Application Of Evidence-supervisory Nursing In Elderly Hemodialysis-associated Hypotension

Background: Hemodialysis-associated hypotension(HDAH)，which isreported an incidence of20%to40%, is one of the most commoncomplications of hemodialysis and an independent factor affecting the survivalrate of patients. The elder who suffers from HDAH is more susceptible toinduce severe hypovolemic shock，cardiopulmonary arrest and even death.Therefore， controlling blood pressure(BP) to normal is regarded as an idealgoal of the treatment of elderly patients with hemodialysis.So, with regard toclinical nursing, it is emergency to find effective and feasible nursinginterventions to reduce HDAH, which plays an important role in improvingquality of life, enhancing dialysis adequacy and extending length of life ofpatients with hemodialysis.Objective: Through taking two different nursing interventions on the elderwith maintenance hemodialysis to explore effective and feasible nursing interventions to reduce HDAH, which will provide a necessary scientific basisfor the elderly dialysis patients’ health and quality of life.Methods:According to inclusion and exclusion criteria and conveniencesample criterion,we selected80cases of elderly dialysis patients who tookregular hemodialysis in Nephropathy department of the second the Hospital ofJilin University from March2012to Nov2012. The80elderly dialysis patientswho were divided equally into intervention group(n=40)and controlgroup(n=40)by the method of random sampling,were being taken two differentnursing interventions for3months. The patients in control group acceptedstandardized nursing interventions，and the patients in intervention groupaecepted evidence-supervisory nursing interventions.Then we analyzed thedifference primary diseases,age， sex between the two groups,Compareddifferent nursing interventions for the elder’s HDAH, nutritional status, qualityof life and satisfaction of medical care.Results:1. There were no statistical significance differences between the two groups ingender and age. 2. The incidence rate of HDAH was14.50%in intervention group，which waslower than23.16%in control group.There was statistical significancedifference between the two groups.3. Nutritional status：The nutritional index of intervention group was betterthan control group inalbumin(ALB), prealbumin(PA), hemoglobin(HB),cholesterin(CHOL). There were statistical significance differences betweenthe two groups.4. Quality of Life(QOL): Through estimating the two group of elder patientswith SF-36assessment scale, we found that the intervention group was stillbetter than the control group in eight aspects,such as physiologicalfunctions,bodily pain,and so on. There were statistical significancedifferences between the two groups.And according to emotional functions,there was significant difference between the two groups. It showed that thescore of emotional functions in intervention group was75.57±19.17,whilethe the control group was50.12±25.48(t=5.751,p=0.000).5. In Satisfaction evaluation of medical care, the intervention group was morebetter than the control group. Conclusion:Evidence-supervisory nursing is better than standardizednursing during the hemodialysis process of the elder patients. Compared withthe conventional nursing， Evidence-supervisory nursing can decrease theincidence rate of HDAH, improve elderly hemodialysis patients’ nutritionalstatus and enhance elderly hemodialysis patients’quality of life and Satisfactionevaluation of medical care.