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ms_primers for exam 3 content > Dialysis Primer > Flashcards

Dialysis Primer Flashcards

1
Q

What is dialysis?

A

• Method of filtration w/movement of blood across a semipermeable to remove undesired artifacts

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2
Q

What is dialysis used for?

A
  • Correct fluid/electrolyte imbalances
  • Remove waste products in renal failure
  • Treat drug overdoses
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3
Q

What are the two types of dialysis?

A
  • Peritoneal dialysis (PD)

* Hemodialysis (HD)

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4
Q

When is dialysis generally initiated?

A

• When GFR (or creatinine clearance) = <15mL/min

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5
Q

Dialysis uses diffusion and osmosis for filtration.

Diffusion is the movement of fluid from an area of _____ to an area of _____ concentration of solutes.

A

• greater, lesser

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6
Q

Dialysis uses diffusion and osmosis for filtration.

Osmosis is the movement of fluid from an area of _____ to an area of _____ concentration of solutes.

A

• lesser, greater

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7
Q

What are some conditions that call for immediate dialysis?

A
  • Uremic complications
  • Neuropathies
  • Uncontrolled hyperkalemia
  • Pericarditis
  • Accelerated HTN
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8
Q

What are the components of dialysis?

A
  • Blood
  • Semi-permeable membrane
  • Dialysate
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9
Q

What is the purpose of dialysate?

A

• To control filtration gradients of osmosis

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10
Q

The patient preparation for dialysis consists of…

A
  • Emptying the bladder and bowel
  • Weighing the patient
  • Obtaining a signed consent form.
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11
Q

What is used more often, peritoneal dialysis or hemodialysis?

A

• Hemodialysis, PD is only used in apprx 12% of pts

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12
Q

What is the basic concept of peritoneal dialysis?

A
  • A dialysis catheter is surgically placed through the abdomen into the peritoneal cavity
  • A dialysis solution bag is hung higher than insertion point to drain into peritoneal cavity
  • Dialysate draws impurities into the peritoneal cavity
  • A drain bag is hung below the insertion point to remove fluids
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13
Q

What is the care for a newly placed PD catheter?

A
  • Site clean to heal (This can be w/ or w/out a dressing pending particulars of the individual)
  • Pt is taught to observe for signs of infection
  • Site should not be submerged in bathwater
  • Once healed, the pt may shower and pat dry
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14
Q

With peritoneal dialysis, what serves as the semi-permeable membrane?

A

• The peritoneum (lining of the peritoneal cavity)

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15
Q

What is the active component in dialysate that helps control rates of osmosis?

A

• Glucose

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16
Q

What are the basics to keep in mind re: dialysate for peritoneal dialysis?

A
  • Available in 1 or 2 L plastic bags w/ glucose concentrations of 1.5, 2.5 and 4.25% (3L can be given pending size of pt)
  • Electrolyte compositions is similar to plasma
  • Solution is warmed to body temperature
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17
Q

What are the 3 phases of the PD cycle?

A
  • Infill
  • Dwell
  • Drain
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18
Q

Describe the infill phase of PD.

A
  • Prescribed amount of solution infused through established catheter over about 10 minutes
  • After solution infused, inflow clamp closed to prevent air from entering tubing
19
Q

Describe the dwell phase of PD.

A
  • Diffusion and osmosis occur between patient’s blood and peritoneal cavity.
  • Duration of time varies, depending on the method.
  • 20 – 30 minutes to 8 hours or more
20
Q

Describe the drain phase of PD.

A
  • Peritoneal fluids are drained over 15 to 30 minutes

* May be facilitated by gently massaging abdomen or changing position

21
Q

One cycle = one ______.

A

• Exchange

22
Q

For manual PD, a period of about __ to __ minutes, minimum, is required to complete an exchange.

A

• 30 to 50

23
Q

What is automated peritoneal dialysis?

A

• An automated mechanical Cycler delivers the dialysate, times and controls fill, dwell, and drain

24
Q

APD is the most popular form of PD, as it allows patients to accomplish dialysis while they sleep. The machine cycles four or more exchanges per night with __ to __ hours per exchange.

A

• 1 to 2

25
Q

What are some complications that may occur with PD?

A
  • Exit site infection
  • Lower back problems
  • Peritonitis
  • Hernias
  • Bleeding
  • Pulmonary complications
  • Protein loss
26
Q

Because of increased intraabdominal pressure secondary to dialysate infusion, hernias can develop in predisposed individuals such as _____ women and _____ men.

A

• Multiparous, older

27
Q

What are some Pro’s of PD over HD?

A
  • Short training program (3 to 7 day training program)
  • Independence
  • Ease of traveling
  • Fewer dietary restrictions
  • Greater mobility than with HD
28
Q

Mortality rates are about equal between in-center hemodialysis patients and peritoneal dialysis patients for the first few years. However, after about 2 years, mortality rates for patients receiving _____ dialysis are higher, especially for the elderly with diabetes and patients with a prior history of cardiovascular disease.

A

• Peritoneal

29
Q

How is circulatory access gained for hemodialysis?

A

• Via an Arteriovenous Fistula (AVF)- an anastomosis between an artery and a vein (usually cephalic)

30
Q

For acute (temporary) hemodialysis when an AVF is not available, what type of catheter may be used and where would it be placed?

A

• Double lumen, Y hub catheter in the right jugular

31
Q

What is the basic procedural flow for hemodialysis?

A
  • Two needles placed in fistula or graft
  • Needle closer to fistula or red catheter lumen pulls blood from patient and sends to dialyzer.
  • Blood is returned from dialyzer to patient through second needle or blue catheter.
32
Q

_____ may be infused as a bolus predialysis or through a _____ pump continuously to prevent clotting.

A

• Heparin

33
Q

Dialyzer/blood lines are primed with _____ solution to eliminate ___.

A

• Saline, air

34
Q

HD is terminated by…

A
  • Flushing dialyzer with saline to remove all blood

* Needles removed and firm pressure applied

35
Q

Before HD treatment, the nurse should

A 
Complete assessment of 
•	fluid status
•	condition of access
•	temperature
•	skin condition
36
Q

During HD treatment, the nurse should

A
  • Be alert to changes in condition

* Perform vital signs every 30 to 60 minutes

37
Q

What are the main complications for HD?

A
  • Hypotension
  • Muscle cramps
  • Loss of blood
  • Hepatitis
38
Q

How does hypotension occur during HD?

A

• From rapid removal of vascular volume (hypovolemia), decreased cardiac output, and decreased systemic intravascular resistance

39
Q

What are some factors that contribute to the development of muscle cramps during HD?

A
  • hypotension,
  • hypovolemia,
  • high ultrafiltration rate (large interdialytic weight gain), and
  • use of low-sodium dialysis solution
40
Q

How can blood loss occur during HD?

A
  • From blood not being completely rinsed from the dialyzer
  • Accidental separation of blood tubing
  • Dialysis membrane rupture
  • Bleeding after the removal of needles at the end of dialysis
41
Q

True or False

At one time, hepatitis B had an unusually high prevalence in dialysis patients, but the incidence today is quite low.

A

• True

42
Q

Why does individual adaptation to maintenance HD vary considerably?

A

• Initially, many patients feel positive about the dialysis because it makes them feel better and keeps them alive, but often great ambivalence is expressed about whether it is worthwhile.

43
Q

What are the advantages of peritoneal dialysis over hemodialysis?

A
  • Immediate initiation
  • Less complicated
  • Portable system
  • Fewer dietary restrictions
  • Usable in patients with vascular access problems
  • Less cardiovascular stress
  • Home dialysis possible
44
Q

What are the advantages of hemodialysis over peritoneal dialysis?

A
  • Rapid fluid removal
  • Rapid removal of urea and creatinine
  • Effective K+ removal
  • Less protein loss
  • Lowers serum triglycerides
  • Home dialysis is possible as temporary access can be provided at home

ms_primers for exam 3 content (13 decks)

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