Renal Replacement Therapy

Question 1

Dialysis

Answer 1

Artificial processes for removing waste and water from the body when kidneys no longer function
or near-fatal incidence
not enough kidneys for transplant, not suitable for transplant

Question 2

Dialysis is used when GFR is

Answer 2

less than 15

Question 3

What religion would not use a kidney transplant?

Answer 3

Jehovah witness

Question 4

Who needs Dialysis?

Answer 4

Acid-base problem
electrolyte problems (Potassium)
intoxications
overload of fluids
uremic symptoms

Question 5

Methods of Dialysis

Answer 5

Hemodialysis (HD)
Peritoneal dialysis (PD)

Question 6

Hemodialysis

Answer 6

Obtaining vascular access is one of the most difficult problems

Question 7

Types of Hemodialysis access

Answer 7

Arteriovenous fistulas and grafts (less chance of infection)
Temporary vascular access

Question 8

The Hemodialysis Dressing should be changed

Answer 8

7 days or PRN

Question 9

Hemodialysis looks like

Answer 9

double-lumen

Question 10

How long do you have to wait for the Arteriovenous fistulas and grafts to heal before using long-term?

Answer 10

3 months

Question 11

Can heparin be used inside the Hemodialysis?

Answer 11

yes with order

Question 12

HD complications

Answer 12

Hypotension
Muscle cramps
Loss of blood
Hepatitis (rare)
Losing volume and weight
rapid changing electrolytes
Systemic infection
HA
Dialysis dementia
Disequilibrium syndrome
AV fistula complication

Question 13

Nursing Interventions of HD

Answer 13

Help the patient maintain a healthy self-image
Return the patient to the highest level of function possible
- Including returning to work

Question 14

Continuous Renal Replacement Therapy

Answer 14

For acutely ill with AKI or severe fluid overload
ICUs

Question 15

CRRT contraindicated for

Answer 15

rapid treatment for life-threatening manifestations of uremia
Hyperkalemia
Pericarditis
Fluid Overload of toxins

Question 16

Can CRRT be used with HD?

Answer 16

YES, but not ideal

Question 17

What is the number 1 cause of death for Dialysis pts?

Answer 17

stroke
death

Question 18

Peritoneal Dialysis works because

Answer 18

semipermeable membrane in peritoneal cavity

Question 19

Peritoneal access is

Answer 19

obtained by inserting a catheter through the anterior abdominal wall

Question 20

PD Catheter placement

Answer 20

Technique for catheter placement varies
Usually done via surgery
Prep for placement includes emptying bladder and bowel

Question 21

PD pts should not

Answer 21

take baths
when healed shower
I&Os
INT or continous

Question 22

PD forms

Answer 22

Automated peritoneal dialysis
Continuous ambulatory peritoneal dialysis (CAPD)
Intermittent peritoneal dialysis

Question 23

3 Phases of PD cycle aka Exchange

Answer 23

Inflow (fill) – insert
Dwell (equilibration) - defusion
Drain

Question 24

If the pt starts to cramp during PD, then

Answer 24

slow infusion

Question 25

PD Contraindications

Answer 25

History of multiple abdominal surgeries Chronic abdominal conditions Recurrent hernias Obesity Pre-existing back problems Severe chronic obstructive pulmonary disease Exit site infection Peritonitis Hernias Lower back problems Bleeding

Question 26

PD Pulmonary complications

Answer 26

atelectasis pneumonia bronchitis

Question 27

PD loses what electrolyte

Answer 27

protein

Question 28

Nutrition PD

Answer 28

Vital signs Daily weights (fluid retainment) Nutrition Lab values: K and WBCs

Question 29

Nursing Interventions HD Fistula

Answer 29

**bruit/thrill** neuro assess post dialysis V/S

Question 30

Nursing Interventions CRRT

Answer 30

frequent V/S fluid assess

Question 31

Nursing Interventions PD

Answer 31

abdominal girth monitor outflow V/S

Question 32

Pts dialysis needs to have HOB at

Answer 32

30-45 degress

Question 33

Bruit in Fistula sounds like

Answer 33

Good: hum or buzz like a whoosh drum beat Bad: no or low sound, change noted, different sound from beat

Question 34

Thrill in Fistula

Answer 34

feel

Question 35

Renal Transplants are usually

Answer 35

successful

Question 36

Renal Transplant is not

Answer 36

a cure

Question 37

Sources of Kidney donors

Answer 37

Cadaver donors with compatible blood type Blood relatives Emotionally related living donors Altruistic living donors (friends) Paired organ donation

Question 38

Transplant Contraindications

Answer 38

Malignancies (advanced cancer) Refractory/untreated cardiac disease Chronic respiratory failure Extensive vascular disease Chronic infection Unresolved psychosocial disorders

Question 39

Complications of Renal Transplants

Answer 39

Rejection Infection

Question 40

Immunosuppressants of Kidney Transplants

Answer 40

Adequately suppress the immune response to prevent rejection Maintaining sufficient immunity to prevent infection

Question 41

Immunosuppressants in Transplants

Answer 41

Corticosteroids Calcineurin Inhibitors Cytotoxic Clonic antibodies Mycophenolate (Cellcept) Tacrolimus (Prograf)

Question 42

Hyperacute Rejection

Answer 42

no cure malasise, high fever, tender graft

Question 43

Acute Rejection

Answer 43

First 6 months after transplant Reversible Increase immunosuppressive therapy

Question 44

Is it normal to have at least 1 acute episode of renal rejection?

Answer 44

yes increase immunosuppressants

Question 45

Chronic Rejection

Answer 45

Occurs over months or years Irreversible --**proteinuria**

Question 46

Watch for s/s of infection

Answer 46

Fever/chills Tachypnea Tachycardia Increase/decrease in WBCs indicating leukocytosis or leukopenia

Question 47

Acite Rejection s/s

Answer 47

polyuria anuria K and creatiine BUN elevated retention Chronic s/s high BP, temp