Review: Dialysis & MNT Flashcards
(60 cards)
hemodialysis types
center: 3-5 hr/3 per wk home conventional: 3-4 hr/3 per wk short daily: 2 hr/5-7 per wk nocturnal: 6-8 hr/6 per wk or every other night
NxStage system
daily home dialysis, may feel better, less drastic fluid etc fluctuations
short daily & nocturnal HD
ppl need less BP & anemia meds, easier to control phos, less fluid restriction, more liberal diet, sleep better
HD: when is it needed
when BUN >80 mg/dL and creatinine >8 mg/dL
HD goals
maintain plasma levels of protein waste and electrolytes acceptable for dialysis pt.
try MNT and meds to control CKD related probs: anemia, osteodystrophy, CVD
HD Energy
30-50 kcal/kg (usual adult 35, over 60 years = 30-35)
always use dry or post-dialysis wt
HD Protein
1.0-1.5 g/kg dry wt
KDOQI = 1.2 g/kg
acutely ill = 1.2-1.3
half of protein should be high biological value
dialysis pts need a higher than RDA intake of 0.8
low plasma BUN and/or albumin
may indicate need for higher protein intake
high plasma BUN and/or albumin
may indicate protein intake is too high
acceptable BUN for dialysis pt
60-90 mg/dL
MNT HD tool
urea kinetic modeling to be sure dialysis is adequate
carnitine
decrease during dialysis (about same as normal urinary loses)
oral dose = 2g/day or less and IV 1.4g/day
higher dose have negative effects
MNT Variables that may help HD
control hypertriglyceridemia. increase HDL, improve ejection fraction/heart pumping.
lessen cardiac arrhythmias during dialysis, less muscle pain, weakness, cramps, hypotension.
help w/EPO resistant anemia.
acidosis
measure predialysis/stabilized serum bicarb monthly, should be >22mmol/L.
correct w/ oral administration of alkali therapy/bicarb dialysate solution.
fluid restriction
restricted to 1000ml/day + output.
excessive fluid
lead to edema, pulmonary edema, high wt gain b/w dialysis, high/low BP, CHF, cramps during dialysis
wt gain b/w treatments
should not exceed 1-2 lb/day.
common to see 2-4 lb b/w M & W, and 3-5 lb gains over weekend.
1 pt/2 c = 1 lb
thirst
increased by high BG or Na
what counts as a fluid
anything that melts to a liquid. IV fluids or blood. TF or liquid sups.
ice, ice cream, ices, jello, popsicles, pudding (juicy fruits also increase fluid intake)
K restriction
1500-3000 mg/day
K mEq
39 mg K = 1 mEq
K high plasma values
d/t high K consumption. salt substitutes (Morton Lite Salt, Cardia) are very high in K
high K foods
F&V, lima bean, peanut, sardine, yogurt
Na mEq
23 mg Na = 1 mEq
