Complicações Decorrentes Do Tratamento Dialítico: Contribuição Do Enfermeiro No Cuidado E Educação Ao Paciente

Abstract

<jats:p>A doença renal crônica (DRC) é a incapacidade dos rins eliminarem substâncias tóxicas e manter o equilíbrio hidroeletrolítico. O paciente com DRC vive grandes dificuldades durante o tratamento dialítico, especificamente a hemodiálise. Durante o período de tratamento ele enfrenta uma avalanche de mudanças em sua vida, psicológica, física, familiar e social. O objetivo deste estudo visa conhecer as complicações sofridas pelo paciente renal crônico submetido à terapia dialítica e as intervenções do enfermeiro no cuidado e educação desse cliente. O método utilizado trata-se de um estudo em língua portuguesa, de caráter exploratório, com pesquisa na base de dados Scielo, em livros na área de nefrologia, bem como pesquisa eletrônica na internet. A literatura aponta que os pacientes com DRC encontram dificuldades no tratamento dialítico como falta de conhecimento da doença e seus sintomas, desconhecimento do tratamento, vindo a ter reflexo no ambiente familiar, psicológico e social. Tais dificuldades podem mudar com a intervenção do enfermeiro por ser o profissional mais próximo e constante desse paciente, através de medidas educativas ao paciente e familiar.</jats:p>

Pandemia de COVID-19 e os cuidados de enfermagem aos pacientes em tratamento hemodialítico

“…32 The CKF is characterized by the insufficiency of the kidneys, which due to several factors and pathologies, becomes ineffective in its filtration process as well as in its capacity to maintain the hydroelectrolytic balance, accumulating toxic and harmful elements to the body. 14 As a consequence of the numerous systemic complications and the affected kidney function, the organism as a whole suffers alterations, making Renal Replacement Therapy (RRT) indispensable in its terminal stage, such as HD, peritoneal dialysis or kidney transplantation, in order to balance the disorders caused in the organism and the progression of the disease. 15 HD is one of the most common RRT, performed by more than 90% of patients in dialysis treatment registered in 2019 in Brazil, 16 generally persistent mode for life, since kidney transplantation is not available and recommended for all patients.…”

“…18,41 The nurse, together with the nursing team, should: reorganize the flow of people, orienting patients and companions to avoid moving in common areas unnecessarily, as well as avoiding the sharing of food or personal objects; advise the presence of companions only in cases of extreme necessity; to guide patients and family members to make phone contact with the dialysis service in case the patient presents signs and symptoms of the disease or has had contact with third parties suspected/confirmed with the virus; besides promoting health education by providing masks, encouraging and guiding patients and companions as to the correct use during the entire stay in the dialysis service. 14,18,42,43 The nurse should also: elect individual rooms to dialise suspect and/or confirmed patients with COVID-19; perform the disposal of lines and dialysers used in patients under suspicion or confirmation of the disease, after each hemodialysis session and ensure the sending of water and blood samples for laboratory analysis. 18,42,43 Among the specific recommendations for dialysis units, the following are also highlighted: ensuring the continuity of dialysis treatment for patients under suspicion or diagnostic confirmation; defining strategies to reduce the spread of microorganisms in the environment and a distinct flow for symptomatic/suspected patients; guide patients and relatives to make immediate telephone contact in case of signs and symptoms or close contact with people with diagnostic suspicion/confirmation of the disease; apply questionnaires to patients to research the possible presence of respiratory symptoms; post posters with guidelines that help in understanding the hygiene measures to be adopted and provide an appropriate place for hand hygiene, reducing direct contact with taps and garbage cans to a minimum.…”

“…13 This confluence of risk factors ends up making patients with CKF more vulnerable to COVID-19 and its complications more severe, since the risk of aggravation is related to the greater age and duration of the disease and the state of metabolic control, and can even lead to death. 13 It is important to note that patients with CKF already have impaired metabolic control, since the kidneys become inefficient to perform the blood filtration process, 14 in need of Renal Replacement Therapy (RRT), with more use being made of hemodialysis (HD). 15,16 In the hemodialysis services, specifically, there is a greater concern in the prevention of infection by the virus, mainly due to the fact that the hemodialysis treatment occurs in collective rooms, 17 with customers coming from different places and for having contact with other people.…”