Dialysis

Question 1

List the 5 indications for dialysis

Answer 1

Volume overload
High K+
Metabolic acidosis
Elevated BUN/creatinine
Drug/toxin overdose

Question 2

What 2 principles drive dialysis? Explain ultrafiltration

Answer 2

Osmosis
Diffusion

Ultrafiltration: Creates pressure gradient with blood pump (HD) or glucose (PD)

Question 3

Why are patients undergoing peritoneal dialysis encouraged to maintain a normal caloric intake instead of a high one?

Answer 3

Glucose is added to dialysate

Question 4

Explain HD
-Done ____, __x/week, for ____ hours

Answer 4

Intermittently, 3/week, 3-4 hours

Question 5

Peritoneal Dialysis
-1 exchange consists of?
-Dwell time?
-Fluid amount?
-Bathing?

Answer 5

1 exchange= inflow, dwell, drain

Dwell time: ordered- usually 4-6 H

Volume: usually 2L/exchange for average sized person

No bathing, showering is fine

Question 6

What is the #1 complication of PD?

Answer 6

Peritonitis
-rebound tenderness/abdominal pain
-Cloudy effluent, elevated WBC or bacterial growth in effluent
-V/D, distention, hyperactive bowel sounds, fever

TREATMENT
-antibiotics, repeat infections cause adhesions

Question 7

HEMODIALYSIS
-requires?
-3 access types?

Answer 7

Requires very rapid blood flow and large vessel access

Fistula-takes 6 weeks to heal before use

Graft- 2-4 weeks to heal

CVC- temp. access/emergency

Question 8

What 2 normal findings should be ensured before hemodialysis

Answer 8

Feeling a thrill and hearing a bruit

Question 9

What is added to blood during HD to prevent clots?

Answer 9

Heparin

Question 10

BP should be checked every _____ during HD

Answer 10

20-30 mins

Question 11

What is the #1 complication of HD?

Answer 11

Hypotension

Question 12

What infections are possible from HD?

Answer 12

Hep B and C

Question 13

Explain CRRT

Answer 13

Continuous Renal Replacement Therapy

-Slower dialysis, lower hypotension, better for hemodynamically unstable patients
-Only ICU, 24-hour runs

-CVC access
-Monitor I&O, VS
-1:1 pt/RN ratio