exam 2 lecture 6 & 7 Flashcards Preview

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Flashcards in exam 2 lecture 6 & 7 Deck (65):
1

hemodialysis

perfusion of blood & a physiologic solution on apposite sides of a semipermeable membrane

2

peritoneal dialysis

peritoneal membrane serves as the semippermeable membrane

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when do you begin planning for dialysis

- stage 4 CKD or CrCl

4

dialysis access created

- GFR 4
- 1 year prior to anticipated need for dialysis

5

evaluate for dialysis

when GFR or CrCL

6

when do you begin planning for dialysis

- stage 4 CD or CrCl

7

dialysis access created

- GFR 4
- 1 year prior to anticipated need for dialysis

8

evaluate for dialysis

when GFR or CrCL

9

acute indications for dialysis

- AEIOU
- acidosis
- electrolytes (hyperK)
-intoxication
- fluid overload
- uremia (BUN>80)

10

chronic indications for dialysis

- sxs of kidney failure (acid-base, electrolyte, pruritis)
- inability to control volume status or BP
- progressive deterioration in nutritional status
cognitive impairment

11

is Scr an indication for dialysis?

no!

12

diffusion in hemodialysis

- MW
- concentration gradient
- membrane resistance
- blood & dialysate flow rates

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ulrafiltrate (convecion) in hemodialysis

- transmembrane presure
- ultrafiltration coefficient

14

conventional or standard dialyzers

- small pore limit clearance to small molecules (Urea
- low blood flow rate & Cr)

15

high efficiency dialyzers

- larger surface area
- high blood flow rates

16

high flex dialyzers

- large pores increase removal of high MW substances
- high blood flow rates

17

what is dialysate solution composed of?

-purified water & electrolytes
- glucose, Na, K, Ca
- similar to body fluids but lacking waste

18

normal metabolism produces

- acids
- pts with ESRD are unable to clear

19

dialysis solution bases

- acetate (converted to bicarb)
- bicarb (DOC in liver impairment & sever acidosis)

20

major challenge for success & long-term feasibility of HD

vascular access

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types of vascular access

- AV fistula
-AV synthetic graft
- venous catheter

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AV fistula advantages

- longest survival
- lowest complication rate
- increased survival & decreased hospitalization rates
- most cost-effective

23

disadvantages of AV fistula

- takes 1-2 months to mature
- difficult to create in elderly or PVD pts

24

AV fistula

surgical connection between vein & artery

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AV synthetic graft

- graft connects the artery & vein

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advantages to AV synthetic graft

-easily implanted
- longer survival than catheters

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disadvantages with AV synthetic graft

- shorter survival than fistula
- higher rates of complications
- 2-3 wks to endothelialize prior to use

28

venous catheters

- least desirable
- femoral, subclavian, or internal jugular vein
- immediate use
- high risk of infection

29

adequate urea reduction ratio

>60%

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intermittent HD

- most commonly 3Xwk
- sustained low-efficiency dialysis (SLED)
- PRN basis

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continuous HD

- based on access
- arteriovenous
- venovenous

32

pros to HD over PD

- intermittent treatment
- effectiveness more easily measured
- low technique failure rate
- closer monitoring of pt

33

disadvantage of HD

- loss of independence
- long adjustment time
- risk associated with vascular access
- more rapid decline in residual renal function

34

ulrafiltrate (convecion) in hemodialysis

- transmembrane pressure
- ultrafiltration coefficient

35

main ultrafiltration force in PD

osmotic force

36

in PD there is

- no countercurrent flow
- cannot regulate blood flow

37

types of PD

- continuous ambulatory PD (Q4-8H)
- automated PD (at bedtime)
- intermittent PD (acute pts)

38

advantages of PD over HD

- continuous removal of solutes
- improved clearance of larger solutes
- better preservation of residual renal function
- increased independence
- improved quality of life

39

disadvantages of PD

- predisposition to malnutrition
-excessive glucose load
- continued aseptic technigue
-time consuming exchanges
- injury prone peritoneum
-peritonitis

40

HD complications

- hypotension
- muscle cramps
-pruritis
-N/V
- HA
- chest pain
- fever & chills

41

possible causes or precipitating factors of hypotension in HD

- hypovolemia
- antiHTN meds or meals prior to HD
- target dry weight set too low
- acetate dialysis solution base- vasodilation

42

acute management of hypotension HD

- trendelenburg position
- decrease ultrafiltration rate
- fluid bolus: 100-200mL IV NS

43

HD hypotension prevention nonpharm

- re-evaluate target dry weight
- bicarb dialysate
- avoid food before/during HD

44

HD hypotension prevention pharm

- midodrine 30min before HD
- levocarnitine after HD
- fludrocortisone before HD
- sertraline daily

45

causes of muscle cramps in HD

- dehydration
- Na in dialysate too low

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acute management of muscle cramps in HD

fluid bolus 100-200mL IV NS

47

prevention of muscle cramps in HD

- dialysate Na>serum Na
- stretching, massage, flexing
- vitamin E
-quinine- do NOT use

48

management/prevention of pruritis in HD

- capsaicin cream
- antihistamines
-cholestyramine
-activated charcoal

49

causes of pruritis

- unknown
- uremia
- hyperphosphatemia
- dry skin

50

prevention & treatment of intrinsic thrombosis with catheter

- saline, heparin, alteplase locks to prevent
- saline flush or alteplase instillation to treat

51

AVF infection

antibiotics for 6 wks

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AVG infection

antibiotics + removal of graft

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catheter infection

removal of catheter+ culture catheter tip+ ABX

54

PD complications

- mechanical
-pain
-metabolic complications
- peritoneal membrane damage
- infection

55

peritonitis is higher in

CAPD than APD

56

peritonitis

- gram + predominant (Staph epidermidis)
- Gram - less common but higher mortality

57

peritonitis- no empiric antibiotics if:

-no increase in WBC
- no predominance of PMNs
- no bacteria on gram stain
- asymptomatic & above are true

58

empiric therapy for G+

vancomycin

59

empiric therapy for G-

AGs, ceftazidime, cefepime, carbapenem, FQs or aztreoname
- cover pseudomonas

60

enterococcus

- G+
- start ampicillin 125mg/L for 21 days

61

Staph aureus

- MSSA: nafcilin or oxacillin
- MRSA: vanc or clindamycin
- 21 days

62

single G- other than pseudomonas or stentotrophomonas

- E.coli, klebsiella
- therapy based on sensitivity
- 14 days

63

pseudomonas

- DC vanc
- continue antipseudomonal therapy based on sensitivity
- 21 days

64

stentrophomonas

- start bactrim
- 21 days

65

multiple G- and/or anaerobes

- DC vanc
- add metronidazole
- surgery if no improvement
- 21 days