dialysis Flashcards
Compassionate end of life care
*pain and symptom management
*respect for pt’s wishes
*effective communication: open, honest, and compassionate communication between pt, family, and care team
*emotional and psychological support
*family involvement and support
*comfort and dignity
*holistic care
*bereavement support
interactions w/ pts and fam when discussing stopping dialysis and starting hospice (notes from document Mary gave)
*it is normal to feel obligated to continue with tx however the rigorous routine of dialysis can be physically and emotionally challenging. Stopping dialysis is a choice you can make if you feel your quality of life has declined to the point that you no longer want to continue dialysis. But before making such life-altering decision, its essential that you consider it very carefully
*when stopping you may experience confusion, otherwise known as delirium. There are effective medications your doc and team can use to help reduce distress r/t confusion
*Kidney failure is usually a peaceful and painless progression that typically involves slipping into a coma (deep sleep).
*You have the option to change your mind if you choose
*hospice is a program designed to give you palliate and emotional support in a homelike setting.
*you have the choice on what setting you’d like to pass in
s/s when dialysis is stopped (7)
*sleepiness and weakness
*breathing changes
*changes in body temp
*appetite changes
*emotional changes
*nausea
*confusion
dialysis: def
*tx of pushing and pulling fluids through the semipermeable membrane (dialyzer)
*pt’s blood is pulled from their body and mixed with the dialysis concentrate (dialysate) to correct the electrolyte imbalance or clear out toxins and waste the person may have
dialysis: how does it work (two main methods)
*peritoneal dialysis: the peritoneal membrane is used at the dialyzer
*hemodialysis: the dialyzer is made of the artificial material and synthetic fibers that the blood and dialysate flow through
main principles of fluid removal (3)
- diffusion: moving the high waste and electrolyte concentration out of the pt’s blood and move the dialysate into the pt’s blood
- Osmosis: glucose may be added to the dialysate to pull more fluid from the blood
- ultrafiltration: creating a pressure differential creating a pressure differential to remove excess fluid from the blood in the dialyzer
common indicator for beginning dialysis
when pts uremia (kidney filtering ability) is no longer able to manage on its own
uremic complications that indicate immediate dialysis tx are… (5) (PANUE)
Encephalopathy
neuropathies
uncontrolled hyperkalemia
pericarditis
accelerated htn
skin/access management (4)
*assess for bleeding
*assess for infection
*avoid using blood pressure cuffs
*do not access w/o proper equipment,reason,training
dialysis access (3)
*central venous catheter: immediate but temporary
*Arteriovenous fistula: most common/ideal
*arteriovenous graft: artificial
complication monitoring (3)
*HoTN: d/t rapidly removing fluid. Replenish w/ 0.9% NS bolus
*muscle cramps: low Na levels associated w/ fluid removal. Give hypertonic glucose
*Blood loss: return blood after removal (duh) monitor for bleeding until needle site is clotted
how often will people receive dialysis normally
3 times a week
most common cause of death in ESDR
CVD resulting from withdrawal from dialysis tx
Lifestyle changes (3)
Diet: malnutrition is common
physical disability
lack of mobility
psychosocial changes (3)
social isolation
poor in-home help
transportation to dialysis tx
