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Flashcards in Renal replacement therapies Deck (21):
1

Dialysis

1. Peritoneal dialysis
- Continuous Ambulatory Peritoneal Dialysis
- Automated Peritoneal Dialysis
2. Hemodialysis

2

Indications for Dialysis Therapies

1. Uremia (high level of nitrogen waste)
2. Persistent hyperkalemia
3 .Uncompensated metabolic acidosis
4. Fluid volume excess
5. Uremic pericarditis/Uremic encephalopathy

3

Peritoneal dialysis

Peritoneal membrane: Dialyzing surface Peritoneal dialysis: Process of diffusion and osmosis
Warmed sterile dialysate:
- Instilled into the peritoneal cavity via a permanent indwelling catheter
- May include heparin, potassium, and antibiotics
- Metabolic waste products and excess electrolytes diffuse into dialysate
- Fluid is drained by gravity into a sterile bag

4

Complications of peritoneal dialysis

1.Peritonitis
2. Bleeding
3.Leakage
4. Abdominal hernias

5

PD: advantages

Easy to learn; can be done at home; no machine needed;hemodynamic tolerance; better BP control; less dietary and fluid restrictions; more freedom (traveling)

6

PD: disadvantages

Time consuming; protein wasting; excessive glucose load - hyperlipidemia; sterile technique; permanent catheter; weight gain; peritonitis risk; peritoneum injury risk; not for pts with many abdom. surgeries; chronic back pain; hernia

7

Caring for patient with PD

1.Mask yourself and patient; wash hands
2. Sterile gloves - remove dressing
3. Assess: for infection
4. Use aseptic technique: three swabs for cleaning; 4x4 gauze.

8

Hemodialysis

- Uses the principles of diffusion and ultrafilteration
- Removes excess fluids and waste products
- Restores chemical and electrolyte balance
- Involves passing the client’s blood through an artificial
semi-permeable membrane

9

Types of vascular access for hemodialysis - permanent

1. AV fistula : internal anastomosis of an artery to a vein ; forearm; initial use: 2-4 month or longer
2.AV graft: synthetic vessel tubing tunneled beneath the skin ( artery + vein) ; forearm, upper arm, inner thigh; 1-2 wk
3. Dual -lumen hemodialysis catheter: surgically tunneled, with a barrier cuff; subclavian vein; immediately post op ( x-ray confirmation ).

10

Types of vascular access for hemodialysis- temporary

1.Hemodialysis catheter (dual- or triple lumen)
2.AV shunt ( relatively uncommon)
3. Subcutaneous device

11

To check potency

Palpate for the thrill; auscultate for the bruit

12

Caring for patient undergoing hemodialysis

1. Weigh pt before and after.
2. Know pts dry weight
3. Hold meds: antihypertensives
4. Measure BP, HR, RR, T
4. Orthostatic hypotension
5. Assess vascular access site
6. Observe for bleeding
7. Level of consciousness, headache, N&V

13

Caring for client with AV fistula

1. Do not take BP on that arm
2. No venipunctures, IV lines
3. Palpate for thrills, auscultate for bruits
4. Assess distal pulses and ciculation
5. Elevate extremity post op
6. ROM exercise
7. Bleeding at needle insertion site
8. Instruct: not to carry heavy objects
9.Not to sleep on extremity with body weight

14

Hemodialysis : complications

1. Disequilibrium syndrome
2. Muscle cramps
3. Hemorrhage
4. Air embolus
5. Hypotension , anemia - hemodynamic complications
6. Cardiac dysrhythmias

15

Renal transplantation

1.The surgical insertion of a functioning kidney.
2. The most successful of all transplantation procedures
3. Most transplanted kidneys are harvested from a cadaver or living relative
4. Involves major surgery

16

Nursing care of the client having kidney transplant

Preop. care: immunosuppressive drugs
Postop. care: potency of urinary catheter; measure urinary output - acute tubular necrosis ( early complication); diuresis may occur; replace fluids; diuretics to promote postop. diuresis; remove catheter within 2-3 days; encourage to void every 1-2 hours ; serum electrolytes; renal function test; serum creatinine, BUN;

17

S/S of Transplant Rejection: Acute

1. Acute: 1 week - 2 years postop.; oliguria, anuria; temperature > 37.8 C; high BP; flank tenderness; lethargy; low sp. gravity; fluid retention. TX: increase doses of immunosuppresive drugs.

18

S/S of Transplant Rejection: Chronic

2. Chronic: gradual over months to years; gradual increase in BUN and creatinine; electrolytes imbalances; fatigue. TX: conservative managements until dialysis is required.

19

S/S of Transplant Rejection: Hyperacute

3. Hyperacute: within 48 hrs; high T, BP, pain at transplant site; TX: immediate removal of the transplanted kidney

20

Dialysis disequilibrium syndrome

Due to the rapid decrease in fluid volume and BUN; change in urea levels can cause cerebral edema and increased intracranial pressure. S/s: headache, N/V; restlessness, decreased level of consciousness, seizures, coma, death; TX: anticonvulsants and barbiturates

20

Nursing Diagnoses

1. Imbalanced nutrition: Less than body requirements
2. Excess fluid volume
3. Decreased cardiac output
4. Risk for infection
5. Risk for injury
6. Fatigue
7. Anxiety