multidisciplinary approaches in predialysis care, of GVs in other chronic diseases, and of chronic illness care based on the CCM, a high probability for success exists with the application of GVs in CKD. Although limited by a small sample size, promising improvements in the subscales of disease self-management, self-efficacy, CKD knowledge, and high satisfaction with the GV model for GV participants were revealed in this study. Further research is warranted for the CKD GV model on a larger randomized sample in other locations. Much needed data would be provided on which to base decisions for use of the CKD GV intervention in the predialysis care of Stage 4 patients.
Show less
Date Issued
2013
Identifier
CFE0004724, ucf:49827
Format
Document (PDF)
PURL
http://purl.flvc.org/ucf/fd/CFE0004724