Running head: FRESENIUS 1

Summary of Activities at Fresenius

Kacy Shaffer

Fontbonne University
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Diet Education Reflection

The diet educations at Fresenius were very different from those done at BJSP. These

were outpatients coming in for HD rather than patients in acute care. The main population

included low-income African-American males. Cynthia said most of them were on Medicaid and

had low education. I only did two education sessions during my two weeks at Fresenius. With a

different preceptor, it felt more high pressure. She essentially told me what to say to them during

the education. The first patient was polite and seemed interested in my education and said he

would try to make the changes I suggested. The second patient had a history of drug abuse and

did not seem to take the education seriously, making jokes throughout the session. Overall, it was

good to get some experience with a different population.

Nutrition Care Plans Reflection

This was very different than those I completed at BJSP. Cynthia specifically instructed

that I come with her and watch her assess the patients and not say anything. It was interesting to

see how HD and PD affect a persons life. There is a lot that goes into a patient on dialysis with

labs, medications, and diet. I had a lot of experience seeing patients at BJSP, so this was just a

little insight into a different setting.

Regulations Reflection (Activity 5)

Cynthia explained how another dialysis clinic lost 25% of its income from Medicaid

because they did not meet the standards. They had to fire two nurses because of the decrease in

funding. She explained that they must make sure they are each following proper protocol. For

example, since the albumins were trending low in her patients, Cynthia had to show that she was

addressing this. One thing we did was pass out the Rossi Frosty treats while educating on the

importance of protein.
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Common Medications (Activity 21)

Cynthia talked about a lot of the medications while she went over bone management with

me. She explained how they often start low with a phosphate binder which is usually Renvela or

calcium acetate. She said that Renvela can cause the gut to rupture if too much is taken. If no

success with these, they move to a medication that can reduce phosphate levels called Fosrenol

which has lanthanum in it that competes with calcium but does not cross the blood/brain barrier.

This one, the patient must chew and it has a bad taste, which causes compliance issues. Velphoro

is an iron based medication used to control serum phosphorus levels and can be broken up and

swallowed, so that helps. It also has an ingredient that helps with constipation that people

typically face with iron supplements. Auryxia has to be swallowed and the body can absorb the

left over iron and excrete what it doesnt need.

Sensipar mimics calcium, it gets on the Ca receptors and can decrease Ca so your body

can get the vitamin D it needs. If parathyroid hormone (PTH) increases, active vitamin D can be

given which goes to a receptor and decreases the release of PTH. If the Ca x P product is 70 or

above, vitamin D has to be held. With product above 70, Ca and phosphorus are precipitating

and can cause calcification.

Hemodialysis Treatment (Activity 23)

I watched the whole process as a patient was put on dialysis all the way until they were

removed and got their standing blood pressure. Most patients have a graft or an AV fistula, but

Cynthia said a fistula is a safer option. Some have a venous catheter. There are two needle sticks,

one for taking the blood to the filter and one for returning the filtered blood. The blood is taken

from this to the dialyzer, known as an artificial kidney because it filters the blood. There are

different sizes for different size people because a very tiny person does not have as much blood
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to filter as a very large person, as Cynthia explained. The blood never touches the dialysis

machine. It stays in the tubes which are put in the biohazard container after each round of

dialysis.