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Controlo da hiperfosfatemia na pessoa com doença renal crónica terminal em programa de diálise peritoneal :
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Advisor(s)
Abstract(s)
Este relatório mostra como foram desenvolvidas as competências de mestre e
enfermeiro especialista, analisando as atividades realizadas em vários campos de
estágio. Estima-se que 20% da população portuguesa tenha Doença Renal Crónica
(DRC), sendo um dos países europeus com maior prevalência de pessoas sob
Terapia de Substituição da Função Renal (TSFR). A Diálise Peritoneal (DP) é uma
das TSFR disponíveis possibilitando a diálise domiciliária.
A hiperfosfatemia é uma complicação comum da DRC em pessoas em DP,
devido à falência renal para excretar o Fósforo (P). Entre outras complicações pode
causar hipocalcemia, calcificação dos tecidos moles ou calcificação vascular. Esta
aumenta o risco de morte por doenças cardiovasculares, a principal causa de morte
em DP. Logo, é fundamental ajudar a pessoa a controlar a hiperfosfatemia. O
enfermeiro de DP pode atuar em três dimensões: na restrição dietética de P; na
administração de Medicamentos Fixadores do Fósforo (MFF) e na otimização da
prescrição de DP. Nas duas primeiras o enfermeiro pode mobilizar sistemas de
enfermagem de apoio/educação, capacitando a pessoa para o autocuidado na gestão
do regime medicamentoso e dietético. O enfermeiro também contribui para avaliar a
membrana peritoneal e otimizar a prescrição de DP.
A revisão scoping inserida neste relatório visou responder à questão: “Quais as
estratégias que promovem o controlo da Hiperfosfatemia na pessoa com Doença
Renal Crónica Terminal (DRCT) em programa de DP?”. Conclui-se que as estratégias
para controlar a hiperfosfatemia, que podem ser mobilizadas pelos enfermeiros em DP
incluem: a educação regular sobre os MFF; a educação contínua sobre a restrição de
P, tendo em conta o método de confeção, a seleção dos alimentos e a
biodisponibilidade do P; a otimização da prescrição de DP; e a manutenção da função
renal residual. Constatou-se que existem poucos estudos sobre este tema
desenvolvidos no contexto da DP por enfermeiros, sendo importante que no futuro se
possa investir nesta área, para prevenir as complicações associadas à hiperfosfatemia
na pessoa em DP.
This report shows how the skills of master and specialized nurse were developed through the analysis of the activity developed in diverse internship grounds. An estimated 20% of the Portuguese population has Chronic Kidney Disease, being one of the European countries with a higher rate of people undergoing Renal Replacement Therapy. Peritoneal Dialysis is one of the Renal Replacement Therapies available at the moment, making at-home dialysis possible. Hyperphosphatemia is a common complication in Peritoneal Dialysis patients that occurs when the kidneys fail to excrete phosphorus. Among other complications, it may cause hypocalcemia, calcification of the soft tissues or vascular calcification. It increases the risk of vascular disease, being the main cause of death related to Peritoneal Dialysis. Therefore, it is fundamental to help the patient control hyperphosphatemia. There are three dimensions in which the Peritoneal Dialysis nurse can act: phosphorus dietary restrictions; administration of oral phosphate binders and the optimization of Peritoneal Dialysis prescription. In the first two dimensions, the nurse can mobilize support and educational nursing systems, allowing patients achieve self-care in the management of medication and dietary regimes. The nurse also contributes to the assessment of the peritoneal membrane and the optimization of the Peritoneal Dialysis prescription. The scoping review included in this report was meant to answer the question: "Which strategies promote Hyperphosphatemia control in Chronic Kidney Disease patients undergoing Peritoneal Dialysis?". It was concluded that the strategies to control hyperphosphatemia that can be conducted by Peritoneal Dialysis nurses include: ongoing education on oral phosphate binders; continuous education on dietary control of phosphate, taking into consideration cooking methods, food selection and phosphorus bioavailability; optimization of the Peritoneal Dialysis prescription; and preserving residual kidney function. It was found that there are few studies on this subject developed in the context of Peritoneal Dialysis performed by nurses, which demonstrates the importance of future investment in this area, in order to prevent complications associated with hyperphosphatemia in Peritoneal Dialysis patients.
This report shows how the skills of master and specialized nurse were developed through the analysis of the activity developed in diverse internship grounds. An estimated 20% of the Portuguese population has Chronic Kidney Disease, being one of the European countries with a higher rate of people undergoing Renal Replacement Therapy. Peritoneal Dialysis is one of the Renal Replacement Therapies available at the moment, making at-home dialysis possible. Hyperphosphatemia is a common complication in Peritoneal Dialysis patients that occurs when the kidneys fail to excrete phosphorus. Among other complications, it may cause hypocalcemia, calcification of the soft tissues or vascular calcification. It increases the risk of vascular disease, being the main cause of death related to Peritoneal Dialysis. Therefore, it is fundamental to help the patient control hyperphosphatemia. There are three dimensions in which the Peritoneal Dialysis nurse can act: phosphorus dietary restrictions; administration of oral phosphate binders and the optimization of Peritoneal Dialysis prescription. In the first two dimensions, the nurse can mobilize support and educational nursing systems, allowing patients achieve self-care in the management of medication and dietary regimes. The nurse also contributes to the assessment of the peritoneal membrane and the optimization of the Peritoneal Dialysis prescription. The scoping review included in this report was meant to answer the question: "Which strategies promote Hyperphosphatemia control in Chronic Kidney Disease patients undergoing Peritoneal Dialysis?". It was concluded that the strategies to control hyperphosphatemia that can be conducted by Peritoneal Dialysis nurses include: ongoing education on oral phosphate binders; continuous education on dietary control of phosphate, taking into consideration cooking methods, food selection and phosphorus bioavailability; optimization of the Peritoneal Dialysis prescription; and preserving residual kidney function. It was found that there are few studies on this subject developed in the context of Peritoneal Dialysis performed by nurses, which demonstrates the importance of future investment in this area, in order to prevent complications associated with hyperphosphatemia in Peritoneal Dialysis patients.
Description
Keywords
Enfermagem em nefrologia Insuficiência renal crónica Diálise peritoneal Fósforo Hiperfosfatemia