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MS2 Exam 1 > Dialysis > Flashcards

Dialysis Flashcards

1
Q

Principles of Dialysis

A

Solutes and H20 move across a semipermeable membrane from blood to pending on concentration gradients

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2
Q

Osmosis

A

Water moves by concentration gradient

-lesser to higher concentration

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3
Q

Diffusion

A

Solvent moves by concentration gradient

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4
Q

Ultrafiltration

A

Solution moves by pressure gradient

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5
Q

Purpose of dialysis

A
  • correct fluid and electrolyte balances

- remove waste products and excess

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6
Q

Primary indication for dialysis

A
  • based on clinical status
  • uremia unable to be managed conservatively
  • GFR or creatinine clearance
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7
Q

Who needs Dialysis?

A

A: Acid-Base Problems

E: Electrolyte Problems

I: Intoxifications

O: Overload of fluids

U: Uremic symptoms

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8
Q

Peritoneal Dialysis (PD)

A
  • peritoneum acts as the dialyzing membrane
  • works on principles of osmosis, diffusion, and ultrafiltration
  • transfer of fluid and solute from the bloodstream, through the peritoneum into the dialysate solution
  • peritoneal membrane is large and porous
  • peritoneal cavity is rich in capillaries
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9
Q

Contraindications for PD

A
  • Peritonitis
  • Recent abdominal surgery
  • Abdominal adhesions
  • Other GI problems
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10
Q

Access for PD

A
  • Siliconized rubber catheter is surgically inserted into the client’s peritoneal cavity
  • 3 to 5cm below the umbilicus
  • Catheter is tunneled under the skin, through fat and muscle tissue to peritoneum
  • Stablized with inflatable Dacron cuffs in the muscle and under the skin
  • Fibroblasts and blood vessels grow around the cuff
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11
Q

Dialysate Solution

A
  • Sterile
  • Prescribed by physician
  • Contains electrolytes and minerals
  • specific osmolarity, glucose concentration, and other medications additives as prescribed
  • the higher the glucose concentration, the greater the hypertonicity and the amount of fluid removed during exchange
  • K+ may be added if hyperkalemia is not a problem
  • Heparin is added to each bag to prevent clotting of the catheter
  • Antibiotics may be added to prevent peritonitis
  • Insulin may be added for the patient with DM
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12
Q

Increasing the glucose concentration of the dialysate solution…..

A
  • increases the concentration of active particles that cause osmosis
  • increases the rate of ultrafiltration
  • increases the amount of fluid removed
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13
Q

Interventions before Tx

A
  • Monitor VS
  • Obtain weight
  • Have client void, if possible
  • Assess electrolyte and glucose levels
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14
Q

Interventions during Tx

A

Monitor:

  • VS
  • Resp. Distress
  • Pain
  • discomfort
  • signs of pul. edema
  • hypo/hypertension
  • malaise
  • N/V
  • Dwell time as prescribed
  • Outflow should be continuous stream after clamp is opened
  • Color and charity
  • I & O accurately
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15
Q

Complications of PD

A
  • Peritonitis
  • Abdominal Pain
  • Abdominal outflow
  • Leakage at the catheter site
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16
Q

Peritonitis

A
  • fever
  • cloudy outflow
  • rebound abdominal tenderness
  • abdominal pain
  • malaise
  • N/V
  • obtain a sample of outflow for C&S
  • admin antibiotics

**maintain meticulous sterile technique

  • prevent catheter insertion site from becoming wet
  • follow institutional policy for connecting and disconnecting PD solution bags
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17
Q

Abdominal pain

A
  • peritoneal irritation during inflow

- warm dialysate before admin

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18
Q

Abnormal outflow

A
  • bloody outflow: vascular complications
  • brown outflow: bowel perforation
  • urine: colored outflow: bladder perforation
  • cloudy outflow: peritonitis
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19
Q

Insufficient outflow

A
  • main cause is a full colon
  • catheter migration out of the peritoneal area
  • maintain drainage bag below client’s abdomen
  • kinks in the tubing
  • fibrin clots in the tubing
  • change client’s position
20
Q

Leakage at the catheter site

A
  • clear fluid from the exit site should be reported
  • takes 1 to 2 weeks from fibroblasts and blood vessels grow into the catheter cuffs
  • smaller amounts of dialysate
21
Q

Types of PD

A
  1. Continuous ambulatory peritoneal dialysis (CAPD)

2. Automated peritoneal dialysis

22
Q

Continuous ambulatory peritoneal dialysis (CAPD)

A
  • 4 dialysis cycles are administered in a 24-hour period
  • Includes 8-hour dwell time overnight

-Dialysate (1-2L) instilled and allowed to dwell
as prescribed

  • After dwell, bag is placed lower than insertion site
  • After fluid drains, bag is changed, new dialysate instilled and process continues
  • Between exchanges, catheter is clamped
23
Q

Automated peritoneal dialysis

A
  • Requires a peritoneal cycling machine
  • Can be done as: Intermittent, Continuous, Nightly
  • Exchanges are automatic instead of manual
24
Q

Advantages of PD

A
  • can be used immediately after catheter placement
  • less complicated
  • fewer dietary restrictions
  • No rapid fluctuations in ECF and waste removal
25
Q

Why is PD less complicated?

A
  • No vascular access
  • Short training time
  • Better self management
  • Portable: Home, work
26
Q

Disadvantages of PD

A
  • Peritonitis common
  • protein loss into dialysate
  • hyperglycemia, hyperlipidemia
  • contraindicated with prior GI problems
  • Need for special training
  • Surgery to place catheter
  • Less effective removal of solutes and fluid
27
Q

Hemodialysis (HD)

A
  • Process of cleansing the client’s blood
  • Diffusion of dissolved particles from one fluid compartment into another across a semipermeable membrane
  • Client’s blood flows through one fluid compartment of a dialysis filter
  • Dialysate is in another fluid compartment
28
Q

Functions of HD

A
  • Cleanses the blood of accumulated waste products
  • Removes byproducts of protein metabolism: Urea, creatinine, uric acid
  • Removes excess body fluids
  • Maintains or restores buffer system of the body
  • Corrects electrolyte levels
29
Q

Principles of HD

A

 Semipermeable membrane is made of thin, porous cellophane

 Pore size of the membrane allows small particles to pass through (urea, creatinine, uric acid, H20)

 Proteins, bacteria, some blood cells are too large to pass through

 Blood flows into the dialyzer

 Movement of substances occurs from the blood to
the dialysate by principles of osmosis, diffusion, ultrafiltration

30
Q

Dialysate Bath

A
  • composed of H20 and electrolytes
  • Need not be sterile because bacteria and viruses are too large to pass through, dialysate must meet specific standards, water is treated to ensure a safe water supply
31
Q

Interventions of HD

A
  • Monitor VS before and after
  • Monitor lab values before, during, and after
  • Assess for HYPERvolemia before
  • Assess HYPOvolemia after
  • Weigh client before and after
  • Assess blood access device before, during, and after
  • Monitor for bleeding
  • Provide adequate nutrition

***Withhold antihypertensives and other meds that can affect BP until after tx

***Withhold meds that can be removed by dialysis

***water-soluble vitamins, certain antibiotics, digoxin

32
Q

Access for HD

A
  • Subclavian

- Femoral

33
Q

Subclavian catheter

A
  • catheters usually fill with heparin and capped to maintain patency
  • catheter should not be uncapped except for dialysis
  • client with femoral vein catheter should not sit up more than 45 degrees or lean forward
34
Q

Femoral

A
  • Assess extremity for circulation, temp, and pulses
  • meticulous peri care
  • use an IV pump or controller with microdrip tubing if heparin infusion is prescribed
35
Q

External Arteriovenous shunt

A
  • 2 silastic cannulas surgically inserted into an artery and a vein in forearm or leg
  • forms an external blood path
  • cannulas are connected to form a U
  • Blood flows from artery through the shunt into the vein
  • tube leading to the membrane compartment of the dialyzer is connected to the arterial cannula
  • blood fills the membrane compartment, passes through the dialyzer, is returned back to the client through a tube connected to the venous cannula
  • when complete, the cannulas are clamped and reattached reforming the U
36
Q

Advantages of External Arteriovenous Shunt

A

can be used immediately following insertion

37
Q

Disadvantages of External arteriovenous shunt

A
  • disconnection/dislodgment
  • risk of hemorrhage, infection, clotting
  • potential for skin erosion at catheter site
38
Q

External Shunt Interventions

A
  • avoid getting shunt wet
  • wrap a dressing completely around the shunt
  • keep cannula clamps at bedside
  • teach client that shunt extremity should not used for: BP, blood draw, IV access, IM injections
  • fold back the dressing to expose the shunt tubing and assess for: hemorrhage, infection, clotting, auscultate for bruit, palpate for thrill
39
Q

Internal Arteriovenous Fistula

A
  • permanent access of choice for clients with CRF requiring dialysis
  • fistula created surgically by anastomosis of a large artery and a large vein
  • flow of arterial blood into the venous system causes vein to become engorged
  • maturity takes 4-6 weeks
  • engorged vein is punctured with a large pore needle for dialysis
40
Q

Advantages to internal artiovenous fistula

A
  • risk of clotting/bleeding is low
  • can be used indefinitely
  • decreased incidence of infection
  • no external dressing is required
  • allows freedom of movement
41
Q

Disadvantages of Internal arteriovenous fistula

A
  • Can’t be used immediately so it requires alternate access
  • needle insertions through skin are required
  • infiltration of the needles can occur and can hematomas
  • aneurysm can form in the fistula
  • CHF can occur from the increased blood flow in the venous system
  • arterial steal syndrome
42
Q

Internal Arteriovenous Graft

A
  • internal graft used for clients who don’t have adequate blood vessels for creation of a fistula
  • artificial graft made is made of Gore tex or bovine carotid artery
  • anastomosis of an artery to a vein using an artifical graft
  • graft can be used within 2 weeks of insertion
  • complications include clotting, aneurysms, infection
43
Q

to ensure patency of internal arteriovenous graft….

A

palpate for a thrill and auscultate for a bruit over the fistula or graft

notify MD if absent

44
Q

Complications of HD

A

-air embolus

45
Q

Clinical manifestations of air embolus

A
  • dyspnea/tachypnea
  • chest pain
  • hypotension
  • decreased O2 sats
  • cyanosis
  • anxiety
  • changes in sensorium
46
Q

Nursing Action for patient who develops air embolism during HD

A
  • stop hemodialysis
  • turn the client on the left side
  • place the client head down (Trendelenberg’s)
  • notify the physician
  • admin O2
  • assess VS and pulse ox
  • document the event, actions taken, and client’s response

MS2 Exam 1 (13 decks)

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