Dialysis Flashcards
Functions of Dialysis
1) rids body of excess fluid and electrolytes
2) achieves acid-base balance
3) eliminates waste products
4) restores internal homeostasis by osmosis, diffusion, and ultrafiltration
Hemodialysis
1) shunts blood from body through dialyzer and back into circulation
2) vascular access needed
3) Indications:
- renal insufficiency
- ARF
- CRF
- drug overdose
- persistent hyperkalemia
- hypervolemia unresponsive to diuretics
Preprocedure
1) assess patency of the access site
- presence of bruit
- palpable thrill
- distal pulses
- circulation
2) avoid taking BP, administering injections, performing venipunctures or inserting IV lines on arm with access site
3) elevate extremity following surgical development of AV fistula to reduce swelling
4) assess VS, lab values (BUN, serum creatinine, electrolytes, Hct), and weight
Preprocedure
1) discuss w/ provider any meds that need to be withheld until after dialysis
2) dialyzable medications and medications that lower BP are usually withheld
3) instruct client about procedure
- advise that hemodialysis is usually done 3x/wk, for 3-5 hr sessions
- 2 needles are inserted, 1 in an artery and 1 into a vein or using a special dialysis catheter, fistula, or graft
4) instruct client to notify nurse of muscle cramps, headache, nausea, or dizziness during procedure
Intraprocedure
1) monitor VS and lab values
2) monitor for bleeding (such as oozing from insertion site)
3) monitor for coagulation studies
4) administer anticoagulants as prescribed
5) have protamine sulfate ready to reverse heparin if needed
6) provide emotional support
7) offer activities (books, magazines, music, cards, tv) to occupy client
Postprocedure
1) monitor VS, weight, lab values (BUN, serum creatinine, electrolytes, Hct)
2) decreases in BP, weight, and lab values are expected following dialysis
3) assess for:
a) complications (hypotension, hypovolemia, clotting of vascular access, headache, muscle cramps, bleeding, disequilibrium syndrome)
b) indications of bleeding, and/or infection at access site
c) nausea, vomiting, and change in LOC
4) avoid invasive procedures for 4-6 hr after dialysis due to risk of bleeding r/t an anticoagulant
Client Teaching
1) avoid lifting heavy objects w/ access-site arm
2) avoid carrying objects that compress extremity
3) avoid sleeping on top of extremity w/ access device
4) check access site at intervals following dialysis
5) apply light pressure if bleeding
6) notify provider if site continues to bleed after 30 min following dialysis
Complications of Hemodialysis
1) clotting/infection of access site
a) instruct client to monitor access site for indications of infection
- fever, redness, drainage, swelling
b) teach client to check graft for patency by checking for thrill/bruit and to contact provider for absence or signs of infection
c) advise client to prevent constriction of extremity with vascular access
2) disequilibrium syndrome
a) early recognition essential
b) manifestations: nausea, vomiting, change in LOC, seizures, agitation
c) use slow dialysis exchange rate, especially for older adult clients and those treated with hemodialysis for 1st time
d) administer anticonvulsants/barbiturates if needed
e) advise client to alert nurse if indications of disequilibrium syndrome, such as nausea and headache occur
3) hypotension
a) carefully replace fluid volume with transfusion of IV fluids or colloid as prescribed
b) slow dialysis exchange rate
c) lower head of bed
d) for severe hypotension unresponsive to fluid replacement, discontinue dialysis
e) advise client to notify nurse of headache, nausea, or dizziness during dialysis
f) advise client not to eat during dialysis
4) anemia
a) administer prescribed med therapy (erythropoietin) to stimulate production of RBCs
b) monitor Hgb and RBC levels
c) monitor for hypotension and tachycardia
d) transfuse blood products if prescribed
e) advise client to take meds and supplements as prescribed
f) educate client about diet and nutrition (including foods high in folate–beans, green vegetables)
5) infectious diseases
a) blood transfusions and frequent blood access due to hemolysis pose risk for transmission of bloodborne diseases such as HIV hepatitis B and C
b) use standard precautions
Peritoneal Dialysis
1) involves instillation of fluid into peritoneal cavity
2) peritoneum serves as filtration membrane
3) client should have an intact peritoneal membrane, w/o adhesions from infection or multiple surgeries
4) indications:
- unable to tolerate anticoagulation
- difficulty with vascular access
Preprocedure
1) assess dry weight (obtained when dialysate is drained), serum electrolytes, creatinine, BUN, and blood glucose
2) determine client’s ability to perform self-peritoneal dialysis
3) instruct client about procedure
- client may feel fullness when dialysate is dwelling
- there may be discomfort intitially with dialysate infusion
4) continuous ambulatory peritoneal dialysis (CAPD) is usually done 7 days/wk for 4-8 hrs. (may continue normal activities during CAPD)
Intraprocedure
1) monitor VS frequently during initial dialysis in hospital setting
2) monitor serum glucose level
3) record amount of inflow compared to outflow of dialysate
4) monitor color (clear, light yellow expected) and amount of outflow (expected to equal or exceed dialysate inflow)
5) monitor for indications of infection
- fever
- bloody, cloudy, or frothy dialysate return
- drainage at access site
6) monitor for complications (respiratory distress, abdominal pain, insufficient outflow, discolored outflow)
7) check access site dressing for wetness (risk of dialysate leakage)
8) warm dialysate prior to instilling. avoid use of microwaves, which cause uneven heating
9) follow prescribed time for infusion, dwell, and outflow
10) maintain surgical asepsis of catheter insertion site and when accessing catheter
11) keep outflow bag lower than client’s abdomen (drain by gravity, prevent reflux)
12) reposition client if inflow or outflow is inadequate
13) carefully milk peritoneal dialysis catheter if fibrin clot has formed
Postprocedure
1) monitor weight, serum electrolytes, creatinine, BUN, and blood glucose
2) teach client home care of access site
3) instruct client and family how to perform at home
4) provide support for home peritoneal dialysis w/ home visits and support groups, such as National Kidney Foundation
5) instruct client to follow instructions carefully and take all meds as directed
Complications of Peritoneal Dialysis
1) Peritonitis
- maintain surgical asepsis during procedure
- monitor for infection (fever, purulent drainage, redness or swelling) and cloudy or discolored drained dialysate
- educate client to use strict sterile technique during exchanges
- instruct client to notify provider w/ indications of infection
2) infection at access site
- maintain surgical asepsis of access site
- monitor site for wetness from a leaking catheter
- monitor for infection (fever, purulent drainage, redness, or swelling)
- reinforce education to use strict sterile technique during exchanges
- instruct client to notify provider with indications of infection
- advise client to assess site for leaks and prevent tugging or twisting of tubing
3) protein loss
- monitor serum albumin level
- increase dietary intake of protein
- instruct client to follow recommended renal diet with increase in dietary protein
4) hyperglycemia and hyperlipidemia
- monitor serum glucose and lipids
- administer insulin for glycemic control
- provide lipid therapy as ordered
- instruct client to follow recommended diet
5) poor dialysate inflow or outflow
- rotate catheter to facilitate inflow and outflow
- reposition client if inflow or outflow is inadequate
- milk tubing to break up fibrin clot
- advise client to check tubing for kinks
- instruct on removal of fibrin clot
- tell client to avoid constipation by using stool softeners and eating a high-fiber diet
- remind client to monitor in and outflow and to change position or lower or raise dialysate bag as needed to improve flow.
