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dialysis exam > general dialysis/kidney > Flashcards

general dialysis/kidney Flashcards

1
Q

What is Sodium Ramping?

Why is it done?

A 
-process which sodium in the dialysate is used heavily in beginning of tx and continuously decreases by as treatment progresses 
ex; Na 138-142 / 3 hour tx
 142 at 3 hours left
 140 at 2 hours left
 138 at 1 hours left

-reduces hypotensive episodes and intradialytic symptoms
ex; reduces cramps, pruritus, nausea, fatigue

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2
Q

What is Dialysis?

A

artificial process of eliminating waste (diffusion) and unwanted water (ultrafiltration) from blood

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3
Q

Diffusion

A

movement of molecules from higher solute conc. to lower solute conc. across semi-permeable membrane

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4
Q

Factors affecting rate of diffusion (7)

A
  • molecule size
  • size and number of pores in semi-perm membrane
  • surface area
  • temperature
  • concentration of solutes in blood
  • thickness of blood (thicker the slower)
  • resistance; changes to the rate at which solutes move
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5
Q

Ultrafiltration

A

filtration process which removes fluid volume from a patient; uses pressure and concentration gradient to filter unwanted fluid from blood

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6
Q

Ultrafiltration is influenced by: (2)

A
  • osmosis; movement of water from low solute conc. to high solute conc.
  • hydraulic pressure; fluid and solutes move from greater pressure to lower pressure
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7
Q

Osmosis

A

movement of water from low solute concentration to high solute concentration

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8
Q

Transmembrane Pressure (TMP)

A
  • looks at clotting status
  • difference in pressure in dialyzer; between blood compartment (+) and dialysate compartment (-)
  • positive and negative compartments create pressure gradient
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9
Q

TMP rate depends on: (4)

A
  • mean
  • Kuf; constant specific to membrane, indicates permeability of membrane to water
  • membrane surface area
  • geometry of dialyzer
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10
Q

Concepts related to pressure:

Positive Pressure

A
  • blood compartment of dialyzer

- action of blood pump which pushes water from blood to dialysate

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11
Q

Concepts related to pressure:

Negative Pressure

A
  • dialysate compartment of dialyzer

- creates vacuum which acts to pull water

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12
Q

Concepts related to pressure:

Osmotic Pressure

A

-amount of pressure needed to oppose water movement across membrane, separating two compartments with unequal concentrates
(even though both sides diff solute concentrations, water wont move)

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13
Q

Concepts related to flow:

Blood Flow

A
  • rate which blood is removed and returned to body (mL/min)

- greater volume processed=better clearance

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14
Q

Concepts related to flow:

Dialysate Flow

A

-dialysate solution is delievered to dialyzer (mL/min)

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15
Q

Functions of Kidneys (4)

A
  • osmolarity; fluid balance
  • filtration; excretes wastes and toxins
  • regulates ion concentration; pH levels
  • creates hormones; which helps with productions in RBC, promotes bone health , and regulates blood pressure
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16
Q

Causes of Kidney Disease (3)

A
  • glomerulonephritis
  • type 1/2 diabetes
  • high blood pressure
17
Q

Signs of Kidney Disease (9)

A
  • nausea and vomiting
  • loss of appetite
  • fatigue/weakness/sleeping probs
  • changes in urination
  • muscle twitches/cramps
  • swelling of feet/ankles
  • persistent itching
  • chest pain
  • uncontrolled hypertension
18
Q

Nephrons are the site of: (9)

A
  • filtration of blood
  • maintenance of renal blood pressure
  • formation of rine
  • counter current mechanism
  • acid-base balance
  • regulation of electrolutes
  • reabsorption of materials
  • secretion of material/production of hormones
  • excretion of wastes
19
Q

3 Major Functions of the Kidney

A
  • excretion
  • secretion
  • reabsorption
20
Q

3 Major Functions of the Kidney:

Excretion (4)

A
  • removal of metabolic waste products
  • removal of excess fluid
  • regulates acid-base balance
  • regulate electrolyte levels
21
Q

GFR

A

GLOMERULAR FILTRATE RATE

  • measure how much blood volume gets filtered in a minute
  • waste etc
22
Q

Removal Pathway of Metabolic waste

A
  • blood enters through afferent arteriole, into the glomerulus
  • waste goes through bowman’s capsule and into the proximal convoluted tubule and makes urine
  • filtered blood exits efferent arteriole
23
Q

3 Major Functions of the Kidney:

Secretion (3)

A
  • secretes RENIN; regulates BP
  • secretes ERYTHROPOETIN; regulates RBC prod
  • secretes CALCITRIOL; regulates calcium uptake and activate vitD
24
Q

3 Major Functions of the Kidney:

Reabsorption
+tubular reabsorption

A
  • reabsorbs essential minerals and nutrients
  • reabsorbs water

Tubular Reabsorption: sodium and water gets reabsorbed in the distal convoluted tubule

25
Q

Kidneys excretory fx:

Kidneys regulatory fx:

A
  • formation of urine
  • metabolic waste production
  • body water volume
  • electrolyte balance
  • acid-base balance (buffer system)
26
Q

Fluid Balance: Key Transport Mechanisms (3)

A

Active Transport: ATP assists in transporting
Osmosis: movement of fluid from [low solute] to [high solute]
Diffusion: movement of solute from [high solute] to [low solute]

27
Q

Fluid Balance: ADH

A

Anti-Diuretic Hormone

[H] ADH: dark urine
[L] ADH: dilute urine

28
Q

Importance of obtaining Dry Weight:

DW too high (leaving above ordered DW) (4)

A
  • hypertension
  • LVH
  • CHF
  • increased mortality
29
Q

Importance of obtaining Dry Weight:

DW too low (leaving below ordered DW, taking too much) (4)

A
  • repeat hypotension
  • myocardial stunning
  • decreased residual renal function
  • ischemic gut; arteries supplying intestines are slowed or stopped due to low blood supply
30
Q

Dietary Sodium Intake

-why care?

A

-less than 2000 mg/day
(less than 3/4 tsp)

  • higher fluid consumption
  • expands extracellular fluid volume
  • higher BP
31
Q

Hemoscan

A
  • monitors blood volume difference and UFR

- drop in BV = drop in BP

dialysis exam (7 decks)

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