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410 Patho Exam 3 > Dialysis & Kidney transplant > Flashcards

Dialysis & Kidney transplant Flashcards

1
Q

what does dialysis mean ?

A

movement of fluid/molecules across a semipermeable membrane from one compartment to another

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2
Q

what is dialysis used for ?

A

used to correct fluid and electrolyte imbalance
and
removes waste products from kidney failure

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3
Q

interesting to note, can dialysis be used to help treat drug overdoses?

A

yes

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4
Q

what are the two methods of dialysis that are available ?

A

peritoneal dialysis
hemodialysis

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5
Q

when is dialysis normally started on?
typically a criteria that we have to see if a patient is eligible for it

A

when patients uremia can no loner be adequately treated

gfr < 15ml/min/1,73m^2

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6
Q

what do you think is more effective with peritoneal or hemodialysis ?

A

hemodialysis

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7
Q

what are the two general principles of dialysis ?

A

diffusion and osmosis

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8
Q

what does diffusion mean ?
what does osmosis mean ?

A

movement of solutes from an area of greater concentration to an area of lesser concentration

movement of fluid from an area of lesser concentration of solutes to an area of greater concentration

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9
Q

ultrafiltration is fluid and water removal
- results when there is an osmotic gradient or pressure gradient across membrane

pd - glucose in dialystae
hd - pressure gradient

excess fluid moves into dialysate

A
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10
Q

peritoneal dialysis typically is a short term training program, usually how many days ?

A

3-7 days

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11
Q

what are some advantages of peritoneal dialysis ?

A

simplicity
home based program
increasing patient participation
no need for special water system
equipment set up is simple

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12
Q

what is the process of peritoneal dialysis ?
typically how do you insert the catheter ?

A

peritoneal access is obtained by inserting a catheter through anterior abdominal wall

through surgery

( patients does it at home, can be done overnight )

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13
Q

how do patients do peritoneal dialysis ?

A

there is dialysis solutions, gets instilled into the perineum then clamps it off, then you let it sit

then you have this exchange of fluid and electrolytes, soothed balance out

then you leave it in the abdomen for a certain amount of time (dwell time)

then you unclamp and drain it out

you do several exchanges

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14
Q

what are the 3 phase of periotoneal dialysis ?

A

inflow (fill)-2-3l over 10mins
dwell (equilibration) 20-30mins - 8 Hours
drain 15-30mins

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15
Q

most of the time we like to wait until the catheter site is healed before you even start dialysis treatment in order to avoid what?
think basic

even waiting for like going to the pool or anything risky

A

infection, irritation, tenderness

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16
Q

if a patient has an infection on their catheter site for their dialysis, what do we give?

A

antibiotics

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17
Q

what is the biggest concern or complication with peritoneal dialysis ?

A

peritonitis

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18
Q

what are some clinical manifestation of peritonitis ?
dont over think it

A

abdominal pain
rebound tenderness
diarrhea, vomitting, distention

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19
Q

if we are removing fluid from a patient who has a perionteal dialysis, what should the fluid normally be ?

if they have an infection, what does the fluid end up looking like ?

A

clear

cloudy, pus-y

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20
Q

what other 4 complications, not as common but can occur with peritoneal dialysis ?

A

hernias - increased abdominal pressure from dialysate

lower back problems - increase pressure fromi infusion

bleeding - initial catheter placement, checking for internal bleeding

pulmonary complications
- increase fluid and pain, increase respiratory rate

21
Q

how do we treat hernias ?
how do we treat back pain ?
how do we treat bleeding?
how do we treat pulmonary issues?

A

hernia repair
binders and exercise
check bloodpresure and stop it
elevate head of bed, deep breathing/slow down fluid

22
Q

what is hemodialysis ?

A

blood goes out from you then goes to the machine, gets cleaned, then returns back in you

23
Q

hemodialysis, arteriovenous fistula is what?

A

created in the forearm or upper arm and allows partial blood to flow through vein

24
Q

we often will place the fistula inside the upper arm 3 months in advance in order for to what?

A

mature

25
Q

patient may end up feeling ____or hear ___due to high velocity of blood flow when having a arteriovenous fistula

A

thrill
bruit

26
Q

what is ateriovenous grafts?

A

synthetic material surgically placed under the skin to form a bridge between artery (brachial) and vein (antecubital)

27
Q

something i want to add to the hemodialysis is that when a patient is taking medications, what is the procedure or procaustion behind this ?

so we do what

A

if they just received med and on dialysis, its just going to be flushed and filtered out

so you want to hold it and then do it after

28
Q

how long is the healing time for arteriovenous grafts?

A

2-4weeks

29
Q

arteriovenous grafts is more likely to get infected or form clots, so we want to monitor and give antibiotics if infected

we usually give some form of heprain during the hemodialysis

A
30
Q

what is the biggest risk of having an AV fistula and grafts ?

A

distal ischemia (steal syndrome)
- pain distal to access site
- numbness or tingling of fingers
- poor capillary refill
- aneurysms

31
Q

if there is a time where immediate access is needed, we like to do a catheter insertion of the internal what ?

A

jugular or femoral vein

32
Q

blood is pumped from top into ____
dialysate pumped from bottom and bathes the ____of the fibers

A

fibers
outside

33
Q

Two large bore needles placed in fistula or graft

One needle is placed to pull blood from circulation to HD machine

Other needle is used to return dialyzed blood to the patient

Heparin is added to prevent clotting

Dialysate delivery and monitoring system is used

Dialyzer/blood lines primed with saline solution to eliminate air

Terminated by flushing with saline to return all blood to patient

Needles removed and firm pressure applied

Most treated in a community-based center

Dialyzed for 3 to 4 hours, 3 days/wk

A
34
Q

what is a major complication of hemodialysis ?

A

dialysis disequilibrium syndrome

35
Q

what is dialysis disequilibrium syndrome?

A

neurologic changes during or immediacy followed a hemodialysis, a result of cerebeal edema
change in fluid so fast it causes cerebral edema

vomiting, headache, blurred vision

36
Q

how do we manage and treat dialysis disequilibrium syndrome?

prevention
medication ?

A

slow speed of dialysis
mannitol/hypertonic solution

decrease cerebral edema

37
Q

hypotension can occur how ?
treatment ^

muscle cramps can occur how ?
treatment ?

loss of blood can occur how ?
treatment ?

hepatitis can occur how ?
treatment ?

A

remove too much fluid
slow down the removal

electrolytes
slow down fluids

blood not rinsed off
rinse all the blood

from the needle
- vaccine

38
Q

continual renal replacement therapy is used for ?

A

acute kidney injury

39
Q

continual renal replacement therapy helps how ?

for how long

A

acid-base status and electrolyte are adjusted slowly and continuously in hemodynamically unstable patients

24 hours

40
Q

we dont use continual renal replacement therapy for what and who ?

A

patients who have life threatening manifestation of uremia that require rapid treatment

41
Q

kidney transplant

A
42
Q

what is the best treatment for end stage renal disease ?

A

kidney transplant

43
Q

what are some contraindications of a transplant?

A

cancer
chronic respiratory failure
chronic infection
extensive vascular disease

44
Q

hiv and hep b are not contraindications of kidney transplants

A
45
Q

Postoperative care
Kidney transplant recipient
Dehydration must be avoided
Assess for hyponatremia/hypokalemia
Acute tubular necrosis can occur
Monitor urine output; maintain catheter patency
Patient education: signs and symptoms of rejection, infection, and surgical complications; follow-up care

A
46
Q

Postoperative care
Kidney transplant recipient
Maintenance of fluid and electrolyte balance is first priority
Large volumes of urine may be produced soon after transplanted kidney placed due to
New kidney’s ability to filter BUN
Abundance of fluids during operation
Initial renal tubular dysfunction

A
47
Q

remember you only need 1 good kidney to manage well

A
48
Q

Live donor
Extensive interprofessional evaluation
Crossmatches—check antibodies
Advantages
Better patient and graft survival rates
Immediate organ availability
Immediate function/minimal cold time
Opportunity to have recipient in best possible medical condition since elective surgery

Deceased (cadaver) kidney donors are relatively healthy persons that have suffered an irreversible brain injury and are brain dead
Must have effective CV functions and on ventilator to preserve organs
Permission of next of kin requested even with signed donor card
Kidneys removed and preserved up to 72 hours
Preferred cold time less than 24 hours

A

410 Patho Exam 3 (5 decks)

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