Dialysis and CRRT

Question 1

dialysis

Answer 1

technique in which substances move from the blood through a semipermeable membrane and into a dialysis solution (dialysate)
used to correct fluid and electrolyte imbalances and to remove waste products in kidney failure
maintain fluid balance by removing excess fluid from the blood

Question 2

osmosis

Answer 2

movement of fluid from an area of lesser concentration to an area of greater concentration of solutes

Question 3

diffusion

Answer 3

movement of solutes from an area of greater concentration to an area of lesser concentration

Question 4

ultrafiltration

Answer 4

water and fluid removal, mimics the ultrafiltration function of the kidneys
removes a predetermined percentage of plasma water from the blood before being returned to the body

Question 5

convection

Answer 5

the movement of solutes out of the blood compartment along with movement of water or ultrafiltration

Question 6

adsorption

Answer 6

binding of substances to the surface of the filter/membrane

Question 7

3 methods of dialysis

Answer 7

peritoneal dialysis
hemodialysis
CRRT

Question 8

peritoneal dialysis

Answer 8

uses the patient’s peritoneal membrane as the permeable membrane to removes wastes and water
dialysate infused through catheter in abdomen and “dwells” for a specific period of time and is then drained out of the patient
unable to remove precise amounts of water

Question 9

potential complications of peritoneal dialysis

Answer 9

peritonitis
hernias
atelectasis/PNA

Question 10

intermittent hemodialysis access methods

Answer 10

dialysis catheter (short term)
AV fistula or graft (long term)

Question 11

intermittent dialysis indications

Answer 11

BUN >90 & Cr >9
K>/=6
drug toxicity
GFR <15 mL/min
metabolic acidosis

Question 12

intermittent dialysis contraindications

Answer 12

hemodynamic instability
inability to coagulate
no access

Question 13

AV fistulas and grafts: special considerations

Answer 13

assess patency of fistula with thrill and bruit
protect integrity with restricted extremitiy
infection and thrombus prevention

Question 14

CRRT

Answer 14

gradual over 8-24hrs
uremic toxins and fluids are removed while acid-base status and electrolytes are adjusted slowly and continuously
requires dialysis catheter

Question 15

CRRT indications

Answer 15

hemodynamic instability
fluid overload
oliguria
electrolyte disturbances: hyperkalemia and hypercalcemia
acidosis
sepsis
major burns w/ AKI
drug overdose
rhabdomyolysis
contrast induced nephropathy

Question 16

dialysis nursing management

Answer 16

monitor VS for hemodynamic stability
monitor fluid balance w/ hourly I/O
monitor electrolytes:
hyperkalemia: kayaxelate
metabolic acidosis: bicarbonate
hypocalcemia: calcium supplements/vitamin D
hyperphosphatemia: phosphate binders
monitor patency of dialysis access
administer meds at appropriate times: hold BP, water soluble vitamins, abx with order
fatigue management: EPO and iron
teaching: renal diet, fluid restriction
GI disturbances: N/V/C
psychological care

Question 17

renal diet

Answer 17

high protein
low potassium
low phosphorus