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Renal Exam 2 > Part 1 Dialysis > Flashcards

Part 1 Dialysis Flashcards

1
Q

Define hemodialysis

A

Perfusion of blood and a physiologic solution on opposite side of semi-permeable membrane
Blood removed from body

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2
Q

Define peritoneal dialysis

A

Peritoneal membrane serves as the semipermeable membrane

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3
Q

HD Dialysis access created:

A

GFR less than 25
SCr great than 4
1 year prior to anticipated need for dialysis

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4
Q

The need for dialysis is recommended if

A

GFR or CrCl less than 15

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5
Q

***Acute indications for dialysis

A 
Acidosis
Electrolytes (hyperK)
Intoxication (drug over dose
Fluid overload
Uremia
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6
Q

***Chronic indications for dialysis

A

Signs of kidney failure (acid base, electrolyte imbalance, pruritus)
Inability to control volume status or BP
Deterioration in nutritional status
Cognitive impairment

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7
Q

Conventional or standard dialyzers

A

Small pores limit clearance to small molecules (urea or creatinine)
Low blood flow rate

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8
Q

High efficiency dialyzers

A

Large surface area (increased capacity to remove water, urea, small molecules)
High blood flow rate

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9
Q

High flux dialyzers

A

Large pores increase removal of high molecular-weight substances
High blood flow rate

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10
Q

Dialysate solution

A

Composed of purified water, glucose, sodium, K, Ca

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11
Q

Dialysis solution bases

A

Base is added to dialysate to neutralize acids

Acetate –> bicarbonate in liver (bicarb is more expensive)

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12
Q

Bicarbonate is

A

drug of choice in liver impairment and sever acidosis

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13
Q

Vascular access is:

A

major challenge for success and long-term feasibility of HD

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14
Q

Types of access

A

AV fistula
AV synthetic graft
Venous catheter

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15
Q

Advantages of AV fistula

A

Longest survival
Lowest complication rate
Increases survival and decreased hospitalization rate

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16
Q

Disadvantages of AV fistula

A

Take 1-2 months to mature

Difficult to create in elderly or PVD pts

17
Q

Advantages of AV synthetic graft

A

Easily implanted

Longer survival than others

18
Q

Disadvantages of AV synthetic graft

A

Short survival than fistula
Higher rate of complications
2-3 wks to endothelialize prior to use

19
Q

Advantages of venous catheters

A

Immediate use
Easy to place and remove
(femoral, subclavian or internal jugular vein)

20
Q

Disadvantages of venous catheters

A

Short survival
High risk of infection
May not provide adequate blood flow

21
Q

Urea reduction ratio (URR)

A

Percentage of blood being cleared of urea
100X(predialysis BUN - postdialysis BUN)/predialysis BUN
>60% is adequate

22
Q

Intermittent HD

A

3 sessions/wk
3-5 hrs/session
Sustained Low-Efficiency Dialysis (SLED)
PRN basis***

23
Q

Continuous HD

A

Based on access

24
Q

Advantages of HD over PD

A

Intermittent treatment
Effectiveness more easily measured
Low technique failure rate
Closer monitoring of pt

25
Q

Disadvantages of HD

A

Loss of independence
Long adjustment time
Risk with vascular access
More rapid decline in renal function

26
Q

PD Principles

A

Blood filled compartment: Blood vessels that supply and drain abdominal viscera, musculature and mesentery
Dialysate filled compartment: peritoneal cavity
Semipermeable membrane: peritoneal membrane

27
Q

PD Effiacy is not as easily manipulated bc

A

Distance between compartments
Cannot regulate blood flow
No countercurrent flow
Cannot change permeability

28
Q

Continuous Ambulatory Peritoneal Dialysis (CAPD)

A

Manual exchange every 4-8 hrs during the day
Requires about 20 minutes per exchange
No machine

29
Q

CAPD Advantages and disadvantages

A

A: independence
D: infection risk

30
Q

Automated peritoneal dialysis (APD)

A

Automatic cycler performs exchanges at night

31
Q

APD Advantages and disadvantages

A

A: fever exchanges, sterility, convenience
D: machine in bedroom

32
Q

Continuous cycling peritoneal dialysis (CCPD)

A

APD with “wet” day

Multiple exchanges at night with a long daytime dwell

33
Q

Tidal peritoneal dialysis

A

Initial partial fill, then drain, then replacement

Creates tidal flow

34
Q

Nightly intermittent peritoneal dialysis

A

APD with “dry” day

Multiple exchanges at night without a daytime dwell

35
Q

Intermittent Peritoneal DIalysis

A

Reserved for acute pts

Operater can change concentration, volume, time

36
Q

Disadvantages of Intermittent Peritoneal DIalysis

A

High cost and risk of infection

37
Q

Advantages of PD over HD

A

Continuous removal of solutes
Improved clearance of larger solutes
Better preservation of renal function
Increased independence

38
Q

Disadvantages of PD

A 
Predisposition to malnutrition
Excessive glucose load
Continued aseptic technique
Time consuming exchanges
Injury prone peritoneum
Peritonitis

Renal Exam 2 (10 decks)

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