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Effect of Intradialytic Range of Motion Exercises on Dialysis Efficacy and Blood Pressure Among Patients Undergoing Hemodialysis Sahar A

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Effect of Intradialytic Range of Motion Exercises on Dialysis Efficacy and Blood Pressure Among Patients Undergoing Hemodialysis Sahar A https://menj.journals.ekb.eg MNJ Print ISSN: 2735-3974 Menoufia Nursing Journal Online ISSN: 2735-3982 Faculty of Nuring DOI: --------------------------------- Menoufia University Effect of Intradialytic Range of Motion Exercises on Dialysis Efficacy and Blood pressure among Patients Undergoing Hemodialysis Sahar A. Mohamed1, Amal A. Kanona2, Nahed F. El-Gahsh3 1B.Sc. Nursing, 2Assistant Professor of Nursing, 3Assistant Professor of Nursing Medical Surgical Department, Faculty of Nursing, Menofia University Abstract: Background: End stage renal disease is a major public health problem in developing countries. Purpose: To determine the effect of intradialytic exercises on dialysis efficacy and blood pressure among patients undergoing hemodialysis. Setting: The hemodialysis unit of Menoufia University Hospital. Sampling: A consecutive sample of 50 adult hemodialysis patients were selected and divided alternatively into two equal groups: 25 patients for each group (study - control). Instruments: Four instruments were used for data collection: Structural interview questionnaire, bio-physiological instrument, and observational checklist. Results: There was a reduction in mean urea one month after intervention and mean of blood pressure (128.48 ± 9.70 Vs 134.55 ±3.78). Conclusions: Intradialytic exercises were effective in improving dialysis efficacy and blood pressure scores for patients undergoing hemodialysis. Recommendations: A health teaching program about intradialytic exercises should be carried out for all hemodialysis patients to improve dialysis efficacy and blood pressure. Besides, a colored booklet should be available and distributed to all hemodialysis patients. Key words: Blood pressure, Dialysis efficacy, Intra dialytic exercises. Introduction Kidney disease is defined as a global adequate waste removal, and normal public health problem that affects more hormonal function. To survive, people than 750 million persons worldwide. with ESRD must undergo some form of Chronic kidney disease (CKD) is not a renal replacement therapy, namely, a functionally static process because it is peritoneal dialysis, or hemodialysis a progressive one that can lead to end- (HD), or kidney transplantation stage renal disease (ESRD). ESRD (Parsons et al., 2016a). substantially alters the patient’s End-stage renal disease is associated lifestyle and imposes increased with severe morbidity, mortality, high morbidity and mortality in those cost for management and different patients (Webster et al., 2017). impacts on general health and patient End-stage renal disease (ESRD) is the wellbeing. More than 90% of patients point in kidney failure when almost diagnosed with end-stage renal disease (ESRD) regularly receive hemodialysis 90% of renal function has been lost, rendering the body unable to maintain (HD) as renal replacement therapy. proper fluid and electrolyte balance, During the last three decades, patients MNJ, Vol. 5, No. 2, Nov 2020, PP: 39-54 39 Effect of Intradialytic Range of Motion Exercises on Dialysis Efficacy and Blood pressure among Patients Undergoing Hemodialysis. who receive maintenance dialysis hemodialysis patients in Menoufia globally increased dramatically. In governorate was 483(pmp) (El- 2010 it was estimated that the number Zorkany, 2017). of patients on dialysis was more than 2 The maintenance hemodialysis (MHD) million worldwide, and modeling data patients are profoundly deconditioned, suggest this number will more than often vulnerable, and older with muscle double by 2030 (United States Renal wasting and altered nutritional status. Data System, 2019). Hemodialysis leads to distinct The prevalence of ESRD continues to metabolic changes such as increase in many countries: more than hypovolemia, electrolyte imbalance, 2000 person per million populations and systemic inflammation (Cano et al., (pmp) in Japan, about 500 pmp in the 2017; Kono et al., 2018). USA, and about 800 pmp in the The hemodialysis nurse has an essential European Union. In developing role in hemodialysis unit, as the dialysis countries, the figures vary from less nurse typically operates the than 100 pmp in sub-Saharan Africa to hemodialysis machine that extracts about 400 pmp in Latin America and blood from the patient, cleans it and more than 600 pmp in Saudi Arabia returns it into the body. Other HD (El-Arbagy et al., 2016). nurses' responsibilities include Patients with end-stage renal disease administration of treatments, have only two options in order to stay monitoring patient vital signs especially alive: life-long dialysis (hemodialysis blood pressure, communicating or peritoneal dialysis) or renal procedure details with patients, and transplantation. Of these options, assessing the effectiveness of dialysis is considered the treatment of procedures, as well as being choice. The majority of patients receive responsible for the cleanliness of work hemodialysis, as patients on area. It is also the responsibility of the hemodialysis account for dialysis nurse to be sympathetic, caring, approximately 98.7% of patients patient, positive and responsible when receiving hemodialysis and 1.3% who caring for patients (Alyaseen, 2019). received peritoneal dialysis (Gaipov et- Exercises are very important non- al., 2020). pharmacological method for primary Hemodialysis (HD) is a life-changing and secondary prevention of process as it requires the ESRD patient cardiovascular disease. Physical to visit the dialysis unit usually 3 times activity ameliorates cardiovascular risk per week for 3-5 hours. As one would factors such as blood pressure (BP) and expect, this lifestyle change decreases lipid profiles as well as dialysis the quality of life (QOL) of these efficacy (Abd El-Halim et al., 2017a; patients as compared to healthy adults. Anding et al., 2015). In fact, the more advanced the CKD Intradialytic exercise (IDE) is defined stage, the more impaired the QOL as exercise training program during the (Aggarwal et al., 2016). hemodialysis (HD) session aiming to In Egypt, the total prevalence of increase strength and endurance of HD patients on dialysis increased from 225 patients and hence targeting various person per million (pmp) in 1996 to physiological and psychosocial 483 pmp in 2008 (according to last parameters. The nature of the IDE Egyptian renal registry). In Menoufia, includes resistance, aerobic and the total prevalence rate of stretching, and using different 40 Menoufia Nursing Journal, Vol. 5, No. 2, Nov 2020 Effect of Intradialytic Range of Motion Exercises on Dialysis Efficacy and Blood pressure among Patients Undergoing Hemodialysis. equipment. IDE has shown to have a nausea, vomiting, tremors, abnormal positive effect on the overall health and mental function and increase of blood hospitalization rate of HD patients pressure measurements. Also, they are (Kouidi et al., 2019). liable to develop uremia and Intradialytic exercise revealed strong hypertension (Ferrans & Powers, positive correlations with dialysis 2017). In Egypt, although all patients efficacy, blood pressure, high- undergoing hemodialysis suffer from sensitivity C-reactive protein, arterial the same complaints, limited researches stiffness, health-related QOL, and were done to alleviate their sufferings. depression (Sheng et al., 2014). Therefore, this study is conducted to Moreover, several researches have determine the effect of intradialytic proven that exercise during exercises on dialysis efficacy and blood hemodialysis is easy and safe showing pressure among patients undergoing significant changes in physical and hemodialysis. psychological conditions, which Research Hypotheses positively influence their social life The following research hypotheses are (Motedayen et al., 2017a). formulated in an attempt to achieve the The intradialytic exercises results in aim of the study: increased muscle blood flow and 1) Patients who participate in opened capillary surface area. Patients intradialytic range of motion doing exercises during dialysis have exercises (study group) will have a toxic substances, also called uremic higher dialysis efficacy score than toxins in the blood. This results in patients who don't participate in malaise, paraesthesia, peripheral intradialytic range of motion circulatory disturbance, mental exercises (control group). impairment and muscle dysfunction move through the dialyzer with a large 2) Patients who participate in flux from the tissue to the vascular intradialytic range of motion compartment (Parsons et al., 2016 b; exercises (study group) will Silva & Marinho, 2015). experience more stable blood pressure than patients who don't An exercise protocol can lead to participate in intradialytic range of improvement in many functions, such motion exercises (control group). as blood pressure, heart function (especially ventricular function in Methods hemodialysis patients), muscle strength, Research Design: and respiratory capacity, and reduce muscle atrophy, with excellent results Quasi-experimental (study and control). for the quality of life. Range of motion Setting: exercises can be considered as a routine care while delivering hemodialysis as it The study was carried out in the is performed for 15 min/day, three Hemodialysis Unit of Menoufia times a week during dialysis sessions University Hospital, Shebin El-Kom, (Heiwe & Jacobson, 2018; Mohamed & Menoufia Governorate, Egypt. Soliman, 2015). Sample: Significance of the study A consecutive sample of 50 patients Worldwide, hemodialysis is a undergoing hemodialysis. Inclusion physically
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