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Nursing Excellence

The Online Newsletter for Children's Nurses
e-Edition, Issue 10 

Michele Machel

Nephrology and Peritoneal Dialysis Clinical Nursing:
What Goes On In There?

By Michele Machel, ADN, RN

Ambulatory care is definitely a specialty area that needs to be recognized. We see a number of patients in a short period, but at the same time we need to provide the education and tools essential for family involvement and learning.

Nephrology Practice
In the nephrology practice, the nurses teach parents how to manually take a blood pressure and document the blood pressures appropriately. The families need to be aware of the guidelines and when to hold prescribed blood pressure medications. They also need to understand the side effects and what to look for in the event of hypotension or hypertension. All of this information is given to the patient/caregiver by the nurses and is reinforced through return demonstration at the close of the visit.

The nephrology nurses also provide nephrotic syndrome education, which involves showing the patient/caregiver how to perform urine dipsticks and monitor for signs and symptoms of potential remission. Various other educational offerings include: education for patients undergoing a kidney biopsy, urinary tract infection prevention, non-steroidal anti-inflammatory drug (NSAID) teaching, contact sport teaching, as well as explaining how to correctly obtain urine specimens ordered by the doctor.

Peritoneal Dialysis Practice
Peritoneal dialysis is a part of the nephrology practice with approximately 20 patients that require close supervision. Part of the peritoneal dialysis nurse’s accountability involves monitoring a patient’s lab values at least monthly, making follow-up appointments as necessary, making appropriate medication changes, and providing reinforcement as needed.

Summary of Nephrology and Peritoneal Dialysis Nurse’s Role
Some of the duties performed by nurses in the nephrology and peritoneal dialysis practice include:

  • Answering phone calls related to a patient’s medication dose change
  • Phoning caregivers with new orders or confirming doses and medication changes
  • Calling the pharmacy with prescription orders
  • Verifying medications with insurance companies, which may require the nurse to complete a prior authorization form for each medication and resubmit for approval and follow-up until completed
  • Making physician referrals and/or referrals for physical therapy or  occupational therapy
  • Providing education to the patient/caregiver on the patient’s condition
  • Answering questions regarding what dialysis solution should be used and for how long
  • Adjusting dialysis programming as necessary to ensure sufficient ultra-filtration as ordered
  • Performing multiple urine dip testing
  • Keeping monthly tabs on each patient’s lab values and evaluating if the patient is meeting target lab values for the criteria set based on the renal network
  • Following up on how well the dialysis is working by obtaining a Kt/V (way of measuring dialysis adequacy) and adjusting the program again if needed
  • Obtaining home blood pressure measurements and providing blood pressure education as necessary
  • Providing education on renal failure and dialysis
  • Providing education to the patient/caregiver to safely perform peritoneal dialysis at home
  • Teaching the patient/caregiver to recognize what peritonitis is, what causes it, what treatment is needed if peritonitis occurs, and knowing when to call the clinic and when to go to the emergency department
  • Supporting the treatment of the patient with peritonitis in clinic and providing the necessary antibiotics for the patient to go home
  • Educating the patient/caregiver on instilling antibiotics into the dialysis bags
  • Providing peritoneal dialysis catheter care education and support to the patient/caregiver while in the hospital and follow-up care and treatment as appropriate when at home
  • Providing care for the kidney transplant patient/caregiver and follow-up care as needed
  • Remaining current on changes related to the peritoneal dialysis machines and/or supplies. 

Ambulatory care nursing is a unique realm of specialized nursing practice. Ambulatory nurses are leaders in their practice settings and across the continuum of care. They are uniquely qualified to influence organizational standards related to patient safety and care delivery in the outpatient setting. Ambulatory care nurses are knowledge workers who function in a multidisciplinary, collaborative practice environment, where they utilize critical thinking skills to interpret complex information and guide patients and families to health and wellbeing.

The current ambulatory care setting is diverse and multifaceted, requiring nurses highly skilled in patient assessment and with the ability to implement a broad range of nursing interventions in a variety of settings. Registered nurses in ambulatory care must possess strong clinical, education, and advocacy skills and demonstrate the ability to manage care in complex organizational systems.

Registered nurses are uniquely qualified, autonomous providers of patient/family-centered care that is ethical, evidence-based, safe, expert, innovative, healing, compassionate, and universally accessible.1


1 Haas, S.A. (2008). Resourcing evidence-based practice in ambulatory care nursing.
   Nursing Economics, 26(5), 319-322.


In This Issue

Becoming The BEST

Evidence, Research and Quality Improvement in Clinical Practices

Intentional Care of the Spirit - A Nurse's Gift to Her Community

A Nursing Career - Challenges in Care for Ourselves

Nephrology and Peritoneal Dialysis Clinical Nursing: What Goes On In Here?

Surviving Childhood Cancer

Necessity is the Mother of Re-Invention

Patient Satisfaction Comments