Dialysis Flashcards
Dialysis
separation of solutes by moving through a semipermeable membrane
removes waste and excess fluid
corrects electrolyte imbalances
Dialysis primary treatment
Renal Failure
Diffusion
Solutes
Ultrafiltration
fluids
Timing for Dialysis
Labs - BUN, creatinine, GFR
Electrolyte imbalances (K)
Fluid overload from pulmonary edema, heart failure, HTN
metabolic acidosis
Drug OD/Toxicity
Uremic complications
uremic complications
Mental status changes, N/V
Hemodialysis
“separating from the blood”
excess electrolytes, fluids and toxins by a hemodialyzer
Intermittent, done on a regular basis
takes 3-4hrs; need anticoagulation and vascular access
Peritoneal Dialysis
movement of solutes and fluid through a pt’s peritoneal membrane; may take up to 36 hrs for therapeutic effect
slow correction of biochemical imbalance
home-based, portable
Continuous Renal Replacement Therapy (CRRT)
continuous therapy where wastes and fluids are removed, electrolytes and acid-base status are adjusted gradually
monitored by critical care RN
Vascular Access - Catheter Access
percutaneous cath; used short term (up to 3 weeks) or tunneled (long term)
Nursing management of catheters
strict aseptic technique
exit sites inspected for infection
dressing changes using sterile technique
minimal manipulation: no fluid administration or meds; no blood sampling unless with a specific order
permanent vascular access: Arteriovenous Fistula
surgical anastomosis of a peripheral artery or vein
preferred mode of access
Permanent vascular access: arteriovenous graft
artificial synthetic device surgically implanted inside the limb
Nursing care of AV fistula or graft
protect the site: no BP, blood puncture, IV sites, IM injection; alert other personnel to presence (bracelet, sign); avoid constrictive clothes or jewelry on arm
check for thrill and bruit regularly
monitor for complications: check distal pulses and perfusion
Hemodialysis complications
hypotension muscle cramps dysrhythmias viral hepatitis blood loss hemolysis air embolism (rare)
hemodialysis nursing management
monitor hemodynamic stability specialized monitoring before, during and after (labs) vascular access care prevent complications Med management
phases for peritoneal dialysis
Inflow (fill), Dwell, Drain
complications of peritoneal dialysis
peritonitis (most common) exit site infection hernias low back problems pulmonary complications protein loss
CRRT indications
for hemodynamically UNSTABLE pt’s
Hypervolemic, edematous pt not responding to diuretics
multiple organ dysfunction syndrome
When pt can have HD or PD
CRRT contraindications
Terminal illness
complications of CRRT
decreased ultra infiltration rate clotting of filter hypotension fluid and electrolyte changes bleeding access dislodgment or infection
CRRT nursing management
critical care monitoring
monitor hemodynamic status, I&O’s hourly
assess ultrafiltration volume hourly
Assess hemofilter for clotting; whole system for kinks, blood tubing warm
monitor for complications
