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Review for NUR 427 Entry Exam > 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
External devices for Hemodialysis are:
Right IJ, Femoral, "Udall" catheter
26
External devices are:
temporary
27
Characteristics of Right IJ?
Tunneled, cuffed catheter Placed by HCP Lasts 1-3 weeks
28
How long does a femoral external device last?
1 week
29
Patient will be.... when they have a femoral external device?
on bedrest with minimal leg movement
30
What can be used in place of AV Fistula while waiting for it to mature?
External devices: Right IJ, Femoral
31
A Udall catheter is used for....
patient with AKI | needing dialysis short term (7-10 days)
32
How often is Hemodialysis done?
4hrs, 3x a week rest of life NO MATTER WHAT
33
What is needed for Peritoneal Dialysis?
A catheter
34
Most common type of Peritoneal Dialysis catheter?
Tenckhoff
35
How often is Peritoneal Dialysis done?
4x a day, rest of life
36
What does a Peritoneal Dialysis "cycle" consist of?
Inflow or "Fill" Dwell Drain
37
What happens during inflow or "fill" phase?
2L dialysate into abdomen | Takes about 10 minutes
38
What happens during dwell phase?
Diffusion and osmosis takes place Dwell time varies (prescribed) Patient can ambulate during this time
39
What happen during drain phase?
Emptying of used dialysate By gravity flow Takes about 15-30 minutes
40
Advantages of Peritoneal Dialysis?
``` No going to dialysis clinic Autonomy Increased Mobility Less CV stress Less complicated ```
41
Disadvantages of Peritoneal Dialysis?
Done a lot more often then Hemodialysis Body image issues Requires high motivation Risk for peritonitis
42
Automated Peritoneal Dialysis...
Automatically cycles times and controls fill, dwell and drain phases
43
Automated Peritoneal Dialysis uses...
A cycler
44
When is APD primarily used?
At night
45
How many exchanges per night using APD?
About 4 or so exchanges at about 1hr per exchange
46
Characteristics of Continuous Ambulatory Peritoneal Dialysis...
Manual exchanges At least 4x/ day Dwell times vary May be able to disconnect bag during dwell period
47
Can use Tenckhoff catheter after how many weeks?
1-2 weeks
48
Caring for a Tenckhoff catheter
Shower and pat dry | Requires daily catheter care: antiseptic solution, remove dressing once healed, examine site for S/S for infection
49
What is the MAJOR complication of Peritoneal Dialysis?
Peritonitis
50
Why is peritonitis a major risk of Peritoneal Dialysis?
Constant contact of site with less-than-meticulous aseptic technique
51
Complications of Hemodialysis...
``` Infection Decreased Cardiac Output Cardiac Dysrhythmias Disequilibrium Syndrome (disorientation, seizures, HA, agitation, N/V) ***unique to Hemodialysis*** Air Embolism ```
52
Complications of Peritoneal Dialysis...
``` Infection Decreased Cardiac Output Fluid Overload Respiratory Insufficiency Abdominal Pain ```
53
Advantages of Hemodialysis?
Rapid removal of fluid, urea/ creatinine, K+
54
Disadvantage if Hemodialysis?
Requires vascular access, may require heparin Dietary/ Fluid restrictions more strict Hypotension during dialysis Does NOT mimic a normal urine output
55
What are Nursing Considerations for Dialysis?
``` 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
Dark, cloudy dialysate could indicate what?
Peritonitis
57
Patient who are on dialysis may have _____ levels of drugs due to drugs not being ______?
toxic; excreted *Particularly drug that are excreted by way of kidneys
58
Some drugs are lost during dialysis, this causes....
post-dialysis subtherapeutic levels
59
Drug therapy and Hemodialysis
Be aware of which drugs are dialyzed out Administer those AFTER dialysis Dosing may need to be altered to reduce chance of toxicity

Review for NUR 427 Entry Exam (27 decks)

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