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Therapeutics II > Dialysis and Renal Replacement Therapies > Flashcards

Dialysis and Renal Replacement Therapies Flashcards

1
Q

Renal Replacement Therapies

A

-Hemodialysis
-Peritoneal Dialysis
-CAPD
-CCPD
-NIPD
-NTPD
-CAVH
-CVVH
-CVVHD

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2
Q

Renal Replacement Therapy indications (AEIOU)

A

-Acid/base balance (metabolic acidosis)
-Electrolytes (Na and K)
-Intoxication (poison)
-Overload of fluid
-Uremia

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3
Q

RRT does NOT tx

A

-mineral bone disorder
-anemia
-phosphorus

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4
Q

Hemodialysis

A

-intermittent
-3-4 hour sessions MWF or TRS
-for ESRD

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5
Q

When to initiate hemodialysis

A

-BUN > 100
-SCr > 10
-s/sx of uremia

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6
Q

Goal of hemodialysis tx

A

-remove middle molecules (500-5000Daltons)
-B2 microglobulin
-Uric Acid
-Creatinine
-etc

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7
Q

Vascular access for HD

A

-AV fistula
-AV graft
-no needle sticks or BP cuffs on access arm

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8
Q

AV fistula

A

-anastamosis between radial artery and cephalic vein for HD access
-longest survival rates (~20 years)
-less complications
-1-2 months to mature

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9
Q

AV graft

A

-alt to fistula
-graft created from connecting artery and vein with polytetrafluoroethylene tube
-shorter survival (higher infection rate)
-2-3 weeks to mature

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10
Q

Steal Syndrome

A

-issue with AV fistula
-restricts too much blood from hand
-might prefer graft for diabetes patients with PVD

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11
Q

Dialysis Procedure

A

-blood and dialysate in hemodialyzer
-blood back to body
-dialysate to waste
-concentration gradient (semipermeable membrane)
-K out of blood
-bicarb into blood

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12
Q

Fishbone diagram?

A

Fishbone diagram?

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13
Q

Higher rate of dialysis

A

-pulls more fluid out of patient
-good for edema

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14
Q

Substances NOT removed by dialysis

A

-high Vd (in tissue not blood)
-high lipophilicity
-large molecular weight
-Highly protein bound

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15
Q

Take meds before or after dialysis

A

after

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16
Q

Effectiveness of dialysis session

A

-Kt/v = 1.4 or more
-URR = 70% or more

17
Q

Kt/v

A

-fraction of body water that is cleared of urea
-K= clearance of urea
-V= volume of urea
-T= time

-goal: 1.4 or more
-time only factor we can change

18
Q

Urea Reduction Ratio (URR)

A

-measure reduction of BUN
-goal over 70%

19
Q

Complications of hemodialysis

A

-hypotension
-pruritis
-muscle cramps (fluid leaving muscle too fast)

20
Q

Peritoneal Dialysis

A

-peritoneal membrane is the filter
-solution bag, drainage bag, catheter
-keeps working w kidney function
-dif molecules might need longer dwell times
-continuous therapy
-CAPD
-CCPD
-NIPD
-TPD

21
Q

CAPD

A

-short wells throughout day
-one long well at night time
-only one that does NOT require cycler
-cheapest

22
Q

CCPD

A

-one long dwell all day
-connect to cycler at night

23
Q

NIPD

A

-nothing during day
-fast cycles at night on cycler
-not gonna get rid of things that need longer dwell time

24
Q

TPD

A

-most expensive
-nothing all day
-quick dwells and long dwells at same time during the night
-cycler

25
Q

Peritonitis

A

-infection from PD
-staph epi
-gm neg
-some gram +

26
Q

Sx of Peritonitis

A

-cloudy effluent
-ab pain
-fever
-NV
-chills

27
Q

Peritonitis tx

A
  1. empiric therapy for gm + and -
    2.obtain cultures and modify tx
  2. route of admin (IP, IV, PO)
28
Q

Empiric therapy options

A

-1st gen cephs (Cefazolin or Cephalothin) + 3rd gen cephs (ceftazidime) +pseudomonas
-aminoglycoside + pseudomonas (dont use if there is still kidney function?)

29
Q

Why can antibiotics admin be intraperitoneal?

A

-where infection is
-NV from peritonitis eliminates oral route
-pt may have poor vascular access

30
Q

Continuous Renal Replacement Therapies (CRRTs)

A

-CAVH
-CVVH
-CVVHD
-CVVHDF

-turn down rate and let it run 24/7
-rely on HR to pump

31
Q

CRRT use

A

-acute renal failure
-mostly pt in the hospital
-hemodynamically unstable patients

32
Q

Continuous arteriovenous hemoFILTRATION (CAVH) and CVVH

A

-blood + ultrafiltrate replacement solution
-FILTRATION not dialysis
-ultrafiltrate keeps blood volume up to go through filter
-need heparin to prevent coagulation

33
Q

Continous Venovenous HemoDIALYSIS

A

-blood + ultrafiltrate
-into dialyzer
-waste and URS rate the same

34
Q

Continuous Venovenous hemoDIAFILTRATION

A

-dialyzer and filtration
-preffered?
-waste rate > URS rate
-get more fluid out of body bc we can’t use diuretics

Therapeutics II (38 decks)

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