Clinical Reasoning-Dialysis Flashcards
What are the two types of dialysis?
Hemodialysis and peritoneal dialysis
When would you put someone on dialysis?
Patients with acute kidney injury waiting recovery. Patients with stage 4 CKD (GFR 15-30), usually when GFR<10 and they develop uremic syndrome.
What symptoms in a patient with acute renal failure indicate a need for dialysis during recovery?
“AEIOU” = Acidosis, Electrolyte abnormalities (hyperkalemia), Intoxication (alcohol, lithium), Overload (fluid), Uremia (bleeding, pericarditis and encephalopathy).
How are solutes and fluid removed from the blood during dialysis?
The dialysate has a low electrolyte concentration and allows for diffusion of electrolytes from the blood. You also adjust the hydrostatic pressure in the blood tube to increase solvent drag and push out fluid.
Why do you have blood and dialysate traveling in opposite direction?
To maximize the concentration gradient along the entirety of the membrane.
How do you gain access for dialysis?
Surgically created AV fistula (takes time) or arterio-venous graft (can use 1 week post-op). If you are crunched for time, you put in a catheter (internal jugular or femoral vein)
What diet restrictions do patients on dialysis have?
Low phosphorus/potassium diet. Drink less than 1 liter of water per day.
What electrolytes can be manipulated in dialysis?
Na, K, Ca and HCO3
How does peritoneal dialysis remove electrolytes and fluid?
A high glucose solution is put into the peritoneum. Uremic solutes and K+ diffuse down the gradient into the peritoneum. The high glucose solution also causes water to cross the peritoneal membrane. This fluid is then sucked out and replaced with new fluid to continue dialysis.
What are the advantages of peritoneal dialysis?
Avoids dramatic shifts and can be tolerated better in patients w/heart failure or brain injury. Home therapy. Peds.
What complications happen with hemodialysis?
Hypotension, cramping, clotting in circuit/access, disequilibrium syndrome (cerebral edema from rapid removal of solutes), allergic reactions, hemolysis (from Cl in H2O), arrhythmia (hypokalemia) and air embolism.
What complications happen with peritoneal dialysis?
Peritonitis, abdominal hernia, hydrothorax, clotting and loss of peritoneal efficiency.
