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2.4 - ABSN NUR 334 Urinary > Chronic Kidney Disease - Dialysis Content > Flashcards

Chronic Kidney Disease - Dialysis Content Flashcards

1
Q

Dialysis works through?

A

Osmosis

Diffusion

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2
Q

What is Dialysis?

A

Substances move from blood through a semipermeable membrane and into a dialysis solution

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3
Q

What is the dialysis solution called?

A

Dialysate

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4
Q

What percentage of people get Hemodialysis?

A

90%

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5
Q

What percentage of people get Continuous Ambulatory Peritoneal Dialysis?

A

10%

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6
Q

Where is the membrane located for Hemodialysis?

A

Outside of body

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7
Q

Where is the membrane located for Peritoneal Dialysis?

A

Peritoneum

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8
Q

What is needed for Hemodialysis?

A

An access

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9
Q

Types of Accesses

A

AV Fistula

External Devices

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10
Q

The AV Fistula is…

A

permanent

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11
Q

Most common placement for AV Fistula?

A

Forearm

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12
Q

What happens to the vein and artery where the AV Fistula is placed?

A

It is anastomosed

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13
Q

An anastomosis requires how long to “mature” before using?

A

Months

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14
Q

Nursing Implications for the AV Fistula?

A

Assess for a thrill and a bruit every shift
Avoid BPs, IV sticks in affected arm
Assess peripheral perfusion distal to site

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15
Q

Who does an anastomosis?

A

OR surgeon

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16
Q

An AV Fistula should last up to ___ ___with dialysis, if it used and does well its first ___ ___.

A

20 years; 6 months

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17
Q

Thrills and bruits are ______ findings?

A

expected

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18
Q

A _____ and _____ confirms patency

A

thrill; bruit

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19
Q

If no thrill or bruit is heard…

A

notify the provider

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20
Q

Assess peripheral perfusion by:

A

checking cap refill, radial and ulnar pulses, numbness/tingling, motor dexterity, pain

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21
Q

AV graft is made of…

A

synthetic material

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22
Q

Advantage of AV Graft…

A

matures or can be used quicker than AV Fistula

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23
Q

Disadvantage if AV Graft…

A

body recognizes it as a foreign object and it can become infected

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24
Q

AV Graft used for…

A

small weak veins or if need to use quicker than when a AV Fistula can be used use

25
Q

External devices for Hemodialysis are:

A

Right IJ, Femoral, “Udall” catheter

26
Q

External devices are:

A

temporary

27
Q

Characteristics of Right IJ?

A

Tunneled, cuffed catheter
Placed by HCP
Lasts 1-3 weeks

28
Q

How long does a femoral external device last?

A

1 week

29
Q

Patient will be…. when they have a femoral external device?

A

on bedrest with minimal leg movement

30
Q

What can be used in place of AV Fistula while waiting for it to mature?

A

External devices: Right IJ, Femoral

31
Q

A Udall catheter is used for….

A

patient with AKI

needing dialysis short term (7-10 days)

32
Q

How often is Hemodialysis done?

A

4hrs, 3x a week
rest of life
NO MATTER WHAT

33
Q

What is needed for Peritoneal Dialysis?

A

A catheter

34
Q

Most common type of Peritoneal Dialysis catheter?

A

Tenckhoff

35
Q

How often is Peritoneal Dialysis done?

A

4x a day, rest of life

36
Q

What does a Peritoneal Dialysis “cycle” consist of?

A

Inflow or “Fill”
Dwell
Drain

37
Q

What happens during inflow or “fill” phase?

A

2L dialysate into abdomen

Takes about 10 minutes

38
Q

What happens during dwell phase?

A

Diffusion and osmosis takes place
Dwell time varies (prescribed)
Patient can ambulate during this time

39
Q

What happen during drain phase?

A

Emptying of used dialysate
By gravity flow
Takes about 15-30 minutes

40
Q

Advantages of Peritoneal Dialysis?

A 
No going to dialysis clinic 
Autonomy
Increased Mobility
Less CV stress
Less complicated
41
Q

Disadvantages of Peritoneal Dialysis?

A

Done a lot more often then Hemodialysis
Body image issues
Requires high motivation
Risk for peritonitis

42
Q

Automated Peritoneal Dialysis…

A

Automatically cycles times and controls fill, dwell and drain phases

43
Q

Automated Peritoneal Dialysis uses…

A

A cycler

44
Q

When is APD primarily used?

A

At night

45
Q

How many exchanges per night using APD?

A

About 4 or so exchanges at about 1hr per exchange

46
Q

Characteristics of Continuous Ambulatory Peritoneal Dialysis…

A

Manual exchanges
At least 4x/ day
Dwell times vary
May be able to disconnect bag during dwell period

47
Q

Can use Tenckhoff catheter after how many weeks?

A

1-2 weeks

48
Q

Caring for a Tenckhoff catheter

A

Shower and pat dry

Requires daily catheter care: antiseptic solution, remove dressing once healed, examine site for S/S for infection

49
Q

What is the MAJOR complication of Peritoneal Dialysis?

A

Peritonitis

50
Q

Why is peritonitis a major risk of Peritoneal Dialysis?

A

Constant contact of site with less-than-meticulous aseptic technique

51
Q

Complications of Hemodialysis…

A 
Infection
Decreased Cardiac Output
Cardiac Dysrhythmias
Disequilibrium Syndrome (disorientation, seizures, HA, agitation, N/V) ***unique to Hemodialysis***
Air Embolism
52
Q

Complications of Peritoneal Dialysis…

A 
Infection
Decreased Cardiac Output
Fluid Overload
Respiratory Insufficiency
Abdominal Pain
53
Q

Advantages of Hemodialysis?

A

Rapid removal of fluid, urea/ creatinine, K+

54
Q

Disadvantage if Hemodialysis?

A

Requires vascular access, may require heparin
Dietary/ Fluid restrictions more strict
Hypotension during dialysis
Does NOT mimic a normal urine output

55
Q

What are Nursing Considerations for Dialysis?

A 
Monitor VS
I&Os, weigh daily
Monitor S/S complications
Monitor lab values
Daily catheter/fistula care
PD:
Turn side to side to facilitate drainage
Observe color of dialysate
HD:
No BP, injections, IVs on affected limb
56
Q

Dark, cloudy dialysate could indicate what?

A

Peritonitis

57
Q

Patient who are on dialysis may have _____ levels of drugs due to drugs not being ______?

A

toxic; excreted

*Particularly drug that are excreted by way of kidneys

58
Q

Some drugs are lost during dialysis, this causes….

A

post-dialysis subtherapeutic levels

59
Q

Drug therapy and Hemodialysis

A

Be aware of which drugs are dialyzed out
Administer those AFTER dialysis
Dosing may need to be altered to reduce chance of toxicity

2.4 - ABSN NUR 334 Urinary (6 decks)

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