Acute Kidney Injury

Throughout your lifetime you may experience a disorder that affects your kidneys.  There are several disorders that can affect your renal system and its ability to function which could include kidney stones, urinary tract infections, and many other conditions.  Our focus at this point will be on acute kidney injury.  The kidneys are the regulators in the body of fluid, acid-base, and electrolyte balance…and while regulating all of that they also work to eliminate wastes from the body. 

Acute kidney injury (AKI) is the sudden cessation of renal function that happens when blood flow to the kidneys becomes interrupted and significantly compromised.  The signs and symptoms of AKI occur very abruptly, and this condition consists of four phases as described below.

·         Onset – As the name states, it begins at onset and will last hours to days.

·         Oliguria – This refers to a significant decrease in urine output.  This begins when there is insult to the kidneys; your urine output will only be 100 to 400 mL over 24 hours, even if you take diuretics, which you may know better as “water pills.”  This phase lasts for 1 to 3 weeks.

·         Diuresis – This means that you will begin to urinate in large amounts.  Begins when the kidneys start to recover.  Diuresis of a large amount will occur, and it can last for 2 to 6 weeks.

·         Recovery – This final phase continues until kidney function is fully restored, which can take up to 12 months.

There are also three different types of acute kidney injury, described as follows:

·         Prerenal acute kidney injury

o   Happens because of volume depletion in the body and a prolonged reduction of blood flow to the kidneys.  In more simple terms, this happens when there is a reduction of blood flow, meaning the kidneys are not able to function as efficiently as they could with normal blood flow.

o   If early intervention is carried out by restoring your fluid volume, AKI can be reversed to prevent more complications and chronic kidney disease (CKD).

·         Intrarenal acute kidney injury

o   This happens because there has been direct damage to your kidneys from a lack of oxygen.

o   Things such as physical trauma, a blood clot, use of antibiotics, or having an infection can cause this type of AKI.

·         Postrenal acute kidney injury

o   This happens when there is an obstruction of all the structures that are leaving the kidney, which includes things such as a kidney stone or a tumor.

Total Home Health has a program that you can completely relate to with all your renal questions and concerns during your time of treatment with us.  Conditions related to the kidneys can seem rather confusing, so our nursing professionals will be available to you as your educator, nurse, advocate and friend.  Once your provider determines which type of AKI you are experiencing, treatment measures will be started that will hopefully reverse your condition before it turns into something worse.  The goal of Total Home Health once you return to your home will be that of health promotion and disease prevention of acute kidney injury.  In this treatment regimen our nursing professionals will include:

·         Only if recommended by your doctor we will encourage you to drink at least 2 to 3 liters of fluid daily if there are no restrictions on the amount of fluid you consume.

·         Promoting you to quit smoking, encouraging weight loss, providing education related to cautious use of NSAID medication (Aspirin, Ibuprofen), and providing education related to controlling other conditions such as diabetes and hypertension.

·         Education related to taking antibiotics as prescribed if you have an infection.

Total Home Health professionals are ready to take part in your care related to your renal disorder.  Our goal is to manage it as effectively as possible so that you may continue your normal ways of life, and enjoy each moment with your loved ones.  Let’s get started, enroll today!

Urinary Tract Infection

Urinary tract infections can be very uncomfortable.  They can occur in both young people and the elderly, depending upon the situation.  At some point in your life you may experience this type of infection.  A urinary tract infection can cause many different signs and symptoms and there are several risk factors you should be familiar with.  It is our goal at Total Home Health to educate you as best as possible in order to promote your health and prevent any urinary tract infections that could happen to you and interrupt your normal ways of life.

There are three parts that make up the urinary system: the ureters, bladder, and urethra.  The ureters are where the urine flows down into the bladder where it is then stored, after being stored it is eliminated out of the body via the urethra.  Urinary tract infections are commonly caused by Escherichia coli…better known by you as “E. coli.”  E. coli is found in stool and can cause a urinary tract infection if you or your loved one has bowel incontinence, or if your perineal personal hygiene is not as efficient as it should be.

Following are some risk factors that may increase your chance of acquiring a urinary tract infection at some point in your life:

-  Being female

·         Due to their anatomical make-up, females have a shorter urethra, which predisposes them to more frequent urinary tract infections.

·         The urethra, where urine is eliminated from, is much closer to the rectum than in men, which leaves a greater chance of contamination with stool.

·         Frequent use of sanitary napkins, feminine hygiene sprays, etc.

·         Changes in hormones with aging

·         Taking tub baths more frequently than showers

-  Having an indwelling catheter for urinary elimination

·         This puts you at an increased risk because whenever there is something that enters the body from the outside, such as a catheter, it is also a perfect entrance for organisms that can cause an infection.

-  Stool incontinence

·         If you experience stool incontinence and are not cleaned timely and correctly, stool could contaminate the perineal area and/or enter the urethra, which could  cause an infection.

-  Distention of the bladder

·         If this is your case, the bladder will not be completely emptied and the urine that remains may be a host for an infection to set in.

ü  An enlarged prostate in males

·         This could cause incomplete emptying of the bladder which could lead to a urinary tract infection.

-  Certain diseases, such as diabetes mellitus

From the list above it seems like women are at a huge disadvantage and are more likely to be the ones to get urinary tract infections.  However, if you are a man you should not be too confident because anyone can get this type of infection.  In addition, if you are an older adult and come down with a urinary tract infection your caregivers and loved ones around you may also notice things such as mental confusion, more frequent incontinence, loss of appetite, and more urination at night.  Older adults tend to have these more pertinent signs and symptoms just due to the way the body is aging and even though things are still working, they generally continue to work slower and slower.  Following are the signs and symptoms that may be experienced if you have a urinary tract infection:

-  Lower back or lower abdominal discomfort

-  Nausea and/or vomiting

-  More frequent urination

-  Feeling like you need to urinate but cannot go

-  Discomfort when urinating

-  Feeling like you did not get finished urinating

-  Itching in the perineal area (the area where the penis or vagina is located)

-  Urine that is red-tinged, smoky, or coffee-colored

-  Fever

-  Voiding, but in small amounts

-  Discharge from the urethra

-  Urine that is cloudy or foul-smelling

Here are just a few important reminders that our professional staff at Total Home Health would like to extend to you so that you can better prevent your chance of acquiring a urinary tract infection.  We want you to be proactive and stop the infection before it starts, so here are a few ways you can do just that:

-  Drink lots of water…around 3 liters a day would be great!

-  Use the bathroom at least every 3 to 4 hours, don’t wait until your bladder is full!

-  Females…after urinating make sure to wipe front to back to avoid contamination of your urethra.

-  Drink cranberry juice…it may stop certain bacteria from causing infections, but if you have cystitis…DO NOT drink it because it could irritate your bladder.

To determine whether or not you are experiencing a urinary tract infection, your provider will do a urinalysis.  This involves collecting a sample of your urine, either by obtaining a clean catch specimen where you urinate like normal, or via a more invasive straight catheterization procedure.  A urinalysis is the basic diagnostic test that will be completed in order for your treatment plan to begin, from that point if your condition warrants further testing your provider will then explain that more in-depth with you. 

With Total Home Health, our professional nursing staff is well educated when it comes to this condition and is ready to join your team.  We will teach you all we know when it comes to preventing urinary tract infections now and in the future.  Our ultimate goal is to promote your independence in your home, while strictly adhering to your treatment plan and treating you as one of our own every second of every visit.  We believe that when clients have a great relationship with their caregivers it creates that much more of a positive effect on their health, which is what we strive for!

Peritoneal Dialysis

Each and every part of our body must work together in order for us to maintain a healthy balance and go about our day to day life.  If there is ever a part of our body that begins to function improperly, the other parts must pitch in and work harder to make up the differences for us to maintain our health.  However, sometimes the inadequate functioning may become too much to compensate for, which could lead to organ failure. 

Our kidneys can suffer from injury and/or failure, and we simply cannot survive without function of at least one of them.  In the case of kidney failure, you may have the option to participate in peritoneal dialysis for your treatment.  Dialysis simply rids the body of excess fluid and electrolytes that may be playing a role in why your kidneys are suffering.  By getting rid of excess fluid and electrolytes, acid-base balance is achieved which will allow for more normal functioning and repair to occur.  Dialysis also eliminates any waste products that also could be causing problems, but it does not replace the normal hormonal functions of the kidneys. 

It is important to remember that the process of dialysis can sustain life for you if you have either acute or chronic renal failure.  There are two types of dialysis you or your loved one may be involved in at some point in your life, they include hemodialysis and peritoneal dialysis.  Our focus is going to be on peritoneal dialysis because it is the type that is more frequently carried out in the home setting.

The process of peritoneal dialysis is completed entirely through your abdominal wall and into your peritoneal cavity, no vascular access is needed, which means you will not be poked with needles.  The peritoneal cavity is the fluid-filled gap that is between the walls of your abdomen and the organs that are present there.  With this type of dialysis you will have access that remains in your abdominal area, so it can be easily accessed each time peritoneal dialysis is carried out.   When the process begins a hypertonic dialysate solution is allowed to enter the peritoneal cavity where it dwells, or stays in the cavity for a short time, to gather up excess fluids and waste products.  What does hypertonic mean and what does the solution do?  Well, when the solution enters into the peritoneal cavity it will pull wastes and excess fluid out with it, because being “hyper,” it is stronger than your blood and other fluids in your body.  After the dwell period is over and once the solution is drained out of your body, you will then be rid of most of the extra stuff that was causing your kidney function to be compromised.

Following are indications that prove you are most likely to be a candidate for peritoneal dialysis:

·         Treatment of choice for the older adult.

·         If you are unable to tolerate taking anticoagulant medications.

·         If there is difficulty getting vascular access for hemodialysis, you will have to resort to having abdominal/peritoneal access placed instead.

·         If your condition is unstable or you have chronic infections.

It is highly important that this procedure is carried out in a sterile manner because whenever there is an opening in the body to the outside, if anything enters that shouldn’t, it could cause big problems.  Total Home Health has a program that is right for you to fit all your peritoneal dialysis needs.  Our professional nursing staff have gone that extra mile to be trained for this condition so they can provide you with the best care possible.  The highly skilled staff will educate you on how to correctly perform each step of this important task in your home, and in a sterile manner.  However, we feel like we should share the following important pieces of information with you ahead of time so you can be more prepared about what to expect, and become familiar with some options your provider may suggest for you.  This information includes:

·         You may experience a feeling of fullness when the dialysate solution is dwelling.

·         There may be initial discomfort when the solution begins to enter your body.

·         Continuous ambulatory peritoneal dialysis (CAPD) is a certain type of dialysis that is usually done 7 days per week for 4 to 8 hours, and during CAPD you can go about your normal activities.

·         Continuous-cycle peritoneal dialysis (CCPD) is a 24-hr dialysis.  This exchange will occur at night while you are sleeping and the final exchange will be left in your peritoneal cavity to dwell during the day.

·         Automated peritoneal dialysis (APD) is a 30 minute exchange repeated over 8 to 10 hours while you are sleeping.

·         When the dialysate solution comes out after dwelling it should be clear or light yellow in color, and the amount should equal or be more than what was put in.

·         ALWAYS report any abnormalities, even the slightest things, to our Total Home Health staff or your provider as it could indicate infection or other problems.

With Total Home Health we understand what inconvenience the process of peritoneal dialysis may impose on you and your loved ones.  We will be there to help you in every way possible, while also providing support to you and your family day in and day out.  This process can be overwhelming at first, but with our talented nurses you will learn in no time and it will become easier and easier each time.  Ultimately, we are in this for you and will do whatever we can so you can maintain the greatest independence and most normal life possible.