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Flashcards in Clinical (Week 5) Deck (188)
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1

How quickly does blood flow through the dialysis machine?

300ml/min

2

The following ions are in the dialysate, but are they in higher or lower concentrations than the patients blood:
- Na+
- Bicarbonate
- K+
- Glucose

Na+ is lower
Bicarbonate is higher
K+ is lower
Glucose is about equal (if not slightly higher)

3

How is water removed from the patient?

Dialysate hydrostatic pressure

4

Why is pure water used for the dialysate?

No cytokines, bacteria or toxins present that may damage the patients

5

How efficient is dialysis?

Not very:
- 10-12ml/min/1.73m^2

6

If a patient was on dialysis 3hrs/3times/week, what would their absolute death risk increase be?

6% (1% for each half hour and they would be 3 hours down)

7

If a patient on dialysis is anuric, what must their fluid intake be restricted to?

1L per day

8

What foods contain high levels of K+ so should be avoided when a patient is on dialysis?

Bananas
Chocolate
Potatoes
Avacado

9

Why should a low phosphate diet be observed when on dialysis?

It isn't dialysed well

10

What should be avoided as they are high in phosphate?

Ready meals

11

When are phosphate binders taken and what do they do?

With meals (6-12 per day):
- Prevent GI phosphate absorption

12

What is the main con of using a Scribner shunt for dialysis?

Eventually clogs

13

When is a Scribner shunt still used?

For dialysis in AKI or ESRD

14

What veins can a tunnelled venous catheter be inserted into and which is preferred?

Jugular (preferred)
Subclavian
Femoral

15

Which of the following can be used in dialysing and AKI patient:
- Scribner shunt
- Fistula
- Tunnelled venous catheter

Scribner shunt
Tunnelled venous catheter

16

In which of the following is infection most likely and with what organism:
- Scribner shunt
- Fistula
- Tunnelled venous catheter

Tunnelled venous catheter
Staph. aureus

17

If a dialysis site gets infected, what can result?

Endocarditis
Discitis

18

How is an infected dialysis line treated?

Vancomycin
Line removal

19

How does intradialytic hypotension arise?

ICF -> ECF -> Intravascular -> Hypotension

20

If a patient becomes fluid overloaded on dialysis, what can result?

Pulmonary oedema
Hypertension
Appearance of LVF

21

What drug should not be given if a patient on dialysis becomes fluid overloaded?

Furosemide

22

What are some other complications of dialysis?

Blood leaks -> Exsanguination?
Loss of vascular access
Hypokalaemia -> Cardiac arrest

23

What drives water removal across the peritoneal membrane in peritoneal dialysis?

High [Glucose] in the dialysate fluid

24

How is continuous peritoneal dialysis carried out?

4 bag exchanges per day
Fluid drained then replaced
30 minutes per exchange

25

How is automated peritoneal dialysis carried out?

1 bag left in all day
Overnight machine drains it in and out (over 9hrs)

26

What are the benefits of continuous peritoneal dialysis?

Simpler
Lower-tech
Cheaper

27

Where can infection arise in peritoneal dialysis?

Peritonitis
Exit site

28

What are typical contaminants that cause infection in peritoneal dialysis patients?

Staph
Strep
Diphtheroids

29

What gut bacteria can cause infection in peritoneal dialysis patients?

E. coil
Klebsiella

30

What must we do before treating infection in peritoneal dialysis?

Culture PD fluid