kidney II Flashcards
hemodialysis
3x a week
M/W/F
T/T/S
each treatment about 3-4 hours and usually about 3L is removed each session
HEPARIN IS USUALLY USED
Peritoneal dialysis
at home
daily
10-24 hours (mostly overnight)
about 1.5 L of fluid is removed each treatment
heparin is usually not used
access for hemodialysis
- temporary catheter – internal jugular vein (high risk of infection )
- permanent catheters - placed in internal jugualr or subclavian
- primary AV fistula - foraem and hen upper arm - usually lower risk of infection
- syntehtic AV graft – if pt. does not have adequate veins for access
peritoneal dialysis
temporary/ permanent catheter is placed in abdominal cavity (periotoneal space)
major cause of death in ESRD patients
cardiac related 50% of time
infections 15%
20% withdrawl from dialysis
life span after dialysis
7-11 years if 40-44
4-5 years if 60-65
patient survival post renal transplant
can be up to 91% with a living donor kidney
84% - non-extended criteria and recipient of deceased
70% - recipients of deceased and extended criteria
bleeding with CKD?
yes - anemia –> but levels are normal bu the FUNCTION IS ABNORMAL - so longer bleeding time
*so normal platelet numbers, but defects in platelet aggregation and adhesion
bleeding risk with anemia and precautions you should take
discontinue ASA 1 week prior to surgery and other antiplatalet drugs at least 72 hours before surgery
heparin free dialysis he day of or wait to perform surgery the next day
dialysis can help treat uremic bleeding tendency?
True
antibiotic prophylaxis for?
periotnela dialysis patients
2g amox 2 hour before
oral manifestations of CKD
- xerostomia
- metalic taste – due to urea
- uremic stomatitis - rare oral mucosa disorder assoicated with CKD
- bone resorption and tooth mobility
- higher degree of calculus, perio disease
T/F periodontal disease is a modifiable risk factor for cardio disease in ESRD patients?
Looks like it because of the systemic inflammation associated
which days are the longest gaps between treatment?
mondays and tuesdays depending on their 3 day schedule of MWF or TTS
when to treat dialysis patients
day after is best
narcotics and renal failure?
they can accumulate in renal failure so use sparingly and avoid Meperidine (seizures)
dental managment of transplant patient
all transplant patients should undergo screening prior to transplant to assess periodontium and need for any extractions
care regarding bleeding, antibiotic prophylaxis, hypertension control and drug dosing is same as CKD patients
indications for extraction in transplant patients
mobility greater than 5 or 6 and teeth with periapical lesions – or extensive caries or endo-perio problems
implants = postponed until health is stabilized
dental care of transplant patients post transplant
all patients will be on immunosuppressants and must be continued throughout care
first 6 months – exam
over 6 months – safe to perform typical procedures
