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Flashcards in Genitourinary Deck (378)
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211

What happens to JVP in fluid overload?

becomes more visible and increases

212

What should be done for fluid management?

fluid input and output chart, weight and stool chart, oral fluid if able, IV if unable

213

What are the two types of IV fluid?

crystalloid and colloid

214

What is crystalloid fluid?

small molecules pass through cell membrane form intravascular to extravascular, if fluid contains salt, it stays in intravascular space a bit longer than 5% dextrose e.g. isotonic solutions

215

What is colloid fluid?

large molecules which do not pass through cell membrane, remains in intravascular compartment and expands the intravascular volume through higher oncotic pressure

216

What patients are at risk of hypovolaemia?

elderly, ileostomy, short bowel syndrome, bowel obstruction

217

What patients are at risk of hypervolaemia?

CKD, heart failure, liver failure

218

What is euvolaemia?

no signs or symptoms of hypo or hypervolaemia

219

How to treat a rise in creatinine?

reduce diuretics or relax fluid restriction

220

What are the 3 methods of renal replacement therapy?

haemodialysis, peitoneal dialysis, transplant

221

How does haemodialysis work?

exchange out side the body, it is removed for cleansing, dialysed then returned to the body via and AV fistula

222

What is an AV fistula?

joining of an artery to a vein to provide permanent and easy access for insertion of needle with good blood flow, 2 needles, one to add and one to remove

223

How long does it take for an AV fistula to be mature?

pressure from the artery makes the vein bigger, taking 4-8 weeks

224

How is haemodialysis used in urgent situations?

on right atrium and one other side of chest, using a cuffed haemodialysis catheter

225

How often is haemodialysis done?

in hospital 4hrs 3x a week or 2-3hrs 4-5x a week at home

226

What drug is also given during haemodialysis?

heparin as an anticoagulant as foreign bodies would activate the clotting cascade

227

Side effects of haemodialysis?

hypotension from excessive extracellular fluid removal, cramps, nausea, headache, chest pain, fever, rigors

228

What are the potential risks in haemodialysis?

blocked dialysis or catheter, infection, fistula aneurym, removal too fast, amyloidosis

229

What is peritoneal dialysis?

uses the peritoneum as a membrane to exchange fluids and solutes in the blood in the lower abdomen, waste products move down conc gradient into dialysis fluid

230

What type of catheter is used in peritoneal dialysis?

Tenckoff

231

What is the difference between continuous ambulatory peritoneal dialysis (CAPD) and APD?

capd - done every 3-4 hours for about 30 minutes

apd - done at night

232

When would peritoneal dialysis be the preferred choice?

young, full time work, want control and responsibility, severe HF

233

When would haemodialysis be the preferred option?

live alone, frail, elderly, scared of operating machienes, previous abdominal surgery, hernia, lack of space at home

234

Long term complications of dialysis?

CV disease, sepsis, peritonitis, amyloidosis

235

Why is amyloidosis caused by dialysis?

accuulation and polymerisation of B2 microglobulin as it is not excreted by the kidney but not dialysis

236

Benefits of renal transplant?

increased survival over dialysis (80% at 10yr)
can get pregnant
economic advantage
increased QoL, can go abroad

237

Treatment of stage 5 CKD?

renal transplant

238

Which is better, living or deceased donor and why?

living as increases survival and graft half life, reduces mortality by CV, infection, malignancy, treatment withdrawal

239

Surgical complications of renal transplant?

bleeding, infection, blood clot in renal artery, need immuno suppression

240

What is cross matching?

final step before any transplant, to see if donors lymphocytes and recipients serum to see any attack, a better match is better survival