Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Nursing Foundations 3 > Module 14: Care of a Patient Requiring Dialysis > Flashcards

Module 14: Care of a Patient Requiring Dialysis Flashcards

You may prefer our related Brainscape-certified flashcards:
Nursing Pharmacology flashcards NCLEX-RN® flashcards Nursing Mental Health flashcards Nursing Fundamentals flashcards Nursing Safety & Infection flashcards Nursing Adult Health flashcards NCLEX-PN® flashcards Nursing Management of Care flashcards Nursing Pediatrics flashcards Nursing Maternity flashcards
1
Q

renal system

A
  • entire blood volume filtered through the kidneys every 4-5 minutes
  • normal renal blood flow is 1200 ml/minute
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

kidney failure

A
  • acute kidney injury (AKI)
    • rapid onset (1-7 days)
    • may be reversible
    • high mortality rate (35-65%)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Chronic Kidney disease (CKD)

A
  • progressive loss of kidney function resulting in decline in glomerular filtration rate
  • may be swagged according to glomerular filtration rate
  • signs and symptoms minimal until more than 75% of glomerular filtration lost
  • risk factors: diabetes. hypertension, smoking
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Monitoring Kidney Function

A
  • glomerular Filtration Rate (GFR) *
  • urine output and urinalysis
  • Serum creatinine *
  • creatinine clearance
  • BUN *
  • electrolyte
  • arterial blood gases
  • hemoglobin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

GFR (glomerular filtration rate)

A
  • normal adult value: 90-120 ml
  • used to detect and screen for early kidney damage and monitor kidney status
  • determines how well blood is filtered by the kidneys
  • calculated using a formula
  • used as indicator for the need of hemodialysis or peritoneal dialysis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Creatinine

A
  • normal adult value: 45 - 110 umol/L
  • is part of complete renal function panel which assists in the diagnosis of kidney function
  • is excreted entirely by the kidneys, therefore is directly proportional to kidney excretory function
  • elevated in renal disorders
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

blood urea nitrogen

A
  • normal adult value: 2-9 mmil/L
  • rough estimate of kidney function and GFR in patient’s with normal liver function
  • most kidney diseases cause an inadequate excretion of urea which causes rise in blood concentration
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Explain the reasons why a patient would require dialysis

A
  • used to sustain life after kidneys fail
    • for acute renal failure - temporary
    • for chronic kidney failure - until the patient can obtain a kidney transplant
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Goals of dialysis

A
  • remove the end products of protein metabolism from the blood
    • maintain safe concentrations of serum electrolytes
    • correct acidosis and replenish the body bicarbonate buffer system
    • remove excess fluid from the blood
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

principles of dialysis

A
  • movement of fluid and particles through a semipermeable membrane
    • patients blood, including metabolic waste, excess water and electrolytes are on one side of the membrane
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Peritoneal dialysis

A

membrane lining the abdomen acts as filter

  • lining covering the abdominal organs
  • parietal layer and visceral layer
  • 1-2 square meters in size
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

advantages of peritoneal dialysis

A
  • continuous treatment
    • patient feels better
    • less restrictive diet
    • better blood glucose control
    • better bp control
  • less interference with ADL
  • no needle s
  • no anticoagulation
  • less anemia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

disadvantage of peritoneal dialysis

A
  • change in body image
  • risk of peritonitis
  • no “days off”
  • no tub baths
  • no swimming
  • backpain
  • large amount of storage in the home
  • increased loss of protein
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Catheter types

A
  • percutaneous - through abdominal wall (tenckhoff)
  • implanted
    Patient’s peritoneum is used as a semi permeable membrane
  • 3 phases
    • inflow - about 2L of fluid infused
    • dwell - several hours, depends on order
    • drain -20-30 minutes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Contraindications to Peritoneal Dialysis

A
  • open abdominal wound
  • recent abdominal surgery/ trauma
  • patient opening between peritoneum and pleural cavity
  • inadequate surface area due to scarring
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Complications of Peritoneal Dialysis

A
  • Peritonitis: infection or inflammation of peritoneal cavity:
    • cloudy effluent
    • abdominal pain
    • fever/chills
    • nausea/vomiting
17
Q

Peritoneal Dialysis May be Preferred for:

A
  • patients who lives in rural area
  • severe heart disease
  • patient preference - able to administer at home according to prescribed cycles
  • poor vasculature
  • for some diabetic patients
18
Q

Continuous Ambulatory Peritoneal Dialysis (CAPD)

A
  • the dialysate solution stays in the abdomen for about 4-6 hours
  • exchanges are done about 4 times a day
  • the most commonly used form of peritoneal dialysis
  • highest risk of peritonitis
19
Q

Continuous Cycling peritoneal Dialysis (CCPD)

A
  • a machine automatically fills and drains the dialysate from the abdomen
20
Q

Hemodialysis

A

blood filter through dialysis machine “artificial kidney”

  • filters out waste products, excess fluid, balances electrolytes
  • intermittent (IHD)
  • continuous (CRRT)
  • Treatment takes 4-5 hours 3X week
    • clinic, home dialysis
    • nocturnal dialysis 6-8 hours, 6 nights per week
21
Q

hemodialysis advantages

A
  • shorter time period per treatment
    • quickly resolves acute problems
    • patient not required to learn the procedure
22
Q

hemodialysis disadvantages

A
  • difficulty with hemodynamically unstable patient
    • problems with vascular access
    • specially trained operator required
    • anti-coagualtion required
23
Q

Vascular Access for Hemodialysis:

central venous catheter

A
  • for temporary or long-term dialysis
    • for patient waiting for permanent fistula or graft
    • patient whose fistula or graft is not working
    • for peritoneal dialysis patient who requires hemodialysis
    • types
      • direct percutaneous
      • tunnelled
      • implanted port
24
Q 
Vascular Access for Hemodialysis:
Arteriovenous Fistula (AVF)
A
  • surgical anastomosis of an artery to vein
    • vein wall thickens and dilates
    • requires 2-6 months to mature
    • radial of brachial in non-dominant arm
    • can last up to 20 years ( average 7-9 years)
25
Q

arteriovenous Graft (AVG)

A
  • graft tunnelled under subcutaneous tissue
    • diverts blood from artery to vein
    • usually in the arm
    • 1-4 weeks to mature
    • usually last 3 years
26
Q

Post-Op Care of a New Fistula/ Graft

A
  • neuromuscular checks q1h
  • elevate arm X 2-3 days
  • assess for signs of infection
  • tenderness
  • blemishes
  • bulging
  • pulse distal to site
  • palpate for a “thrill” and auscultate for a “bruit”
    • if these are absent - cannot be the access
    • notify physician
27
Q

Direct Percutaneous Hemodialysis Line

A
  • double lumen - red port and blue port
  • must not be used for anything except dialysis:
    • ports are flushed with high con heparin
    • dialysis line is their lifeline
28
Q
  • Infection control
A
  • infections major cause of death for patient with ERSD (end stage renal disease)
    • infection rate much higher with CVC than with fistula or graft
29
Q
  • Risk of bleeding
A
  • arterial bleeding is life threatening
    • ensure all connections are tight/secured
    • observe site at all times
30
Q

Dialysis Orders -Ordered by Nephrologist

A
  • length of treatment
  • blood flow rate
  • target fluid loss
  • monitoring patient
31
Q

Patient Teaching

A
  • arm exercise start after 10-14 days
    • for fistula only
  • no heavy lifting
  • no tight clothing or jewellery
  • avoid prolonged bending, or sleeping on the access arm
  • keep site clean and avoid trauma
32
Q

Dialysate

A
  • solution containing prescribed amount of fluid and electrolytes
  • used to filter excess fluid and waste products from the body
33
Q

outline the assessments required in caring

for a patient requiring dialysis

A
  • aseptic technique for catheter site
  • initial dressing is left intact x 7 days
  • assessment of catheter site for any signs of infection
  • dressing changes per agency policy
34
Q

Describe the assessments and necessary precautions in caring for a patient with an arteriovenous shunt

A
  • general health, fever, malaise
    • weight gain or loss
    • vascular access site
  • need to assess each system thoroughly
  • monitor urinary output
    • patient in complete renal failure may or may not void
    • foamy urine signifies protein loss
    • in and out catheterizations may be ordered q weekly
  • on the arm with a fistula or graft
    • no BP cuff
    • no bloodwork
    • No IV’s
    • No wrist band
  • Medication
    • all or part of a medication dose may be eliminated by dialysis
    • depends upon:
      • type of drug
      • flow rate of dialysis
      • medication may have to be given after dialysis or additional doses may be give
  • Lab tests to monitor fluids, electrolytes and anemia
35
Q

Outline the common complications associated with renal failure and dialysis according to cause, clinical manifestations and nursing interventions

A
  • Cardiovascular system
    • affecter by hypervolemia, hyperkalemia and hypocalcemia
  • respiratory system
    • crackles to lungs
    • hyperventilation compensates for acidosis
    • ammonia odour to breath
  • Integumentary System
    • affected by the accumulation of waste products
      • greyish-bronze pallor
      • thin, dry, fragile skin and nails
      • puritis
      • bruising
  • Neurologic system
    • peripheral neuropathies - restless legs, burning feet, foot drop, decreased or loss of feeling in legs
    • mental status changes (lethargy, irritability, confusion)
      • altered attention span, memory and moods
  • Gastrointestinal System
    • nausea/vomiting
    • metallic taste in mouth
    • blood glucose levels
    • fluid /food restrictions
36
Q

Describe fluid and dietary restrictions for a patient experiencing renal failure

A
  • based on serum electrolytes and urea
  • can include the following:
    • increased protein
    • limit potassium, phosphorous and sodium
    • limit fluid (1-1.5 L/day)
    • B complex, ViTamin X, folic acid
    • activated Vitamin D

Nursing Foundations 3 (10 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions