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dialysis exam > complications/policies and procedures > Flashcards

complications/policies and procedures Flashcards

1
Q

Hypotension

-signs and symptoms (6)

A
  • dizziness
  • nausea
  • dehydration
  • lack of concentration
  • blurred vision
  • cold/clammy/pale skin
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2
Q

Hypoglycemia

-signs and symptoms (7)

A
  • sweating
  • tiredness/dizziness
  • feeling hungry
  • tingling lips
  • shaking/trembling
  • high HR/palpitations
  • irritability
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3
Q

Anemia

A

condition in which lacking RBC that carry O2 to body’s tissues

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4
Q

Fluid Overload

A

extra fluid in body

-raises BP and forces heart to work harder

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5
Q

Hypovolemia

A

severe blood/fluid loss resulting into the heart unable to pump enough blood throughout the body

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6
Q

Hyperkalemia

-signs and symptoms

A
  • abdominal pain
  • diarrhea
  • chest pain
  • muscle weakness/numbness
  • nausea and vomiting
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7
Q

Hypokalemia

-signs and symptoms

A
  • muscle twiches
  • muscle cramps
  • paralysis
  • abnormal heart rhythms
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8
Q

Hypovolemia

-signs and symptoms

A
  • hypotension
  • tachycardia
  • increased respiration
  • loss of electrolytes
  • dehydration
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9
Q

Hypovolemia

-potential causes

A
  • dehydration
  • bleeding
  • loss of plasma (burns)
  • excessive diaphoresis
  • DW needs to be assessed
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10
Q

Drop in URR

-signs and symptoms

A
  • progressive weakness
  • fatigue
  • loss of appetite due to nausea and vomiting
  • muscle atrophy
  • tremors
  • abnormal mental function
  • frequent shallow respiration
  • metabolic acidosis
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11
Q

Anemia

-signs and symptoms

A
  • fatigue
  • weakness
  • pale/yellow skin
  • irregular HB
  • angina
  • SOB
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12
Q

Fluid Overload

-signs and symptoms

A
  • high BP
  • SOB
  • edema
  • jugular vein distention
  • irritable/confused
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13
Q

Anemia

-potential causes

A
  • bleeding
  • acute/chronic inflammatory conditions
  • hemolysis
  • vit b12 deficiency
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14
Q

LVH

A

LEFT VENTRICULAR HYPERTROPHY

  • muscular chamber of the heart that accepts blood from left atrium and ejects it into the aorta (to rest of body) that is over worked
  • results to thickening of muscle and decreased ability to pump efficiently
  • diastolic filling is impaired
  • can cause dyspnea, heart failure
  • RBC may become unable to carry O2
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15
Q

CHF

A

CONGESTIVE HEART FAILURE
-unable to deliver adequate supply of oxygenated blood to organs and tissues
-kidney tried to compensate; retention of sodium chloride and water to increase blood volume and venous pressure
+retention of sodium chloride results to dilution of plasma proteins; creates edema
-results to extracellular volume expansion and pulmonary edema

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16
Q

CHF

-signs and symptoms

A
  • excessive fatigue or weakness
  • loss of appetite
  • orthopnea
  • confusion
  • chronic dry cough
  • distended neck veins
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17
Q

Renal Osteodystrophy

-explain

A
  • kidney helps with formation of bone and regulation of calcium-phosphorous balance
  • hypocalcemia or hyperphosphatemia can results to abnormal bone growth

-low calcium/high phosphate signal parathyroid gland to fix the problem; resulting in bone cysts and metastatic calcification

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18
Q

Renal Osteodystrophy

-signs and symptoms

A
  • bone pain
  • fractures
  • muscle weakness
  • bone deformities
  • giant cell granulomas in bone
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19
Q

Common Complications

A
  • hypotension
  • cramps
  • nausea and vomiting
  • headaches
  • chest pain
  • fever and chills
  • cardiac arrest
20
Q

Life Threatening Complications

A
  • arrhythmia, palpitations, chest pain
  • air embolism
  • exsanguination
  • hemolysis
  • hypo/hyperglycemia
  • anaphylactic reaction
21
Q

Hyperglycemia

-signs and symptoms

A
  • fruity-breath
  • nausea and vomiting
  • dyspnea
  • dry mouth
  • weakness
22
Q

Muscle Cramps

-possible causes

A
  • hypotension
  • excessive fluid removal
  • below target weight
  • dialysate sodium level too low
  • fluid and electrolyte balance
  • hypomagnesia
23
Q

Muscle Cramps

-treatment

A
  • stop UF; WLM
  • monitor BP
  • massage area
  • dry weight should be assessed
  • evaluate BV
  • changes to sodium profiling?
24
Q

Arrythmia, palpitations, chest pain

-treatment

A
  • decrease pump to 200; increases intravascular BV
  • WLM; allow shifting of fluid from interstitial space to intravascular space
  • admin O2
  • monitor vitals
  • nitro if no hypotension
  • page nephrologist
  • review blood work: Hgb, K, Ca, Mg
25
Q

Air Embolism

A

air entering systemic vein
travels to right ventricle through vena cava
*implodes heart’s pumping ability by reducing blood flow to pulmonary circulation

26
Q

Air Embolism

-causes

A
  • CVC insertion/removal
  • CVC disconnection/loose connection
  • malfunctioning air detector alarm
  • air in blood foam, dialyzer, or empty arterial chamber
27
Q

Air Embolism

-signs and symptoms

A
  • dyspnea, cyanosis
  • chest pain
  • hypotension, tachycardia
  • coughing
  • confusion
  • seizure, coma, cardiac arrest
28
Q

Air Embolism

-treatment

A
  • stop pump, clamp both lines
  • NO RETRANSFUSION*
  • add pressure over CVC removal site
  • position pt on lft side into trendelenburg for 30 minutes; decreases air going to pulmonary circulation and maintains cardiac output
  • adult O2 mask at 15L/min; absorbs for nitrogen to help keep alveoli from collapsing
  • observe vitals; increase in BP and oxygenation indicates air is being cleared
  • page MD asap
29
Q

Anaphylactic Reaction

-signs and symptoms

A
  • flushing
  • pruritis
  • urticaria (hives)
  • sneezing
  • watery eyes
  • cough
  • abdominal cramps
  • diarrhea
  • dyspnea
  • burning throughout body
  • chest tightness
30
Q

Anaphylactic Reaction

-causes

A
  • contaminated dialysis solution

- heparin/drug reaction

31
Q

Anaphylactic Reaction

-treatment

A
  • stop blood pump and clamp venous and arterial lines
  • NO RETRANSFUSION*
  • admin O2 15L/min
  • page MD asap
  • collect blood from both arterial and venous bloodline ports
  • treat hypotension with saline infusion
  • collect water and dialysate sample; call techs to check water system
  • record lot numbers, dialyzer, bloodlines, heparin, acid conc, bicart cartridge
  • create Safety Point Report
32
Q

Hemolysis

-causes

A
  • hyper/hypo-tonic dialysate
  • metal oxidants
  • blood tubing obstruction
  • temp of dialysate
33
Q

Hemolysis

-signs and symptoms

A
  • chest pain
  • back pain
  • dyspnea
  • translucent blood in venous bloodline
  • pain at access point
  • hyperkalemia
  • drop in Hgb
  • arrhythmias
34
Q

Hemolysis

-treatment

A
  • stop pump, camp venous and arterial lines
  • NO RETRANSFUSION; hemolyzed blood = ^ K levels
  • admin O2 at 15L/min
  • monitor vitals; treat hypotension if needed
  • page MD asap
35
Q

Seizures

-causes

A
  • dialysis disequilibrium
  • electrolyte imbalance
  • delivery of improperly prepared dialysate
  • hypotension
  • reaction to chemical agent
  • pre-existing seizure disorder
36
Q

Seizures

-treatment

A
  • take blood sample from arterial port to determine seizure activity; low blood sugar, calcium and sodium
  • retransfuse pt
  • evaluate blood volume monitoring response
  • assess DW and sodium profilling
  • document
37
Q

Blood Leak

A

caused by defective dialyzer membrane ruptures

38
Q

Large Blood Leak

A

visible; blood is light pink

  • clamp venous and arterial
  • NO RETRANSFUSION*
  • monitor vitals; look for signs of pyrogenic rx (chills, fever, nausea and vomiting
  • page MD asap
  • extreme blood loss results in anemia, chest pain, shock, seizures
  • pt stable? continue tx with same machine with new line
  • tell tech asap
  • after tx bleach and pull aside
39
Q

Small Blood Leak

A
  • using gloves take sample from venous fluid tube, use blood leak strip
  • retransfuse and change circuit, contrinue with same machine
  • end of tx, bleach then pull
40
Q

Exsanguination

-causes

A
  • separation of blood lines
  • venous needle falls out
  • rupture of vascular access- anastamosis or aneurysm
  • blood leak
41
Q

Exsanguination

-treatment

A
  • turn pump off, clamp disconnected lines
  • apply pressure to any bleeding sites
  • monitor vitals; saline if hypotension
  • admin O2 if dyspnea
  • retransfuse unless large blood leak
  • page MD
  • draw CBC next treatment to assess need for transfusion
42
Q

Febrile Patient

A

-draw CBC
(check if recent test done, if so check for antibiotic)
-draw 2 sets of aerobic and anaerobic (ana first)

43
Q

Hypoglycemia

-treatment

A
  • check BS asap
  • BS <4 mmol/L; apple juice and glucose tablet
  • recheck BS 15 min
  • BS <4 mmol/L; apple juice and glucose tablet
  • once stabilized give snack package

-50mL 50% dextrose IV STAT
-glucagon 1mg IM or SC
notify MD

44
Q

Hyperglycemia

-treatment

A
  • page MD to require insulin

- insuline may be reassessed

45
Q

Cardiac Arrest

-treatment

A
  • shake and shout
  • check BP
  • WLM
  • position trendelenburg
  • administer saline
  • call for help
  • assess breathing
  • assess carotid pulse 5-10 seconds
  • compressions
  • 5555 CALL CODE BLUE
  • retransfuse is possible
  • insert airway bag

dialysis exam (7 decks)

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