Dialysis

Question 1

Dialysis

Answer 1

separation of solutes by moving through a semipermeable membrane

removes waste and excess fluid
corrects electrolyte imbalances

Question 2

Dialysis primary treatment

Answer 2

Renal Failure

Question 3

Diffusion

Answer 3

Solutes

Question 4

Ultrafiltration

Answer 4

fluids

Question 5

Timing for Dialysis

Answer 5

Labs - BUN, creatinine, GFR
Electrolyte imbalances (K)
Fluid overload from pulmonary edema, heart failure, HTN

metabolic acidosis
Drug OD/Toxicity
Uremic complications

Question 6

uremic complications

Answer 6

Mental status changes, N/V

Question 7

Hemodialysis

Answer 7

“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

Question 8

Peritoneal Dialysis

Answer 8

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

Question 9

Continuous Renal Replacement Therapy (CRRT)

Answer 9

continuous therapy where wastes and fluids are removed, electrolytes and acid-base status are adjusted gradually

monitored by critical care RN

Question 10

Vascular Access - Catheter Access

Answer 10

percutaneous cath; used short term (up to 3 weeks) or tunneled (long term)

Question 11

Nursing management of catheters

Answer 11

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

Question 12

permanent vascular access: Arteriovenous Fistula

Answer 12

surgical anastomosis of a peripheral artery or vein

preferred mode of access

Question 13

Permanent vascular access: arteriovenous graft

Answer 13

artificial synthetic device surgically implanted inside the limb

Question 14

Nursing care of AV fistula or graft

Answer 14

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

Question 15

Hemodialysis complications

Answer 15

hypotension
muscle cramps
dysrhythmias
viral hepatitis
blood loss
hemolysis
air embolism (rare)

Question 16

hemodialysis nursing management

Answer 16

monitor hemodynamic stability
specialized monitoring before, during and after (labs)
vascular access care
prevent complications
Med management

Question 17

phases for peritoneal dialysis

Answer 17

Inflow (fill), Dwell, Drain

Question 18

complications of peritoneal dialysis

Answer 18

peritonitis (most common)
exit site infection
hernias
low back problems
pulmonary complications
protein loss

Question 19

CRRT indications

Answer 19

for hemodynamically UNSTABLE pt’s

Hypervolemic, edematous pt not responding to diuretics

multiple organ dysfunction syndrome
When pt can have HD or PD

Question 20

CRRT contraindications

Answer 20

Terminal illness

Question 21

complications of CRRT

Answer 21

decreased ultra infiltration rate
clotting of filter
hypotension
fluid and electrolyte changes
bleeding
access dislodgment or infection

Question 22

CRRT nursing management

Answer 22

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