Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

NUR 213 > Dialysis and Kidney transplants lecture > Flashcards

Dialysis and Kidney transplants lecture Flashcards

1
Q

In what groups of people is CKD most prevelant

A
  • 60 yrs or older
  • African Americans
  • Native Americans
  • More men than women
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Most common causes of CKD

A
  • Diabetes
  • HTN
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Risk factors for CKD

A
  • Diabetes
  • HTN
  • HLD
  • Smoking
  • Recreational drugs
  • NSAIDs
  • Obesity
  • Glomerulonephritis
  • Lupus
  • Atherosclerosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Artificial process for removing waste and water from the body when the kidneys no longer function

A

Renal Replacement Therapies or RRT’s, dialysis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Name some RRT’s

A
  • Hemodialysis (HD)
  • Peritoneal Dialysis (PD)
  • CRRT
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Hemodialysis (HD) uses what?

A

an artifical membrane

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Peritoneal dialysis (PD) uses what?

A

A Permanent Tenckhoff indwelling catheter

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Continuous RRT is used to treat what?

A
  • Short term for ARF unstable - fluid volume overload (oliguric phase)
  • Does not produce rapid shifts like hemodialysis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

VV

RRT

A

Venovenous

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

AV

RRT

A

Arteriovenus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Goals of dialysis

A
  • Remove end-products of protein metabolism (Cr & BUN)
  • Maintain and correct electrolyte levels (elevated potassium)
  • Correct acidosis
  • Remove excess fluids
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Neuro changes such as lethargy, AMS, and cognitive changes can indicate what?

A

excess build up of urea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What kinds of patients require dialysis?

A

AKI or ESRD with the following:
* Severe F/E imbalances
* Elevated creatinine and/or potassium
* acidosis
* uremic symptoms
* patients with GFR less than 10mL/min

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Types of access for HD

A

Central Venous Catheter
Fistula
Graft

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What type of HD access is this

For short term use or until long term AV fistula or graft

A

Central venous catheter

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What type of HD access is this

Created by surgery with the artery & vein anastomosed and requires maturation of weeks to months

A

Fistula

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What type of HD access is this

Created by inserting a prosthetic graft between the artery and vein

A

Graft

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What needs to be monitored/checked before a patient goes to dialysis and after they return?

A
  • Vitals (BP)
  • Weight
  • HD Access site
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What type of dialysis is this?

  • usually 3 times a week
  • Sessions last 3-5 hrs
  • duration of sessions, and number of sessions per week change as pt’s status changes
  • Can be done outpatient, in the hispital, or at home
A

Hemodialysis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Complications associated with HD

A
  • Hypotension
  • Muscle cramps
  • Headaches
  • N/V
  • Dizziness
  • Malaise
  • Systemic infection is a concern
  • Dialysis dementia
  • Localized AV fistula/graft complication
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

A dialysis patient is complaining of Light-headedness, N/V, seizures, vision changes, and chest pain what do you suspect?

A

Hypotension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

S/S of Hypotension

A
  • Light-headedness
  • N/V
  • Seizures
  • Vision changes
  • Chest pain
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

If hypotension is suspected during HD what needs to be done

A

Fluid removal rate needs to be decreased and NS therapy needs to be added

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

If a patient recieving HD is experiencing

  • muscle cramps
  • headaches
  • N/V
  • dizziness
  • malaise

What needs to be done?

A

Filtration rate needs to be slowed
or
NS Bolus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

HD patients are at higher risk for what?

A
  • Hep B
  • Hep C
  • HIV
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What is this complication of HD

  • Progressive, potentially fatal neurological complication from long-term dialysis
  • May be d/t aluminium present in phosphate binders
A

Dialysis dementia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What is this called?

Happens d/t very rapid changes in the composition of the extracellular fluid (why first HD runs slower)

A

Disequilibrium syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

All of the following are S/S of what?

  • N/V
  • Confusion
  • Restlessness
  • Headaches
  • Decreased LOC
  • Twitching
  • Jerking
  • Seizures
A

Disequilibrium syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

S/S of dysequilibrium syndrome

A
  • N/V
  • Confusion
  • Restlessness
  • Headaches
  • Decreased LOC
  • Twitching
  • Jerking
  • Seizures
30
Q

How to treat dysequilibrium syndrome

A
  • HD can be slowed down or stopped
  • Infuse hypertonic saline solution, albumin, or mannitol to pull fluid off brain
31
Q

What type of RRT is this?

  • Indicated for acutely ill with AKI or severe fluid overload
  • Limit risk of complications that happen in intermittent HD
  • Slow and continuous, can be adjusted hourly depending how patient tolerates
A

Continuous Renal Replacement Therapy

CRRT

32
Q

If a patient has vascular access issues or responds to HD poorly what is the second option?

A

Peritoneal dialysis

33
Q

What type or RRT is this?

  • Offers more control and flexibility
  • Preforms independently or by a family member
  • Greater mobility and fewer dietary restrictions
  • Clearance of metabilic wastes are slower but more continuous
  • Avoid rapid fluctuations in the extracellular fluid composition and associated symptoms
  • Indicated in those with vascular access problems or those who respond to HD poorly
A

Peritoneal Dialysis

PD

34
Q

Name the three phases of PD

A

Fill
Dwell
Drain

35
Q

What phase of PD is this?

Room temp dialysate instilled

A

Fill

36
Q

What phase of PD is this?

Instilled dialysate sits in abd for predetermined hours

A

Dwell

37
Q

What phade of PD is this?

Effluent fluid via gravity

A

Drain

38
Q

Name the types of PD

A
  • Continuous ambulatory peritoneal dialysis (CAPD)
  • Automated peritoneal dialysis
  • Intermittent peritoneal dialysis
39
Q

What type of PD is this?

  • 4-5 exchanges a day with a dwell time of 4-6 hrs w/o machine
  • Ambulatory during dwell time and/or sleeping
A

Continuous ambulatory peritoneal dialysis
or
CAPD

40
Q

What type of PD is this?

  • Uses cycler to preform multiple overnight exchanges
  • Typically 30 min cycles, 10 min. Each phase for 8-10 hrs
A

Automated Peritoneal Dialysis

41
Q

What type of PD is this?

Short dwell times, 30-40 exchanges a week, 30-60 min per exchange

A

Intermittent peritoneal dialysis

42
Q

Contraindications of PD

A
  • Hx of multiple surgeries
  • Chronic ABD conditions (pancreatiti, diverticulitis)
  • Reoccurent abd wall or inguinal hernias
  • Obesity
  • Pre-existing back problems or vertebral disease
  • Severe COPD
43
Q

Complications associated with PD

A
  • Catheter infections
  • Abd pain and/or distention
  • Hyperglycemia and increase in tryglyceride levels r/t glucose in dialysate
  • Outflow problems
  • Respiratory compromise
  • Protein Loss
44
Q

What complication associated with PD is this?

  • Cloudy effluent
  • Increased WBC
  • Redness
  • Swelling
  • Drainage
A

Catheter infection and peritonitis

45
Q

If a pt recieving PD is suffering from chronic infections what is the next step?

A

Switching to HD

46
Q

Dialysate contains glucose therefore it can cause what?

A

Hyperglycemia and an increase in triglyceride levels

47
Q

If a PD patient experiences:
* A kinked catheter
* Catheter migration
* Constipation
What does it cause?

A

Outflow problems

48
Q

Pt is recieving PD and effluent appears cloudy and WBC’s are increased. PD cath site appears red, swollen, and has some drainage. What do you suspect?

A

Catheter infection or Peritonitis

49
Q

If a pt recieving PD is having reoccuent catheter infections and peritonitis what is the next step?

A

Swithing to HD

50
Q

Specific assessments for PD

A
  • ABD girth
  • monitor outflow > inflow
  • clear not cloudy
51
Q

Nursing assessments specific to HD

A
  • Listen to bruit
  • Feel thrill
  • Neuro checks
  • post dialysis vitals & weight
52
Q

Nursing assessments specific to CRRT

A

Frequent hourly VS & assessments

53
Q

General Assessments for Dialysis

A
  • Vital signs - specifically BP, o2, temp
  • Daily weight
  • Lab values- specifically renal function, electrolytes, CBC, H&H
  • Nutritional intake - Na intake & fluid restrictions
54
Q

A patient is going down for HD this morning. They are supposed to recieve metoprolol with their morning medications. What should be done? and why?

A

Metoprolol should be held until after HD. All BP meds should be held until after HD

55
Q

Care for HD fistula/graft

A
  • Avoid lying on fistula/graft, heavy lifting, procedures, blood draws, IV’s or BP’s in the arm with access.
  • pt should preform exercises on access arm
56
Q

Nursing interventions for CRRT

A

Requires intensive nursing support to preform and document hourly functions

57
Q

Medication taken by dialysis patients that frequently experience hypotension with dialysis to try to maintain BP

A

Midodrine

58
Q

General dialysis teaching points

A
  • Teach compliance because it is required to sustain life
  • Assist with social service and counseling services
  • Refer to case management for OP setup
59
Q

Teaching points for pt’s on PD

A
  • Slow instillation if necessary - if pt exp abd pain
  • Check tubing for kinks if intake > OP
  • Proper positioning
  • Check for abd distension
  • Check dressing for dampness and when to chance to prevent infection
  • Dialysate should be warmed
  • Dialysate should be clear if cloudy call MD
60
Q

Pt should be taught that if dialysate is cloudy not clear to do what?

A

CALL MD

61
Q

Kidney transplant education

A
  • Lifelong treatment no cure
  • Requires immunosupressive therapy
62
Q

Contraindications of a kidney transplant

A
  • Untreated/metastatic cancer
  • Refreactory CAD or heard disease
  • psychosocial issues
63
Q

Complications of a kidmey transplant

A
  • Organ rejection
  • Ischemia
  • Renal artery stenosis
  • Thrombosis
  • Infection
64
Q

A kidney transplant patient is experiencing the following:
* Onset 48 hrs
* Malaise, high fever
* graft tenderness
What do you suspect?

A

Hyperacute post kidney transplant rejection

65
Q

A patient with a kidney transplant is experiencing the following:
* 1 wk-2 yrs
* oliguria
* fever
* HTN
* Flank tenderness
* lethargy
* increased BUN, K, Creatinine
* Fluid retention
What do you suspect?

A

Acute post-kidney transplant rejection

66
Q

A patient with a kidney transplant is experiencing the following:
* Gradual over months to years
* Increase in BUN, creatinine
* imbalances in proteinuria & electrolytes
* Fatigue
What do you expect?

A

Chronic post kidney transplant rejection

67
Q

How is Hyperacute post kidney transplant rejection treated?

A

Organ must be removed to decrease S/S

68
Q

Most common and treatable form of kidney transplant rejection

A

Acute rejection

69
Q

What can be done to treat acute kidney transplant rejection?

A

MD will increase the dosages of immunosuppression therapy

70
Q

Nursing management of Kidney transplant patients

A
  • Post-transplant VS and renal function labs
  • Assess incision site and manage pain
  • Daily weights & monitoring I/O
  • Educate to avoid contact sports/injury to kidney and report S&S of infection
  • Education on immunosuppression medication compliance

NUR 213 (29 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions