hemodialysis

Question 1

what is acute kidney failure

Answer 1

-most common in aleady hospitalized->usually critically ill
-develops rapidly->less than a few days
-may only need short term dialysis

Question 2

causes of acute kidney failure

Answer 2

-blood clots
-meds (chemo, antibiotics, radiologic dyes)
-infection
-post op comps
-scleroderma
-tumor lysis

Question 3

s&s of acute kidney failure

Answer 3

-dec urine output
-fluid retention
-SOB
-Fatigue
-confusion
-nausea
-weakness
-irregular HR
-chest pain
-seizures
-coma

Question 4

causes of CHRONIC kidney disease

Answer 4

-diabetes
-glomerulonephritis
-HTN
-polycystic kidneys
-pyelonephritis
-drugs/toxins

Question 5

care for a hemodialysis patient

Answer 5

-increasing prevelance of CRF of approx 10% annually
-multiple comorbidities lead to hospital admission in a multitude of settings
communication of knowledge and expertise between nursing staff

Question 6

what is hemodialysis

Answer 6

fistula is cannulated and blood is pumped through a dialyzer. wastes are filtered through a semi-permeable membrane via diffusion + pressure. blood is put through a bubble detector and instilled into the patients venous circulation

Question 7

how often does someone get hemodialysis

Answer 7

every 3-4 days for 3-4 hours (sometimes more or longer)

Question 8

what is CKD linked to

Answer 8

-cardiovascular disease
-bone disease
-anemia
-HTN

Question 9

common meds added to dialysate

Answer 9

-sodium bicarb (prevent metabolic acidosis)
-erythropoietin (anemia)
-heparin

Question 10

diet for CKD

Answer 10

renal diet
potassium free (40-70MeQ/day) dec phosphorus (600-1200mg/day)
no added salt (750-1000mg/day)
high protein (1-1.2g/kg/day)
fluid restriction (only N/S given Iv)

Question 11

vascular access for hemodialysis

Answer 11

-fistula is created by a vascular surgeon and lies just beneath the skin
-blood flow increased from 20-30ml/min in a health radial artery to 200-300ml/min immediately after creation and 600-1200ml/min after maturation (2-3 months)

Question 12

what is a arteriovenous fistula

Answer 12

-commonly radial artery and cephalic vein
-wait 6-12 weeks post-op to use it

Question 13

assessing the patency of a fistula

Answer 13

auscultate for bruit/thrill ->call vascular if not present

Question 14

dressings and fistula

Answer 14

pressure dressing is removed 2-3h after d/t pressure dressing may dec BF
-tip stop dressing needs to be removed 4h post

Question 15

what is a graft site

Answer 15

-a piece of tubing is surgically inserted under the skin to connect an artery and a vein
used when BV are so fragile a fistula cannot be created
-ready 2-3w post insertion
-tubing is self healing
-inc risk of infection

Question 16

venous access in dialysis pts

Answer 16

avoid cephalic veins for IVs
-stenosis may originate from IVs

Question 17

what is external vascular access via central venous catheters

Answer 17

-can be temp or perm
-permanent are tunneled thru internal jugular in radiology
-entrance ROS x7 days exit ROS x14 days
-can be inserted in femoral or subclavian
-MIN 2 lumens
-pt remains on bedrest if temporary because caths are stiff

Question 18

how to care for a fistula

Answer 18

-NO BP, IV or venipuncture in access arm
-must post signs above HOB
-assess daily and after hypotensive episodes

Question 19

fistula assessment

Answer 19

listen: bruit must be present, notify neph if bruit is diminished or absent
feeling: for thrill
-look: for s&s of infection and decreased circulation

Question 20

preparing the client for dialysis

Answer 20

report should include:
-any changes in condition/meds
-any invasive procedures to assess for heparinization
-send chart, kardex, and meds (if needed)
-hold meal tray
-weight

Question 21

patient care while at dialysis

Answer 21

-check weight (1kg=1L fluid, can only take 1-1.5l off)
-check for edema
-cardiopulmonary assessment
-temp
-vascular access
-check skin
-v/s Q30-60m

Question 22

blood work and dialysis clients

Answer 22

-sent req’s to dialysis unit to avoid unnecessary needle sticks
-done monthly on stable patients, acute pts are drawn pre and post hemo
-increased creatinine (muscle breakdown) and urea (kidney failure)
-increased potassium and sodium (dec after hemo)
-ph (metabolic acidosis)
-dec serum ferritin
-increased phosphorus
-decreased calcium

Question 23

post dialysis client care

Answer 23

-pressure dressing for bleeidng, monitor
-hypotensive post, monitor vitals
-will be exhausted, let them sleep, have food ready for when they are

Question 24

post dialysis treatment

Answer 24

-report includes vitals, meds given, events that occurred
-avoid iM injections 2-4h post d/t heparin
-monitor for hypotension
-have patient lie down

Question 25

what is disequilibrium syndrome

Answer 25

too rapid removal of fluid and solutes
-s&s: N&V, confusion, restlessness, H/A, twitching, jerking, seizures

Question 26

preventing bleeding post ex-cannulation

Answer 26

-constant pressure for 10 mins post
-tipstop bandage applied
-tipstop removed after 4 hours

Question 27

interventions for bleeding from fistula/graft

Answer 27

-remove all bandages and dressings
-apply firm pressure for 10 mins
-assess BF while maintaining pressure
-using a pressure dressing will not stop bleeding & could occlude access
-reapply needle site dsg when hemostasis is achieved

Question 28

care of CVC

Answer 28

-keep cath patent, secure, and infection free
-check exit site for s&s of infection

Question 29

common medications given to hemo patients

Answer 29

-erythropoietin (EPO): eprex or aranesp->stimulated RBC production to dec anemia
-phosphate binders to inc calcium and dec phosphorus (take w meals)
-water soluble vitamins (B and C)
-analgesics (morphine and codeine or tylenol)