LEC 4: Care for Patients with CKD Flashcards
What are the goals of care for CKD patients?
- Slow the disease progression and minimize the cardiovascular risks
- Once damage occurs, it cannot be cured; want to prevent it - Demonstrate knowledge and ability to comply with therapeutic regimen
- Once at stage 5 patient NEEDS to take dialysis otherwise will die - Participate in decision making for the plan of care and future treatment modality
- Demonstrate effective coping startegies
- Continue with ADLs
Health Promotion
- Smoking cessation
- Exercise
- Regular assessments and blood works
a. General well-being, cardiovascular disease,
dyslipidemia, anemia nutritional status, mineral and bone
disorders
b. CBC, electrolytes, urea and creatinine, calcium,
phosphorus, iron
c. Fluid volumes- blood pressure, weight, outputs
- Will weight them everyday before breakfeast
- BP on a daily basis
- Monitor their output
Drug Therapy
- Know medication that are nephrotoxic
- No NSAIDs - Common medications administered:
- Diuretics: facilitate them to urinate
- Sodium bicarbonate: Counter act the acid
- Sodium polystyrene sulfate: Potassium binder, poop out potassium because there is a build up of potassium
- Erythropoietin and iron: Treat anemia
- Cardiovascular drugs
- GI drugs
- Neurological: Medications to trat pain, depression
*Too much potassium causes the body to loose calcium
Nutritional Therapy
- Dietician consult
- Can provide a specific diet due to their lab results
- Will need meal planning and supplementation - May need to restrict (depends on the client)
- Protein
- Sodium and fluid
- Potassium
- Phosphate
What is dialysis therapy?
Treatment which cleans the blood and removes wastes and excess water from blood
- Removes excess waste and water
- The “clean” blood is re-entered into the body
How long does each dialysis treatment take?
Each treatment takes around 4 to 5 hours and needs to be done 3 times per week
What are they two types of dialysis treatments?
- Hemodialysis
2. Peritoneal dialysis
Hemodialysis
- Accesses the blood stream through a central venues catheter
- Is inserted and the IV lines foes to the tip of the superior vena cava - There are two ports
- One to pull the blood out
- One to put the blood back in - There are two options
- AV fistula
- AV graph
What are the two options for hemodialysis?
- AV fistula
2. AV graph
Hemodialysis: AV fistula
A vein and an artery are surgically connected together
- Can take up to 6 weeks for surgery to heal, would then insert the cathalon into the catheter
- Less risk for clotting; surgeons prefer the AV fistula
Hemodialysis: AV Graph
The ones that are permanently put in, you can touch, want to asses them.
- If you can hear that turbulent blood flow
- Are assessing for bruit with stethoscope at site
- Will also feel for that turbulent flow, palpable thrill (vibration)
*Do not touch the ventral venous line if used for dialysis, it is their life line
Peritoneal Dialysis
Another way to eliminate waste from the body
- The blood is cleaned inside the body through the peritoneal cavity
- Will happen 4 to 6 times a day; more time consuming
- Patient can be at home for peritoneal dialysis therapy
Dialysis Access Care
- No blood pressure, IV starts, or blood work on arm with AV fistula or graft
- Report absence of bruit or thrill at AV fistula or graft
- Report signs/ symptoms of exit site infections or movement of dialysis catheter (external IV line)
- Redness
- Pain
- Temperature
- Purulent discharge
Where does hemodyalisis access the blood from?
Accesses the blood stream through a central venues catheter
Where does peritoneal dialysis access the blood from?
The blood is cleaned inside the body through the peritoneal cavity
