Thesis (M.S.)--University of Toledo, 2006. / "In partial fulfillment of the requirements for the degree of Master of Science in Nursing." Major advisor: Jane C. Evans. Includes abstract. Document formatted into pages: v, 53 p. Title from title page of PDF document. Bibliography: pages 42-43.

Made available in DSpace on 2015-12-06T23:47:55Z (GMT). No. of bitstreams: 0 Previous issue date: 2008 / Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) / Objetivo: Avaliar a efetividade da Terapia Cognitivo-Comportamental em grupo (TCC) no tratamento de pacientes com Doença Renal Crônica Terminal (DRCT), com diagnóstico de Depressão Maior. Métodos: Pacientes adultos em hemodiálise, com diagnóstico de depressão feito por instrumentos específicos, provenientes de duas unidades de tratamento dialítico da cidade de São José do Rio Preto, foram randomizados para participar de um estudo de intervenção. Os pacientes alocados para o grupo de intervenção receberam tratamento em grupo com TCC, semanalmente, durante três meses, conduzidos por psicólogo especializado; todos os pacientes alocados para o grupo controle receberam tratamento psicológico individualizado, realizado habitualmente na unidade de diálise. Foram aplicados, no momento de entrada no estudo, no final da intervenção (3o mês) e após mais 6 meses de seguimento, a entrevista psiquiátrica Mini International Neuropsychiactric Interview (MINI), o Inventário Beck de Depressão (BDI) e o Kidney Disease and Quality of Life- Short Form (KDQOL-SF). Resultados: Os grupos mostraram-se homogêneos em relação à idade, gênero, etnia, escolaridade e condição sócio-econômica. O grupo intervenção apresentou, quando comparado ao controle, após 3 e 9 meses do início do estudo, melhora estatisticamente significante nas médias das Subescalas cognitiva (p<0,001) e somática do BDI (p<0,001), nas médias do BDI total (p<0,001), do MINI (p<0,001), e nas médias das dimensões de qualidade de vida do KDQOL-SF: Sobrecarga da doença renal (p=0,002), Função cognitiva (p=0,001), Sono (p=0,001), Qualidade da interação social (p<0,001), Saúde total (p<0,001) e Sumário mental (p<0,001). Conclusões: A TCC em grupo mostrou-se efetiva para tratar a depressão em pacientes com DRCT / FAPESP: 04/08710-8 / BV UNIFESP: Teses e dissertações

Bakgrund: Dialysbehandling är den vanligaste behandlingsmetoden för patienter i de senare stadierna av njursvikt, som är en allt vanligare sjukdom i världen. Det finns därför ett ökande behov för vårdpersonal och samhället i stort att lära sig om denna patientgrupp, för att på bästa möjliga sätt kunna möta deras behov. Syfte: Syftet är att beskriva patienters upplevelse av att genomgå dialysbehandling. Metod: Detta arbetes design är en litteraturöversikt bestående av 16 artiklar från databaserna PubMed och CINAHL. Resultat: Patienter berättade om kroppsliga besvär i samband med dialysbehandlingen. Fokuset i det de berättade låg dock på förlusten i vardagen efter påbörjad behandling, att ständigt tvingas anpassa sitt liv efter behandlingen och förlusten av sin forna identitet som resultat av detta. Slutsats: Upplevelserna som patienterna beskrev verkade ändras över tid, och vårdpersonal i sin yrkesroll kan ha inverkan på hur denna process utvecklas. / Backgrund: Dialysis is the most common form of treatment for patients suffering from end stage renal disease, an increasingly common ailment throughout the world. As such, there is a growing need for health care personell and society at large to learn about this group of patients to provide the best care possible. Aim: The aim of this study is to describe the experiences of patients undergoing dialysis. Method: The design of this study is a literature review consisting of 16 articles aquired from databases PubMed and CINAHL. Result: Patients described physical issues related to the treatment. But patients stories focused on the loss of everyday life, always having to shape their lives around the treatment, och the loss of their former identity as a result. Conclusion: The experiences described by patients seemed to change over time, and healthcare personell play a role in how this process develops.

CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior / A doenÃa renal crÃnica (DRC) representa, atualmente, um importante problema de saÃde pÃblica. Em estÃgios mais avanÃados, a doenÃa pode levar à insuficiÃncia renal crÃnica terminal, que requer diÃlise ou transplante. O retardo da progressÃo da DRC depende da efetividade da farmacoterapia das doenÃas de base. A nÃo adesÃo ao tratamento farmacolÃgico prejudica o alcance dos resultados terapÃuticos. O estudo dos fatores associados à nÃo adesÃo à importante para que estratÃgias de intervenÃÃo bem sucedidas possam ser implementadas. O objetivo do presente trabalho à mensurar a prevalÃncia da nÃo adesÃo ao tratamento farmacolÃgico e identificar os fatores associados à nÃo adesÃo em doentes renais crÃnicos. O estudo foi realizado no ambulatÃrio de nefrologia do Hospital UniversitÃrio Walter CantÃdio, em Fortaleza (CE), entre novembro de 2004 e abril de 2005, com delineamento transversal. A amostra foi constituÃda por 130 pacientes com diagnÃstico de DRC, maiores de 18 anos, em uso contÃnuo de algum fÃrmaco anti-hipertensivo ou imunossupressor e que nÃo estivessem sendo submetidos a diÃlise ou transplante renal. A nÃo adesÃo foi medida atravÃs dos mÃtodos da entrevista com questionÃrio, das estimativas feitas pelos mÃdicos e da anÃlise dos resultados terapÃuticos, sendo considerados nÃo aderentes os pacientes assim classificados por, pelo menos, um dos mÃtodos. As variÃveis independentes estudadas estavam relacionadas Ãs caracterÃsticas sociodemogrÃficas, caracterÃsticas e percepÃÃes dos pacientes sobre a DRC, o tratamento e o atendimento oferecido e o nÃvel de informaÃÃo sobre o tratamento farmacolÃgico. O banco de dados e anÃlise bivariada foram feitos atravÃs do EPI-INFO versÃo 6.04d, utilizando o teste do qui-quadrado corrigido por Yates e o teste exato de Fisher. Foi realizada uma anÃlise multivariada por meio de um modelo de regressÃo logÃstica, utilizando-se o programa SPSS for Windows versÃo 10.0. Em todos os testes estatÃsticos adotou-se o nÃvel de significÃncia de p < 0,05 (bicaudal) em relaÃÃo ao erro alfa. A freqÃÃncia de pacientes nÃo aderentes, identificados por pelo menos um dos mÃtodos, foi de 61,3% (IC95% = 52,0 â 70,1%). Na anÃlise multivariada trÃs fatores apresentaram associaÃÃo estatisticamente significante com a nÃo adesÃo: tempo de diagnÃstico da DRC inferior a 5 anos (p = 0,015), relato do paciente sobre reaÃÃo adversa a algum medicamento prescrito (p = 0,015) e baixo nÃvel de informaÃÃo sobre o tratamento farmacolÃgico (p = 0,028). à medida que aumentou o nÃvel de informaÃÃo sobre o tratamento farmacolÃgico diminuiu a prevalÃncia da nÃo adesÃo. A prevalÃncia da nÃo adesÃo ao tratamento farmacolÃgico à alta entre os pacientes estudados. Os fatores que apresentaram associaÃÃo estatisticamente significante com a nÃo adesÃo sÃo possÃveis causas deste comportamento. IntervenÃÃes educativas e motivacionais sÃo necessÃrias para a diminuiÃÃo da magnitude do problema. Os resultados observados estÃo coerentes com outros trabalhos encontrados na literatura, entretanto, mais estudos sÃo necessÃrios para avaliar as causas da nÃo adesÃo ao tratamento farmacolÃgico da DRC e a efetividade das intervenÃÃes propostas. / Chronic kidney disease (CKD) is currently an important public health problem. At more advanced stages CKD can take to end-stage renal disease, that request dialysis or renal transplantation. Retard of the progression of CKD depends on the effectiveness of underlying conditions pharmacotherapy. Medication non-compliance harms reaching therapeutic goals. Non-compliance associated factors study is important so that well happened intervention strategies can be implemented. The objective of the present study is to measure the prevalence of medication noncompliance and to identify medication non-compliance related factors in CKD patients. A cross-sectional study was performed at renal outpatient care unit of the Academical Hospital Walter CantÃdio, in Fortaleza (CE), between 2004 november and 2005 april. The sample was constituted by 130 CKD patients, at least 18 years old, continuously taking some self-administered antihypertensive or immunosuppressive drug and not being submitted to dialysis or renal transplantation. Non-compliance was measured by questionnaire, physician assessment and outcomes methods, being considered non-compliant patients if non-compliance has been detected by any method. Independent variables studied were related to sociodemographic characteristics, characteristics and patientsâ perceptions on CKD, its treatment and offered service and information level about pharmacotherapy. Database and bivariate analysis were performed at EPI-INFO version 6.04d, using Yates corrected chi-square and isherâs exact tests. A multivariate analysis was conducted through a logistic regression model using SPSS for Windows version 10.0. Confidence level for all tests was p < 0,05 (two-tailed). Frequency of non-compliant patients, detected by any method, was 61,3% (95%CI = 52,0 â 70,1%). Multivariate analysis results showed that less than 5 years CKD diagnosis time (p = 0,015), selfreport of adverse drug reaction (p = 0,015) and low information level about pharmacotherapy (p = 0,028) presented statistically significant association with noncompliance. As greater the information level about pharmacotherapy smaller the noncompliance prevalence. Medication non-compliance prevalence is high among studied patients. Factors associated with non-compliance are possible causes of this comportment. Educational and motivational interventions are necessary for decrease problemâs magnitude. Observed results are coherent with literature, however, more studies are necessary to evaluate causes of the medication non-compliance on CKD and effectiveness of the proposed interventions.

Introdução: O uso de membranas de alto fluxo tornou-se comum na prática de hemodiálise convencional (HDC), hemodiafiltração (HDF) e hemofiltração (HF) devido ao elevado coeficiente de ultrafiltração e à maior permeabilidade do poro. A produção de fluido de reposição online proporciona maior facilidade na execução de HDF e HF. Estas modalidades aumentam a depuração de solutos maiores por convecção. O objetivo do estudo é comparar a eficácia de três métodos dialíticos: HDC, HDF online (HDF-OL) pós-diluição e HF online (HF-OL) pré-diluição, por meio da quantificação direta da dose de diálise pela extração de solutos. Método: Trata-se de um ensaio clínico, envolvendo 14 pacientes em hemodiálise. Os pacientes iniciaram no estudo na modalidade de HDC com prescrição de quatro horas, fluxo de sangue de 350ml/min e fluxo de dialisato de 800ml/min com dialisador novo de alto fluxo e alta eficiência. Posteriormente, os mesmos pacientes foram submetidos à uma sessão de HDF-OL pós-diluição de quatro horas, fluxo de sangue de 350ml/min, fluxo de reposição de 100ml/min e fluxo de dialisato de 700ml/min. Por último, fizeram uma sessão de HF-OL pré-diluição com mesma duração, fluxo de sangue de 350ml/min e fluxo de reposição de 100% do fluxo de sangue. Foram realizadas 42 sessões de tratamento. A extração de solutos foi avaliada por meio de dosagens plasmáticas e quantificação do efluente. Resultados: As concentrações séricas dos solutos pré-diálise não foram diferentes entre as sessões do estudo. O volume de substituição em HDF-OL foi de 20,6 ± 0,8L/sessão e em HF-OL foi de 81,8 ± 7,1L/sessão. A HDF-OL quando comparada com a HDC não apresentou diferença na extração de moléculas pequenas. Da mesma forma, a extração de ?2-microglobulina foi semelhante nas 3 modalidades: 121,1 ± 46,4 mg em HDC, 130,1 ± 46,5 mg em HDF-OL e 106,0 ± 45,0 mg em HF-OL. A perda de albumina foi significativamente maior em HDF-OL (1360,2 ± 425,0 mg) e HF-OL (1310,3 ± 201,4 mg) Vs. HDC (269,6 ± 15,3 mg) (p<0,0001). A depuração de pequenos solutos foi superior em HDF-OL. A depuração de ?2-microglobulina foi maior em HDF- OL (114,0 ± 15,7 ml/min) e HF-OL (116,1 ± 19,5 ml/min) Vs. HDC (86,5 ± 16,1 ml/min) (p<0,0001). A dose de diálise avaliada pelo singlepool, equilibrated, standard Kt/V e pela quantificação direta da diálise (DDQKt/V) não foi diferente entre HDF-OL e HDC. Na HF-OL a ausência de difusão contribuiu para menor extração e menor Kt/V de solutos pequenos (p<0,0001). Conclusão: A dose de diálise avaliada pela extração de solutos foi semelhante entre HDC e HDF-OL sendo a HF-OL menos favorável na extração de solutos pequenos / Introduction: The use of high-flux membranes became common practice in conventional hemodialysis (CHD), hemodiafiltration (HDF) and hemofiltration (HF) due to the high pore permeability and ultrafiltration coefficient. The online production of substitution volume can make easier HDF and HF execution. These modalities can increase the clearance of larger solutes by convection. The aim of this study is to compare the dialysis efficacy among three methods: CHD, online post-dilution HDF (OL-HDF), and online pre- dilution HF (OL-HF) through the direct quantification of dialysis dose by the solutes extraction. Method: This is a clinical trial involving 14 patients on hemodialysis. The patients began the study in CHD modality with a four-hour prescription, blood flow of 350ml/min and dialysate flow of 800ml/min with new high-flux and high efficiency dialyzer. Subsequently, these patients were submitted to a four-hour post-dilution OL-HDF session, with flow replacement of 100ml/min, blood flow of 350ml/min and dialysate flow of 700ml/min. Finally, patients underwent a pre-dilution OL-HF with the same duration, blood flow of 350ml/min and flow replacement of 100% of the blood flow. Forty-two sessions of treatments were performed. The solutes extraction was assessed by plasma measurements and effluent quantification Results: Pre-treatment serum concentrations of different solutes showed no statistical difference among the modalities. The substitution volume in OL- HDF was 20.6 ± 0.8L/session and in OL-HF was 81.8 ± 7.1 L/session. The OL-HDF compared to CHD showed no difference in the small solutes extraction. Similarly, ?2-microglobulin extraction was similar among the three modalities: 121.1 ± 46.4 mg in CHD, 130.1 ± 46.5 mg in OL-HDF and 106.0 ± 45.0 mg in OL-HF. Albumin loss was significantly higher in OL-HDF (1360.2 ± 425.0 mg) and OL-HF (1310.3 ± 201.4 mg) Vs. CHD (269.6 ± 15.3 mg) (p<0.0001). The small solutes clearance was greater in OL-HDF. ?2- microglobulin clearance was higher in OL-HDF (114.0 ± 15.7 ml/min) and OL- HF (116.1 ± 19.5 ml/min) Vs. CHD (86.5 ± 16.1 ml/min) (p<0.0001). The dialysis dose measured by singlepool, equilibrated, standard Kt/V and by direct dialysis quantification (DDQ Kt/V) was not different between CHD and OL-HDF. In OL-HF the absence of diffusion contributed to lower extraction and lower Kt/V of small solutes. Conclusion: The dialysis dose evaluated by extraction of solutes was similar between CHD and OL-HDF being a OL-HF less favorable in small solutes extraction

Submitted by Renata Lopes (renatasil82@gmail.com) on 2016-04-08T10:45:20Z No. of bitstreams: 1 alessandrabatistamarquito.pdf: 2021743 bytes, checksum: 642d2834b464172c471924679b53a3ef (MD5) / Approved for entry into archive by Adriana Oliveira (adriana.oliveira@ufjf.edu.br) on 2016-04-24T03:45:57Z (GMT) No. of bitstreams: 1 alessandrabatistamarquito.pdf: 2021743 bytes, checksum: 642d2834b464172c471924679b53a3ef (MD5) / Made available in DSpace on 2016-04-24T03:45:57Z (GMT). No. of bitstreams: 1 alessandrabatistamarquito.pdf: 2021743 bytes, checksum: 642d2834b464172c471924679b53a3ef (MD5) Previous issue date: 2013-09-02 / INTRODUÇÃO: Nas últimas décadas, o número de pacientes com doença renal crônica (DRC) em todo mundo tem aumentado, ocasionando um grave problema de saúde pública. Os principais fatores de risco para a DRC, além de transplante renal prévio e história familiar de terapia renal substitutiva, são o diabetes mellitus (DM) e a hipertensão arterial (HAS). A essas duas condições potencialmente graves, acrescenta-se o fato de que essa população é constituída predominantemente por indivíduos da terceira idade, que utilizam diversos fármacos, necessários para a abordagem dos fatores de riscos associados à doença, bem como na tentativa de retardar a evolução da doença para estágios mais avançados. Assim, renais crônicos possuem alto risco para a ocorrência de interação medicamentosa (IM), que constitui uma causa de problema relacionado ao medicamento (PRM). Contudo, a extensão e a frequência da IM não têm sido exploradas no processo de uso dos medicamentos desse grupo de indivíduos. OBJETIVO. Identificar potenciais interações entre medicamentos prescritos a renais crônicos em tratamento conservador e fatores associados a sua ocorrência. MÉTODO. Estudo observacional transversal, com análise de 558 prescrições. O potencial interativo dos medicamentos foi traçado tendo como suporte a base de dados MICROMEDEX®, software que disponibiliza farmacopéias conhecidas internacionalmente. RESULTADOS. Houve predomínio de indivíduos do sexo masculino (54,7%), idosos (69,4%), no estágio 3 da DRC (47,5%), com sobrepeso e obesos (66,7%). As comorbidades mais prevalentes foram a hipertensão arterial sistêmica (68,5%) e o diabetes mellitus (31,9%). Interações medicamentosas potenciais foram detectadas em 74,9% das prescrições. De um total de 1364 IMs detectadas, 229 (16,8%) foram de gravidade maior e 5 (0,4%) contraindicadas, com necessidade de intervenção imediata. Interações de gravidade moderada ou menor foram identificadas respectivamente em 1049 (76,9%) e 81 (5,9%) das prescrições. Observou-se que a probabilidade de ocorrência de uma IM aumentou em 2,5 vezes para cada medicamento adicional (IC= 2,18-3,03). Obesidade, diabetes, hipertensão e estágio avançado da DRC foram fatores de risco fortemente associados para ocorrência de IM. CONCLUSÃO. A associação de medicamentos em indivíduos com DRC relacionou-se com alta prevalência de IMs potencialmente graves, especialmente nos estágios mais avançados da doença. / INTRODUCTION: Over the past three decades the incidence and prevalence of chronic kidney disease (CKD) has risen worldwide. The main risk factors for CKD are above previous kidney transplantation and a positive history of renal replacement therapy, diabetes mellitus (DM) and hypertension (HT). Furthermore, patients with CKD are predominantly over sixty and as a consequence have to take a variety of drugs to control the associated risk factors as well as to attenuate the progression of the disease. Thus, patients with CKD are at high risk for drug interactions (DI) that constitute one cause of drug related problems. However, the extent and frequency of DI is unknown in this group of individuals drug´s use process. OBJECTIVE. Identify potential interactions among drugs prescribed to patients with CKD on conservative treatment, and factors associated with their occurrence. METHODS. Observational cross-sectional study, with analysis of 558 prescriptions. Potential DIs were identified by the database MICROMEDEX®, software that provides an internationally known pharmacopoeia. RESULTS. There was a predominance of males (54.7%), seniors (69.4%), stage 3 CKD (47.5%), overweight and obese patients (66.7%). The most prevalent comorbidities were hypertension (68.5%) and diabetes mellitus (31.9%). Potential DIs were detected in 74.9% of prescriptions. Among the 1364 DIs diagnosed, 5 (0.4%) were contraindicated and 229 (16.8%) of greater severity, which need immediate intervention. Interactions of moderate and low severity were identified in 1049 (76.9%) and 81 (5.9%) prescriptions, respectively. The probability of one DI increased by 2.5 times for each additional drug (CI = 2.18 to 3.03). Obesity, hypertension, diabetes as well as advanced stage of CKD were risk factors strongly associated with DI occurrence. CONCLUSION. Drug associations in individuals with CKD were related to high prevalence of serious DIs, especially in the later stages of the disease.

Chronic haemodialysis patients have a high prevalence of Hepatitis B and C virus infections both of which are associated with chronic liver disease and hepatocellular carcinoma Hepatitis B virus (HBV) was identified as a frequent cause of hepatitis during the early years of chronic haemodialysis therapy and strict adherence to infection control measures alone proved inadequate to control the transmission of infection between patients. A policy of regular screening of all patients and blood donations for hepatitis B surface antigen together with isolation of positive patients to separate dialysis units resulted in a significant decline in the incidence of new infections. Hepatitis B vaccination provided an important new means of protection. Despite the finding that haemodialysis patients did not respond to the vaccine as well as normal adults, randomized controlled trials showed significant protection in units with a previously high incidence of infection. Studies have identified both monocyte dysfunction and B cell inhibition by elevated levels of parathyroid hormone (PTH) as possible mechanisms for the reduced response in dialysis patients. Other factors which have been associated with this poor response include increased age, male gender, specific human leukocyte antigens, shorter time on a dialysis programme and poor nutritional status. One study has shown an increased response in patients receiving recombinant human erythropoietin and. there is in vitro evidence that nifedipine improves B cell proliferation in dialysis patients with hyperparathyroidism. Hepatitis C virus (HCV) infection in haemodialysis patients has been associated with blood transfusions in many studies. However, evidence exists that transmission between patients also occurs. There is disagreement as to what measures are necessary to prevent possible nosocomial spread. Some authors recommend isolation of HCV -infected patients to separate dialysis machines or units. There is also concern over the potential of dialyzer reuse to transmit the virus. A protocol for surveillance 0f hepatitis B and C infections was established in the dialysis unit at Groote Schuur Hospital while HCV positive patients were not isolated and reuse of dialyzers was continued for all patients. HBV -infected patients are dialyzed in a separate unit and their dialyzers are not reused. A trial of hepatitis B vaccination of all antibody negative patients was undertaken using four doses of a plasma-derived vaccine given intramuscularly at month 0,1 ,2 and 4.

The pharmacokinetics of orally administered ranitidine were studied in 10 patients with endoscopically proved duodenal ulceration after a single 150 mg dose and after 4 weeks 1 ranitidine treatment (150 mg twice daily), at which time there was endoscopic evidence of complete ulcer healing. After a single dose the median elimination half-life was 135 minutes and the median area under the curve (AUC) was l 844 ng/ml.hr. Although the maximum concentration after a single dose (Cmax = 365 ng/ml) was significantly different from that after continuous treatment (Cmax = 562 ng/ml) (p <0,05) there was no significant difference between the minimum concentrations at 12 hours post-dosing (Cmin = 35 ng/ml and 30 ng/ml respectively) and the median half-lives were identical. No accumulation of ranitidine occurred in these patients after 4 weeks' chronic ranitidine treatment. Five patients received 20 mg ranitidine intravenously. The apparent volume of distribution of the central compartment ranged from 10,5 to 28,4 1 while the elimination rate constant β range from 0,34 to 0,78 h⁻¹ with the t½ ranging from 53 to 122 minutes. The mean oral bioavailability was 51%. The pharmacokinetics of ranitidine were studied in a further 7 patients with chronic duodenal ulceration who showed endoscopic evidence of unhealed ulcers after at least 8 weeks' treatment with ranitidine. There were no significant differences in any of the pharmacokinetic parameters when these patients were compared with the 10 responders above after multiple-dosage except that the disposition rate constant was smaller in non-responders (0,24 h⁻¹ compared with 0,31 h⁻¹, p <0,002). Two patients did, however, have very low plasma concentrations with above average basal and maximal acid output which may have contributed to the lack of response to ranitidine treatment. Single- and multiple-dose pharmacokinetic studies of oral ranitidine were carried out in 6 patients with chronic renal failure (RF) (creatinine clearance <25 ml/min) and compared with those obtained for the 10 patients with chronic duodenal ulceration with normal renal function (creatinine clearance >65 ml/min). There appeared to be no significant differences in absorption rate or amount absorbed but the median elimination rate constant was significantly reduced from 0,31 h⁻¹ in controls to 0,14 h⁻¹ in RF (p <0,002) resulting in a two-fold increase in t½ (312 minutes) after a single dose. Cmax did not differ significantly although Cmin and AUC were significantly larger in RF patients (both p <0,002). It is suggested that the dosage of ranitidine be reduced from 150 mg to 75 mg twice daily in severe renal failure although it was not possible to relate half-life, elimination rate constant or AUC directly to creatinine clearance.

Bakgrund: Kronisk njursvikt innebär att njurens funktioner gradvis minskar och blir nedsatta över tid, vilket kräver dialysbehandling i flera omgångar. Några av symtomen som kan uppstå i samband med kronisk njursvikt är bland annat klåda. Uremisk klåda kan besväras av både fysiskt och psykiskt då det bidrar till sår, ökad trötthet, försämrad livskvalitet. Lidande och obehag som orsakade av uremisk klåda kan ytterligare leda till depression och ångest. Det är därför viktigt att sjuksköterskor kan bemöta och hjälpa patienter som lider av uremisk klåda att lindra symtomen. Syfte: Syftet var att beskriva sjuksköterskors omvårdnadsåtgärder för att lindra uremisk klåda vid kronisk njursvikt Metod: Litteraturöversikten med tolv vetenskapliga artiklar. Databaserna PubMed och CINALH complete användes. Artiklarna analyserades med hjälp av Fribergs analysmodell. Resultat: I resultatet framkom fem teman; (1) Aromaterapi, (2) Termisk terapi, (3) Akupressur, (4) Krämer och (5) Övriga metoder. Dessa fem teman har visat vara effektiva för att lindra uremisk klåda. Slutsats: Sammanfattningsvis har aromaterapi, termisk terapi, akupressur, krämer och övriga omvårdnadsåtgärder visat sig verkande lindrande på uremisk klåda. Genom att tillämpa dessa omvårdnadsåtgärder kan det ytterligare bidra till bättre sömnkvalitet samt livskvalitet för patienterna som lider av uremisk klåda. Dessutom är omvårdnadsåtgärder kostnadseffektiva alternativ gentemot medicinska behandlingen. / Background: Chronic kidney failure means that the kidney's functions gradually decrease and become impaired over time, which requires dialysis treatment several rounds. Some of the symptoms that can occur in connection with chronic kidney failure is itching. Uremic itching can be troublesome both physically and psychologically as it contributes to ulcers, increased fatigue and reduced quality of life. Pain and discomfort caused by uremic pruritus can further lead to depression and anxiety. Therefore, it is necessary that nurses can address and help patients that are suffering from uremic pruritus to relieve the symptoms. Aim: The aim was to describe nurses care measure to treat pruritus in patients with chronic kidney failure. Method: The litterature review based on twelve scientific articles. The databases Pubmed and CINALH complete were used. The scientific articles were analyzed using Friberg´s model. Results: The results showed five themes; (1) Aromatherapy, (2) Thermal therapy, (3) Acupressure, (4) Creams and (5) Other methods. These five themes have been shown to be effective in relieving uremic pruritus. Conclusion: In conclusion, aromatherapy, thermal therapy, acupressure, creams and other methods have been shown to be working in treating uremic pruritus. By applying these nursing interventions can it further contribute to better quality of sleep and quality of life for patients that are suffering from uremic pruritus. Furthermore, are nursing interventions cost-effective alternatives to medical treatment.

Syftet med denna studie var att undersöka hur personer med egenadministrerad peritonealdialys (PD) upplever sitt dagliga liv. Metoden var en intervjustudie där sju personer som behandlades med PD intervjuades med hjälp av en semistrukturerad intervjuguide. Materialet som analyserades med en manifest kvalitativ innehållsanalys resulterade i tre huvudkategorier: kroppsliga förändringar, upplevelser av PD-behandling samt egenvård. Resultatet visade att PD hade inverkan på olika plan i informanternas dagliga liv. Ett viktigt fynd var hur informanterna uppfattade att PD hade lett till vissa kroppsliga förändringar, exempelvis vad gäller vikt och aptit. Det mest framträdande fyndet var emellertid att PD ledde till en bundenhet, vilket orsakade en oönskad passivitet hos informanterna. Det framkom dessutom att de informanter som väntade på njurtransplantation upplevde att denna väntan ledde till mer inskränkning i det dagliga livet än vad PD gjorde. Informanterna beskrev även de positiva aspekterna av PD-behandlingen och betonade fördelen med att PD möjliggjorde en självständighet och en flexibilitet. Denna studie gav ett brett perspektiv av hur personer med PD upplever sitt dagliga liv och visade att det inte bara är de kroppsliga förändringarna som påverkar personerna utan att PD även leder till känslor av bundenhet och passivitet. / The purpose of this study was to explore how people with self-administered peritoneal dialysis (PD) experience their daily life. The method was an interview study in which seven people who were treated with PD were interviewed using a semistructured interview guide. The material was analyzed with a manifest content analysis and resulted in three main categories: bodily changes, sensations of PD treatment and self-care. The results showed that PD had an effect in different levels in the informants’ daily lives. One important finding was how the informants perceived that the PD had led to certain bodily changes for example in terms of weight and appetite. The most striking finding, however, was that the PD led to a lack of freedom causing an undesirable passivity of the informants. It also showed that respondents who were waiting for kidney transplantation felt that this anticipation led to more restriction in daily life than PD did. The informants also described the positive aspects of PD treatment and stressed advantages such as that PD allowed autonomy and flexibility. This study gave a broad perspective of how people with PD experience their daily life and showed that not only the physical changes affected them but also led to feelings of restraint and passivity.