dialysis

Question 1

osmosis

Answer 1

movement of water from an area of lower to higher concentration

Question 2

diffusion

Answer 2

movement of particles from an area of higher to lower concentration

Question 3

what is dialysis?

Answer 3

substances move from blood through a semipermeable membrane and into a dialysis solution (dialysate)

Question 4

hemodialysis

Answer 4

semi-permeable membrane OUTSIDE of body
hooked to an AV fistula
takes ~ 4-5 hours, 3x/week
filtration system in cylinder outside of body (GFR)

90% use

Question 5

peritoneal dialysis

Answer 5

semi-permeable membrane is the peritoneum
pt can get up and move around
peritoneal catheter into peritoneum –> dialysate infused into peritoneum, stays in, then comes back out
4-6x per day

10% use

Question 6

dialysate concentrations

Answer 6

if electrolyte levels are high, the dialysate will be less concentration, so the electrolytes diffuse from the pt to the dialysate

if electrolytes are low, dialysate will be more complicated so electrolytes will diffuse to the low concentration in the body

Question 7

AV fistula

Answer 7

HD access
forearm anastomosis of own artery and vein
(artery and vein sewn together)

permanent and requires months to mature before using (if it does well first 6 months, should last up to 20 years)

Question 8

expected/unexpected findings of an AV fistula

Answer 8

expected: bruit (swishing sounds heard when stethoscope placed over)
turbulent blood flow
thrill (feels like a cat purring)

unexpected: no bruit/sound –> next best nursing action: call HCP
decrease in peripheral perfusion (pulses, cap refill, tingling & numbness)

Question 9

nursing implications of an AV fistula

Answer 9

assess for thrill and bruit q shift (confirms patency)
avoid BP, IV sticks in affected arm
assess peripheral perfusion distal to site (cap refill, tingling & numbness, radial and ulnar pulse, pain?)

Question 10

AV fistula vs. AV graft

Answer 10

fistula: must wait 6 weeks to 2 months to use
*blood supply to dialyzer
*blood return to pt
*basilic vein connected to radial artery

graft: matures quicker than fistula
*looped graft made of synthetic material that connects the antecubital vein to the brachial artery
*body identifies it as a foreign object and it will likely become infected

Question 11

types of temporary EXTERNAL devices

Answer 11

right internal jugular (IJ) –> tunneled, cuffed cath; lasts 1-3 weeks

femoral (thigh/groin area) –> lasts up to 1 week
*bed rest with minimal leg movement
*NOT ideal site

Question 12

udall catheter

Answer 12

AKI pt needing dialysis
NOT permanent –> lasts 7-10 days

Question 13

most common catheter for peritoneal dialysis and insertion is done where?

Answer 13

tenckhoff

peritoneal cath is put in surgically (OR)
and rests in peritoneum

Question 14

cycles of PD

Answer 14

1. inflow (fill)
2. dwell
3. drain

goes through these 3 cycles for a complete exchange

Question 15

inflow (“fill”)

Answer 15

2L of dialysate is introduced in abd
takes about 10 minutes

when finished, cath can be rolled up and pt can move around

Question 16

dwell

Answer 16

diffusion and osmosis take place
time varies

Question 17

drain

Answer 17

used dialysate is emptied out by gravity flow –> place bag on clean towel on floor to allow it to drain
takes about 15-30 minutes

Question 18

peritoneal dialysis systems

Answer 18

APD: automated PD
CAPD: continuous ambulatory PD

Question 19

APD

Answer 19

uses a cycler –> automatically cycles times and controls fill, dwell, and drain phases
used primarily at night during sleep
cycles 4 or so exchanges per night at 1hr per exchange

Question 20

CAPD

Answer 20

manual exchanges
4x/day
dwell times vary
may be able to disconnect from bag during dwell period

Question 21

tenckhoff cath use and care

Answer 21

use after healing period of 1-2 weeks - once healed, can shower and pat dry

requires daily care:
-antiseptic solution
-clean dressing (can be removed when healed)
-examination of site for S/S of infection

Question 22

major complication of PD

Answer 22

PERITONITIS

d/t bad aseptic technique

Question 23

complications of PD

Answer 23

infection
decreased CO
fluid overload
respiratory insufficiency
abd pain

Question 24

complications of HD

Answer 24

infection
decreased CO
cardiac dysrhythmias
disequilibrium syndrome –> disorientation, seizures, HA, agitation, N/V
air embolism

Question 25

advantages of HD

Answer 25

(+) rapid removal of fluid, BUN, Cr, K+

Question 26

disadvantages of HD

Answer 26

requires vascular access/may require heparin

dietary/fluid restriction more stringent

hypotension during dialysis

Question 27

which type of dialysis mimics normal UOP?

Answer 27

peritoneal

Question 28

advantages of PD

Answer 28

less complicated
home dialysis possible
increased mobility
fewer diet restrictions
less CV stress

Question 29

disadvantages of PD

Answer 29

risk for peritonitis
requires high motivation
body image issues (d/t cath)

Question 30

nursing considerations for dialysis

Answer 30

monitor VS
I&O/daily weights
monitor S/S complications
monitor lab values
daily catheter/fistula care

Question 31

nursing considerations for PD

Answer 31

turn side to side to facilitate drainage prn
observe color of dialysate (more concentrated = darker, cloudy)

Question 32

nursing considerations for HD

Answer 32

no BP, injections, IV insertions on affected limb
do NOT use IV accesses for HD

Question 33

post-dialysis sub therapeutic levels

Answer 33

some drugs cross semipermeable membrane and are lost during dialysis

Question 34

what happens to drug levels during dialysis

Answer 34

build up - toxic levels possible
d/t inability to excrete from body, so they circulate in their active form for prolonged periods since not excreted