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the Appendix 1

The text of the first educational conversation of the doctor with the patient who begins treatment by a hemodialysis (a complex of speech messages about conducting a new way of life in the conditions of replaceable nephritic therapy)

I Bioethical section (reflects a bioethical component of the maintenance)

1.

By means of corresponding treatment and efforts of you we can keep yours a life and health - this invaluable gift.

2. But you should understand, your health is a zone and your responsibility too.

3. You should keep health and a life for the sake of yourselves and the relatives, those people who requires you.

4. Maintenance of health and preservation of a life by means of replaceable nephritic therapy will allow you to continue to be engaged in that is important in your life, that you love.

5. Anybody, except you, cannot carry out completely all necessary medical instructions appointed the doctor.

II Prognostichesky section (reflects prognostichesky a maintenance component)

6. If you observe all necessary instructions and a medical mode, your life will be long, practically same, as well as at healthy people.

7. If you observe a medical mode and to co-operate with the doctor concerning treatment we can support quality of your life at as much as possible accessible high level.

8. That you could continue to conduct an active life and to be engaged in that love, it will be necessary for you to change the way of life in a certain order.

III the Basic data on treatment by a hemodialysis (in this section the biomedical component of the maintenance of the text is reflected)

9. Henceforth the hemodialysis is a vital procedure for you.

10. The hemodialysis is the procedure allowing by means of the artificial filter out of an organism to clear blood from toxins collecting in it and a superfluous liquid.

11. Procedure of a hemodialysis is carried out by means of

Connections to the device an artificial kidney.

12. At you on a hand the fistula - the artery and vein connection, providing possibility of access to system of blood for carrying out of procedure of a hemodialysis is for this purpose generated artiovenoznaja.

13. You necessarily should watch hygiene of a fistula.

14. If with a fistula there will be any problems, necessarily immediately inform your attending physician.

15. When the fistula will come in worthlessness, it will be necessary to make the new. In some cases for treatment continuation statement central venous katetera or implantation of a vascular artificial limb is required.

16. Each session of a hemodialysis lasts a minimum 4 hours.

17. The number of sessions in week and duration of procedure is defined by the doctor individually. We will calculate these medical parametres on the basis of result of your analyses and supervision over your condition.

18. Hemodialysis procedure is spent in special halls, in each of which simultaneously can be some person.

19. At the coordination with the personnel, during a session it is possible to sleep, it is possible to have a bite that you took from the house, it is possible to read, listen to music or to look films in ear-phones.

20. Very important during a dialysis to observe a rule: not to stir to other patients.

21. Before a session of a hemodialysis and upon termination of it it is necessary to be weighed.

22. Weighing before a dialysis allows to define, how many a liquid you have typed from the moment of the termination of the previous procedure.

23. Weighing after a hemodialysis allows to define, how many a liquid has been deduced from an organism during a hemodialysis.

24. It is very important, that for each procedure from an organism the necessary quantity of a liquid left. The procedure problem to reach dry weight: your individual weight without superfluous water, such which will be specified you by the attending physician.

IV Mode of visiting of a hemodialysis (in this section the biomedical component of the maintenance of the text is reflected)

25. Your procedure of a hemodialysis will pass in a hall №... In the first/second/third change with. (Time).

26. On a hemodialysis it is necessary for you to come regularly three once a week as only regular sessions a minimum on 3 times a week, can support your life.

27. If not to visit a hemodialysis a minimum three times a week terms of your life will be short. Remember that the two-single dialysis is inadmissible.

28. If you pass even one session in a month, the risk of your premature death will essentially increase.

29. The admission of several sessions of a hemodialysis will lead to that in your organism harmful substances and a superfluous liquid will collect successively. All it can lead to cardiac arrest or a hypostasis of lungs and death.

30. Sometimes, especially if you break a necessary diet, the admission even one session represents life threat. In case of the termination of visiting of a hemodialysis within several days there comes death.

31. For preservation of your health and a life matters not only a total indicator of duration of a dialysis for a week, but also duration of each session. For this reason it is important to spend (and to you - to remain in bed) all session of a hemodialysis up to the end.

32. You should not try to reduce a hemodialysis session, as though you would not like to leave sometimes before.

33. It is necessary to remember, that reduction of time of a hemodialysis negatively affects an organism and life expectancy condition.

34. You always should come on a dialysis in due time in the appointed day, whatever were your mood, desire, circumstances and situations.

35. If it is necessary for you to leave, necessarily inform on it to your attending physician.

36. In case of your departure we will think over for you the individual schedule.

37. If you leave for a long time, it is necessary to find dialysis possibility in a place of stay and to agree about timely carrying out of procedures.

38. To trace all indicators of an organism, you should hand over analyses regularly.

39. That analyses were in norm, it is necessary to keep to a special diet also.

V Diet in the conditions of treatment by a hemodialysis (in this section the biomedical component of the maintenance of the text is reflected)

40. The diet approaching for you taking into account nuances of your organism will be certain by the doctor the dietician or your treating doctor-nephrologist.

41. But it is important to you to remember, that there is a number of principles and rules of a food which to you cannot be broken.

42. You cannot abuse products in which those substances which can put an irreparable harm to your organism (for example, sodium, kaly, phosphorus) contain.

43. Infringement of principles of a food and the excessive use of the products rich with these substances, can lead to a lethal outcome. For example, the use of a considerable quantity of such products as tomatoes, a strawberry, a string bean, a melon, a potato, bananas, dried fruits, grapes will cause giperkaliemiju which is capable to entail cardiac arrest.

44. As a whole, it is necessary to remember, that daily consumption kalija should not be more than 2 gramme.

45. You also cannot use the food rich with phosphorus (dairy products, cheese, eggs, groats). Consumption of such food leads giperfosfatemii (to accumulation neogranicheskih phosphorus connections in blood), and it involves infringement exchange calcium-phosphoric that becomes the reason of development of a tumour parashchitavidnyh glands, damage of bones, accumulation of connections of calcium and phosphorus in cardiovascular system and increases in risk of a heart attack and a stroke.

46. In day you can use the squirrel about 1,2 grammes on kg of weight of a body, Such quantity of fiber is necessary for your organism as during a hemodialysis many amino acids with which it is necessary to fill can be lost. At the same time, superfluous consumption of fiber leads to formation of a considerable quantity of nitrogenous slag, that in addition loads all systems of an organism.

47. It is necessary to lower quantity of the products containing sodium. The basic supplier of sodium in an organism is a table salt. Accordingly, you should exclude from the food any products containing it in a considerable quantity - half-finished products, sausage products, tinned products, cheese etc. In a human body, receiving treatment by a hemodialysis, kidneys cannot remove surplus of sodium and a liquid from a body owing to what in a body water collects that conducts to occurrence of hypostases and pressure increase.

48. It is undesirable to use more than 1-2 gramme of table salt a day.

49. Is better to refuse in general salt use at preparation of dishes as its minimum necessary for an organism already contains naturally in some products (for example, in vegetables, fruit).

50. If necessary to salt meal it is necessary already in a ready kind; so on flavouring qualities the food will seem to more salty, but it is desirable to refrain at all from dosalivanija meal.

51. The meal should be correct image prepared (to avoid zharenija better, conservations). The food prepared in these ways, contains many harmful substances, in particular, sodium (at conservation) and kalija (at zharke products with the high maintenance kalija, it all remains in a dish). The meal is recommended to be boiled, such way of preparation allows to reduce concentration in food of harmful substances as the part leaves them in water.

52. To eat it is necessary regularly, 4-5 once a day. It allows to distribute in regular intervals loading on digestive and secretory systems.

53.pozhalujsta, will pay special attention, that a day you should drink no more than 500 ml of a liquid as bolshee the quantity of a liquid creates excessive loading on all systems of an organism.

54. Pay attention that with meal in an organism water also arrives, the cumulative quantity of a liquid in meal and drink should not exceed 1 litre.

55. With care it is necessary to use the products rich with a liquid, such as water-melons.

56. Totally in an interval between procedures of a hemodialysis you can save up in an organism of a liquid no more than 4 % from weight of a body.

57. In a case if you will break a vodno-drinking mode and to use more liquids, than it is necessary, it will accumulate in an organism, and in fabrics, the hypostasis will develop, pressure and loading upon heart will raise.

58. Restriction of consumption of water and salt also will allow to normalise arterial pressure, to avoid attacks of a hypertension, a hypotonia, spasms in feet during a hemodialysis.

59. To be quiet concerning a food, it is possible to make the special dietary menu which will consist only of the resolved products and will always help you to supervise the diet. Dishes of such menu are tasty enough. There are even special books of recipes for people who are on a hemodialysis. To concern a food thoughtlessly henceforth it is inadmissible, as now it is the extremely dangerous to you.

VI Medicamentous therapy in the conditions of treatment by a hemodialysis (in this section the biomedical component of the maintenance of the text is reflected)

60. To support a condition of various systems of an organism, medicinal therapy also is appointed.

61. For example, to supervise the phosphorus maintenance, it is necessary to accept phosphate-connecting preparations.

62. At your disease besides phosphate-connecting of preparations, it is necessary to accept a number of other medicines also.

63. Many medicines are directed on correction of complications at chronic illness of kidneys of V stage, such, as neurologic, endokrinnye infringements, an anaemia, belkovo-power insufficiency and infringements fosforno-kaltsievogo an exchange.

64. With the list of all necessary medicines we will be defined, as soon as you will hand over all necessary analyses.

65. Not to worry that you can forget to accept medicines, it is possible to get a special box and in it to put tablets for every day weeks. Also you can make for yourselves the drug intake schedule, including, by means of special supplements for smart phones.

66. Remember that a mode of a drug intake it is very serious. Necessarily watch, that all of them have been accepted. You cannot pass reception of tablets.

67. It is important to limit also the use of medicines which have adverse influence (for example, not steroid anti-inflammatory preparations, some groups of antibiotics) on kidneys.

68. At reception of appointments from doctors of other specialities, inform them, that be on a hemodialysis that they could pick up corresponding therapy, and after these appointments and before reception of these preparations necessarily consult to the treating doctor-nephrologist.

VII Other aspects of change of a way of life on a hemodialysis (in this section the biomedical component of the maintenance of the text is reflected)

69. As chronic illness of kidneys of V stage and treatment by a hemodialysis leave traces on work of all systems of an organism, it is important to watch the condition as a whole.

70. Necessarily regularly supervise the arterial pressure, there is an interrelation between work of secretory system and arterial pressure.

71. If in work any of organism systems there is a deterioration, you should inform on it to your attending physician immediately.

72. It is important to observe a healthy way of life as a whole, it is established, that patients who keep to the diet recommended above, do not abuse smoking, alcohol, strong coffee, feel much better. You can independently be convinced of it, having communicated with skilled patients.

73. Also to conducting zdorovesoobraznogo a way of life will be

To promote and regular employment by physical training in a mode of sparing loading.

74. As a whole, remember, that for you vital to observe the recommended mode.

75. Experts, employees of branch of a hemodialysis will give you necessary treatment, consultations and the help in the decision of difficulties arising with health, and you, from its part, should observe all recommendations, treatments concerning parametres, a mode of a life, a diet.

76. Your responsible behaviour, your realised cooperation with the doctor and conducting zdorovesoobraznogo a way of life will allow us to support long years optimum possible quality of your life.

The appendix 2

Questionnaire for the patients receiving treatment by a hemodialysis

QUESTIONNAIRE

The dear patient, we ask you to take part in the given interrogation. Please, read questions and statements and to each of them will choose one the fullest and a right answer.

1. Treatment by a hemodialysis method is capable to keep a life and health of the patient within long years?

A) yes; (1 point - a right answer).

Is not present;

B) I do not know.

2. Health of the patient who is on treatment with a method of a hemodialysis, is a zone of full responsibility:

A) the doctor;

The patient;

B) a zone of joint responsibility of the doctor and the patient (1 point - a right answer).

3. For health maintenance at the greatest possible high level the patient should:

A) to accept the recommended preparations and to reconstruct the schedule of the life according to recommendations of the doctor; (1 point - a right answer).

To trust in the best and to try to conduct a former way of life;

B) to go in for sports and improving experts to win illness.

4. A hemodialysis as the procedure allowing by means of the artificial filter, out of an organism to clear blood of toxins collecting in it and a superfluous liquid, at your disease is:

A) the desirable procedure, allowing to keep a life and health;

Obligatory, vital procedure; (1 point - a right answer).

B) the hazardous to health procedure badly influencing an organism.

5. At you on a hand the fistula, it is generated:

A) the device for a blood sampling on the analysis;

The device for introduction of medical products;

B) the artery and vein connection, providing possibility of carrying out of procedure of a hemodialysis (1 point - a right answer).

6. The fistula demands periodic replacement?

A) yes, it is required to replace a fistula when it becomes unfit for use (1 point - a right answer);

No, the fistula is established once and for ever;

B) some kinds of fistulas demand the replacements some - are not present.

7. The hemodialysis session lasts:

A) not less than 4 hours; (1 point - a right answer).

No more than 4 hours;

B) at each patient differently, but no more than 2 hours.

8. During carrying out of a session of a hemodialysis

A) the patient in coordination with the personnel can sleep, read, listen to music looks films in ear-phones; (1 point - a right answer).

It is not authorised to patient to sleep, read, listen to music, to look films;

B) the patient during a hemodialysis should keep a motionless pose.

9. Before a session of a dialysis and after a session it is necessary for patient to be weighed since:

A) weighing disciplines the patient who should support optimum weight not to suppose adiposity;

Weighing allows to define, how many a liquid has been deduced from an organism during a hemodialysis; (1 point - a right answer).

B) weighing gives the chance to the doctor to watch that the patient did not have the proof weight reduction complicating a current of illness.

10. If the patient passes hemodialysis sessions

A) in an organism, probably, harmful substances both a superfluous liquid will collect, and all it can lead to cardiac arrest or a hypostasis of lungs and death;

In an organism harmful substances and the superfluous liquid will necessarily collect, all it can lead to cardiac arrest or a hypostasis of lungs and death; (1 point - a right answer).

B) in an organism harmful substances and a superfluous liquid will collect, but they can be deduced during the subsequent sessions, having extended time following for passed procedures.

11. There are the substances which are a part of a foodstuff which can put an irreparable harm to your health.

Yes, such substances exist, for example table salt, kaly, phosphorus; (1 point - a right answer).

Yes, such substances exist, for example sugar, magnesium, starch;

No, it is necessary to eat everything, differently the organism will lack useful substances.

12. The use of a considerable quantity of the products rich kaliem, such, as tomatoes, a strawberry, a string bean, a melon, a potato, bananas, dried fruits, grapes for the person, passing treatment by a hemodialysis,

A) it is useful, as kaly well influences functioning of heart and vessels;

Leads giperkaliemii which at the person who is on a hemodialysis, it is capable to cause cardiac arrest; (1 point - a right answer).

B) it is necessary, as well affects brain work.

13. The use of a considerable quantity of the products rich with phosphorus, such as whole milk, cheese, yolks of eggs, nuts, sunflower seeds, fishes, etc. at the person, passing treatment by a hemodialysis

A) leads to accumulation of inorganic connections of phosphorus in blood, and it is good, since phosphorus is the vital element;

Leads to phosphorus accumulation in blood, and phosphorus is necessary for brain work, for maintenance of health of cardiovascular system, for normal functioning myshchts;

B) leads giperfosfatemii (to accumulation of inorganic connections of phosphorus in blood), and it involves infringement of an exchange of calcium that leads to work infringement parashchitavidnyh glands, to damage of bones, cardiovascular system. (1 point - a right answer).

14. What should be consumption of fiber at the patients receiving treatment by a hemodialysis?

A) fiber consumption should be minimum, it is extremely harmful to a human body receiving treatment by a hemodialysis

Fiber consumption should be the highest as the human body, receiving treatment by a hemodialysis, feels requirement for fiber

B) fiber consumption should be moderated (nearby 1,2 gramme on kg of weight of the person): during a hemodialysis many amino acids with which it is necessary to fill are lost, but superfluous consumption of fiber in addition loads all systems of an organism. (1 point - a right answer).

15. You need to lower essentially quantity of the products containing sodium (for example to exclude from a diet half-finished products, sausage products, etc.). Why?

A) sodium is not deduced from an organism, demanding more and more a liquid, it causes puffiness and a hypertension; (1 point - a right answer).

Sodium consumption conducts to increase of appetite and an excess weight set

B) sodium consumption promotes occurrence of a skin itch

16. The use of salt by the person, a hemodialysis passing treatment

A) leads to occurrence of additional hypostases as salt detains a liquid in organism fabrics; (1 point - a right answer).

Does not influence organism functioning;

B) it is useful, as salt is a part of blood.

17. The best way of cooking for the person, passing treatment by a hemodialysis:

A) zharenie as fat unnecessary an organism is thus melted, and all kaly remains in products;

Conservation since thus the food keeps the properties longer and does not spoil, in it sodium remains;

B) otvarivanie and suppression as these ways of preparation reduce concentration of harmful substances in food. (1 point - a right answer).

18. A correct diet at treatment by a hemodialysis:

A) to eat is necessary regularly, 4-5 once a day. It allows to distribute in regular intervals loading on digestive and secretory systems; (1 point - a right answer).

Is it is necessary when there is a feeling of hunger;

B) it is possible to eat both two, and three times a day but so that the organism received all necessary of food.

19. Optimum quantity of a liquid which the person should consume, passing treatment by a hemodialysis:

A) it is necessary to receive as a group (drink +вода, containing in a foodstuff) 1 litre of a liquid since bolshee the quantity of a liquid creates excessive loading on kidneys; (1 point - a right answer).

B) it is necessary to receive as a group 2,5 litres of a liquid (drink +вода, containing in a foodstuff) as the human body consists mainly of water;

It is necessary to drink when there is a thirst, and it is so much, that it to eliminate; the organism regulates it.

20. In case of infringement of a vodno-drinking mode, and the use bolshego quantities of a liquid, than it is necessary

A) it will accumulate in an organism, will develop a hypostasis, arterial pressure will raise and loading on heart will increase; (1 point - a right answer).

It will be necessary to accept special preparations, and the organism will settle into shape;

B) anything bad will not occur, as water is necessary for an organism in considerable quantities.

21. At treatment by a hemodialysis the regular is necessary

Medicinal therapy

A) is not present, it is quite enough treatment by a hemodialysis for maintenance of a good state of health;

Yes, she allows to support a condition of various systems of an organism and to warn possible complications; (1 point - a right answer).

B) it is necessary for some patients, some is not present.

22. As a whole, the good state of health of the person who is on treatment with a hemodialysis, is provided

A) good equipment an artificial kidney;

Strict observance of a mode of a hemodialysis, diet observance, refusal of alcohol, smoking, coffee, following to all recommendations of the attending physician; (1 point - a right answer).

B) good genetics, a strong constitution.

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A source: Vatskel Elizabeth Aleksandrovna. the Lingvodidaktichesky component of educational activity of the doctor. The dissertation on competition of a scientific degree of the candidate of pedagogical sciences. Moscow - 2018. 2018

More on topic the Appendix 1:

  1. the Appendix
  2. the Appendix 4
  3. the Appendix
  4. THE APPENDIX
  5. the Appendix
  6. THE APPENDIX
  7. the APPENDIX 4
  8. the Appendix
  9. the Appendix
  10. the Appendix
  11. the Appendix
  12. THE APPENDIX
  13. the Appendix
  14. THE APPENDIX