• Journal of The Korean Society of Clinical Toxicology
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• v.16 no.2
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• pp.157-160
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• 2018

Chronic silica nephropathy has been associated with tubulointerstitial disease, immune-mediated multisystem disease, chronic kidney disease, and end-stage renal disease. On the other hand, acute intentional exposure is extremely rare. The authors' experienced a 44-year-old man who took rapid cement hardener (sodium silicate) in a suicide attempt whilst in a drunken state. He visited the emergency department approximately 1 hour after ingestion. Information on the material was obtained after 3 L gastric lavage. The patient complained of a sore throat, epigastric pain, and swollen to blood tinged vomitus. Proton pump inhibitors, hemostats, steroid, and fluids were administered. Nine hours after ingestion, he was administered 200 mL hematochezia. Immediately after, a gas-troenterologist performed an endoscopic procedure that revealed diffuse hyperemic mucosa with a color change and variable sized ulceration in the esophagus, whole stomach, and duodenal $2^{nd}$ portion. Approximately 35 hours later, persistent oligouria and progressive worsening of the renal function parameters (BUN/Cr from 12.2/1.2 to 67.5/6.6 mg/dL) occurred requiring hemodialysis. The patient underwent 8 sessions of hemodialysis for 1 month and the BUN/Cr level increased to 143.2/11.2 mg/dL and decreased to 7.6/1.5 mg/dL. He was discharged safely from the hospital. Follow up endoscopy revealed a severe esophageal stricture and he underwent endoscopic bougie dilatation. Acute cement hardener (sodium silicate) intoxication can cause renal failure and strong caustic mucosal injury. Therefore, it is important to consider early hemodialysis and treatment to prevent gastrointestinal injury and remote esophageal stricture.

• Journal of The Korean Society of Clinical Toxicology
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• v.20 no.2
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• pp.39-44
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• 2022

N-Acetylcysteine (NAC) is the standard antidote treatment for preventing hepatotoxicity caused by acetaminophen (AAP) poisoning. This review summarizes the recent evidence for the treatment of AAP poisoning. Several alternative intravenous regimens of NAC have been suggested to improve patient safety by reducing adverse drug reactions and medication errors. A two-bag NAC infusion regimen (200 mg/kg over 4 h, followed by 100 mg/kg over 16 h) is reported to have similar efficacy with significantly reduced adverse reactions compared to the traditional 3-bag regimen. Massive AAP poisoning due to high concentrations (more than 300-lines in the nomogram) needs to be managed with an increased maintenance dose of NAC. In addition to NAC, the combination therapy of hemodialysis and fomepizole is advocated for severe AAP poisoning cases. In the case of a patient presenting with an altered mental status, metabolic acidosis, elevated lactate, and an AAP concentration greater than 900 mg/L, hemodialysis is recommended even if NAC is used. Fomepizole decreases the generation of toxic metabolites by inhibiting CYP2E1 and may be considered an off-label use by experienced clinicians. Since the nomogram cannot be applied to sustained-release AAP formulations, all potentially toxic sustained-release AAP overdoses should receive a full course of NAC regimen. In case of ingesting less than the toxic dose, the AAP concentration is tested twice at an interval of 4 h or more; NAC should be administered if either value is above the 150-line of the nomogram.

• Journal of Korean Public Health Nursing
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• v.15 no.2
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• pp.314-323
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• 2001

The purpose of this study was to investigate the levels of hope and the influencing factors on the hope in the hemodialysis patients. The subjects of this study consisted 101 patients who had received hemodialysis In two hospitals affiliated with Catholic University from June to August, 2000. The instruments used for the study were the Hope scale by Miller(1998) and Quality of life scale, Self esteem scale and Social support scale. Cronbach's $\alpha$ of measurement tools used in the study were 0.93 for the hope, 0.96 for quality of life, 0.78 for self-esteem and 0.92 for the social support. The data were analyzed by mean, t-test, ANOVA. Scheffe test, Pearson correlation coefficients and Stepwise multiple regression using the SAS program. The results were as follows; 1. Out of a score of 164 the mean score of the hope was $107.3\pm16.7$. The mean quality of life score was 102.5 out of 160. The scores concerning social support turned out to have a mean of 67.8 out of 100. The levels concerning self-esteem and self respect had a mean of 25.1 out of 40. 2. There was a positive relation between the quality of life and social support. Furthermore, the hope level was proportional to factors such as quality of life and social support. 3. Social support accounted for $32\%$ of influential variable on the hope. If transportation way to the hospital and quality of life were added. the total predictors explained $45\%$. The results suggested that the hope levels of hemodialysis patients were influenced by their social support and quality of life. Therefore nurses are encouraged to elevate the levels of patients' hope by using the social support and quality of life in caring the patients receiving hemodyalysis.

• Journal of Korean Academy of Nursing
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• v.47 no.1
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• pp.14-24
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• 2017

Purpose: The purpose of this study was to construct and test a hypothetical model of self-management in patients with hemodialysis based on the Self-Regulation Model and resource-coping perspective. Methods: Data were collected from 215 adults receiving hemodialysis in 17 local clinics and one tertiary hospital in 2016. The Hemodialysis Self-management Instrument, the Revised Illness Perception Questionnaire, Herth Hope Index and Multidimensional Scale of Perceived Social Support were used. The exogenous variable was social context; the endogenous variables were cognitive illness representation, hope, self-management behavior, and illness outcome. For data analysis, descriptive statistics, Pearson correlation analysis, factor analysis, and structural equation modeling were performed. Results: The hypothetical model with six paths showed a good fitness to the empirical data: GFI=.96, AGFI=.90, CFI=.95, RMSEA=.08, SRMR=.04. The factors that had an influence on self-management behavior were social context (${\beta}=.84$), hope and cognitive illness representation (${\beta}=.37$ and ${\beta}=.27$) explaining 92.4% of the variance. Self-management behavior mediated the relationship between psychosocial coping resources and illness outcome. Conclusion: This research specifies a more complete spectrum of the self-management process. It is important to recognize the array of clinical resources available to support patients' self-management. Healthcare providers can facilitate self-management through collaborative care and understanding the ideas and emotions that each patient has about the illness, and ultimately improve the health outcomes. This framework can be used to guide self-management intervention development and assure effective clinical assessment.

• Journal of Korean Clinical Nursing Research
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• v.20 no.1
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• pp.134-145
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• 2014

Purpose: The purpose of this study was to develop and apply a video dietary instruction program for hemodialysis patients to understand dietary compliance as well as the effect on the physiological indicator. Methods: This is a quasi-experimental study of a nonequivalent control group pre-post test design. Data were collected from August 6, 2012 to January 10, 2013. Twenty patients were assigned to an experimental group and twenty-one patients were assigned to a control group. A video dietary instruction program was developed and applied only to the experimental group once a week for a total of 8 weeks. Dietary compliance and physiological indicators were subsequently measured. Results: Dietary compliance was improved in both groups over time. There was no significant change in the physiological indicator value in both groups, indicating that there was no correlation between the treatment type and time. Conclusion: The video dietary instruction program could not make a statistically significant change on the physiological indicator value of the experimental group; however, this change was maintained within the allowable limits. Therefore, the video dietary instruction program can be utilized continuously as a standardized nursing intervention program in order to maintain the dietary compliance of hemodialysis patients.

• Journal of the Korean Dietetic Association
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• v.19 no.4
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• pp.373-388
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• 2013

The purpose of this study was to investigate the effects of a nutrition education and exercise on nutritional status in hemodialysis patients, with regard to quality of life (QoL), and fatigue. The subjects were divided into two groups : an educated (E) group (11 men and 9 women) and a non-educated (NE) group (7 men and 22 women). The educated group received a nutrition education and a regular exercise program for 3 months. Data on anthropometric indices and biochemical parameters were obtained from medical records. Dietary habits and nutrient intake were assessed through questionnaires and three-day food records. QoL (through the SF-36 questionnaire) and fatigue (measured by a visual analogue scale questionnaire) were assessed before and after the interventions. Dietary habit scores regarding food variety and fluid intake control significantly increased (P<0.05) after the nutrition education. Furthermore, the intake of total energy, carbohydrates, Fe, and vitamin A significantly increased (P<0.05). Vitamin C intake also significantly increased (P<0.01). Hb levels decreased whereas TG levels increased in the NE group. BUN levels decreased in the E group. After the nutrition education, QoL aspects, such as feelings of pain and general health, and the total score significantly increased (P<0.05) and the level of fatigue score decreased (P<0.01). The results of this study indicate that nutrition education and exercise for hemodialysis patients provides changes in dietary habit, daily nutrient intake, biochemical parameters, QoL, and the level of fatigue. Therefore, nutrition education and exercise help improve nutritional status and QoL.

• Korean Journal of Psychosomatic Medicine
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• v.6 no.1
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• pp.59-69
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• 1998

Objectives: This research was performed to know severity of depression and anxiety, the psychopathology of hemodialysis patients and kidney transplantation patients using Minneesota Multiphasic Personality Inventory(MMPI) and Zung's Self-rating Depression Scale (SDS), Zung's Self-rating Anxiety Scale(SAS), MMPI Subscales. Methods: We surveyed 31 hemodialysis patients and 119 kidney transplantation patients. 119 kidney transplantation group(KT) was investigated at ; 1) Before kidney transplantation (KT-1), 2) Three days after kidney transplantation(KT-2), 3) Three weeks after kidney transplantation(KT-3),4) Follow up at OPD(F/U). Results: 1) According to dermographic data, mean age was KT 33.1, HD 42.2, Control 33.1 years old and KT, HD were belonged to lower economic states and lower educational level than Control. 2) In the depression scale for SDS, KT-1 was more depressed than F/U and Control but depression scale was significantly decreased at KT-2 in comparison with HD. In the anxiety scale for SAS, KT-1 was more anxious than Control but anxiety scale was not different within IT subgroups and in comparison with HD. 3) In comparison of MMPI scales, Hs, D, Pt, Ma at KT-1, Pd, Pa, Pt, Ma at KT-2, F, D, Pd, Pt, Pa, Sc, Ma at KT-3, Pt at F/U were more high scores than Control.

• Journal of Korean Clinical Nursing Research
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• v.17 no.2
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• pp.286-296
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• 2011

Purpose: This research was done to compare the pain relief effects of various nursing interventions, such as cold therapy, attention diversion and 10% Lidocaine spray during arteriovenous fistula needling for patients on hemodialysis, and also to identify and develop more effective nursing interventions for pain relief in these patients. Methods: This research was conducted from October 1, 2010 to January 31, 2011 with 8 hemodialysis patients, who were on regular dialysis (3 times a week) at K University Hospital in Seoul and had an arteriovenous fistula within the past 3 months. Each patient received the three nursing interventions (cold therapy, attention diversion and 10% Lidocaine spray therapy) prior to the arteriovenous fistula needling and applied in turn with the series being repeated 4 times. After each intervention, physiologic indexes, subjective and objective pain were measured at the time of needling. ANOVA was used with SPSS/WIN 12.0 to analyze pain scores and comparison of physiologic indexes (BP, pulse). Results: No significant differences were found for subjective pain (p=.574), objective pain (p=.562) and total pain (p=.506) among the 3 interventions. Systolic blood pressure (p=.689), diastolic blood pressure (p=.969) and pulse (p=.980) also showed no significant difference among the 3 interventions. Conclusion: These 3 interventions are all possible for pain relief during arteriovenous fistula needling for these patients. However, the only interventions that nurses can do independently are cold therapy and attention diversion so we recommend that these nursing interventions be used.

• Journal of the Korea Academia-Industrial cooperation Society
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• v.20 no.7
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• pp.589-598
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• 2019

This study was conducted to build a structural equation model explaining factors that affect hemodialysis patients' quality of life to test the goodness of fit of the model and identify directly and indirectly significant paths. To accomplish this, 230 patients receiving hemodialysis registered at study hospitals in G Metropolitan City and M City were randomly selected, and 201 were used in the final analysis. Data were collected using a self reporting questionnaire from February 1 to March 31, 2014. SPSS WIN 18.0 was used for descriptive statistics and correlation analysis of the general characteristics and for reliability analysis of the research tools. In addition, AMOS 18.0 was used for confirmatory factor analysis of latent variables, to determine the goodness of fit of the hypothetic model, and hypotheses testing. The results of this study were as follows: the fit of the modified model was 41.32, GFI = .96, AGFI = .92, RMR = .04, NFI = .96, CFI = .91 and TLI = .95. Twelve out of the 22 research hypotheses that were improved and improved were statistically significant. The results indicated that hemodialysis patients' quality of life was influenced directly by self-efficacy, depression, and self-care behavior, and indirectly by sleep disturbance, stress, fatigue, and family support. These variables explained 58.6% of the variation in quality of life. Overall, these findings suggest that nursing interventions for hemodialysis patients require strategies for managing patient depression and for increasing self-efficacy and self-care behavior to improve quality of life.

• Journal of Chest Surgery
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• v.53 no.6
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• pp.417-419
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• 2020

Surgeons avoid creating arteriovenous fistulae in obese patients owing to deep vessels, cannulation complications, and inconsistent outcomes. We describe placing an arteriovenous polytetrafluoroethylene (PTFE) graft between the brachial artery and axillary vein to avoid these complications. A 39-year-old super-obese woman with end-stage renal disease had undergone several hemodialysis access procedures on both arms. We traced the course of the arteriovenous graft course with the patient sitting and lying down. The ideal course was more accurate with the patient sitting; thus, the patient sat when the course was drawn, before lying on the operating bed. The PTFE graft was placed between the right brachial artery and axillary vein, according to the course in the opposite arm. No anastomotic dehiscence or pseudoaneurysm has taken place during 2 years of follow-up. In super-obese patients, the ideal course for arteriovenous grafts should be drawn while they are sitting, avoiding skin folds. This tip could avoid anastomotic dehiscence and pseudoaneurysm between the axillary vein and a PTFE graft.