patient undergoing hemodialysis & peritoneal dialysis

Question 1

what does hemodialysis mean?

Answer 1

it is an intermittent renal replacement therapy involving the process of cleansing the client’s blood

Question 2

what are the 5 functions of hemodialysis?

Answer 2

1. cleanses the blood of accumlated waste products
2. removes the byproducts of protein metabolism, urea, creatinine, and uric acid from the blood
3. removes excess body fluid
4. maintains or restores the buffer system of the body
5. corrects electrolyte levels in the body

Question 3

how does hemodialysis work? provide a patho explanation?

Answer 3

the semipermeable membrane is made of a thin porous cellophane, which small particles to move through. The clients blood flow goes into the dialyzer through the process of osmosis, diffusion and ultrafiltration.

Question 4

what does osmosis mean
what does diffusion mean
what does ultrafiltration mean

Answer 4

low concentration to higher concentration
higher concentration to lower concentration

movement of fluid across a semipermeable membrane as a result of an artificially created pressure gradient

Question 5

what is inside a dialysate bath? in essence whats inside a dialysis bag to give to a patient?

Answer 5

water and major electrolytes

Question 6

what are some things you want to do before placing a patient on dialysis? (3)

provide 3 medications we should stop too

Answer 6

vital signs ( temp, monitor for a fever )
lab values ( bun,creatinine)
stop medications like anti-hypertensives, diuretics, digoxin

Question 7

why do we want to weight the client before and after dialysis?

Answer 7

assess the amount of fluid loss before and after

( fluid overload before and fluid deficit after typically )

Question 8

why do we want to monitor for bleeding for hemodialysis?

Answer 8

because heparin is usually added to the dialysis blood tubing to prevent clots from forming inside the bag

or insertion site of the needle

Question 9

why do we want to monitor a patient for hypovolemia?

Answer 9

because it can happen fast from all the blood, fluid and electrolytes we are extracting

Question 10

what are the 5 types of access for hemodialysis we are going to talk about?

Answer 10

subclavican cath
femoral cath
external av shunt
internal av fistula
internal av graft

Question 11

why would we want to use a subclavian or femoral catheter for a patient needing to go under dialysis?

Answer 11

typically these are for short-term, or temporary use for a patient with an acute kidney injury or used first as an access site until another site matures

Question 12

a subclavian or femoral catheter is used until how many weeks or what?

Answer 12

6 weeks until the fistula or graft matures

or

when the clients fistula or graft has failed because of an infection or clotting

Question 13

what are some things you want to assess before administering anything in a femoral catheter?

Answer 13

circulation, temperature and pulses

Question 14

because the femoral cath is in a groin, what do we tell patients?

Answer 14

maintain meticulous perineal care

Question 15

why do we tell patients with a femoral cath they can not sit up more than 45 degrees?

Answer 15

because the cath may kink or occlude

Question 16

how does an external arteriovenous shunt work?

Answer 16

two silastic cannuals are surgically inserted into an artery and vein in the forearm or leg to form an external blood path

U shape
artery to vein

Question 17

what is the greatest advantage of having an external av shunt?

Answer 17

the shunt can used immediately following its creation

Question 18

what are the disadvantages behind an external av shunt?

Answer 18

disconnection
hemorrhage, clot, infection
skin erosin around the cath

Question 19

what are some patient education we are going to provide to someone with an external av shunt? (3)

Answer 19

dont get it wet
put a dressing around it do it stays dry and intact
no bp, iv, injections in that arm

Question 20

what are some signs of clotting for a patient with an external av stunt?

Answer 20

white flecks in tubing
absence of thrill or bruit previously heard
coolness of the tubing or extremity
tinging sensation at site or extremity

Question 21

what is the best access of choice for a patient who has chronic kidney disease or needs chronic treatment of dialysis?

Answer 21

internal arteriovenous fistula

Question 22

what is the patho on how an internal av fistual works ?

Answer 22

the vein and artery are pretty much surgically joined together in order to help the vein engorge

Question 23

why would we want the vein to engorge for a patient who has an internal av fistula?

Answer 23

because we are going to be puncturing that vein in order to do the dialysis

Question 24

how long does it take for the fistula and vein to engorge to reach full maturity in order we can use it?

Answer 24

4-6 weeks

Question 25

what are some things that can help a fistula mature quicker?

Answer 25

hand-ball squeezing,

Question 26

during this time, while the fistula is maturing, what are some ways we can help the patient still receive dialysis?

Answer 26

peritional, subclavican or femoral and external av shunt

Question 27

what are some great advantages of having an internal fistula?(4) mobility? healing time? risks? duration?

Answer 27

it can be used forever less likely to clot or bleed or infect once healing is done, no need for dressing freedom of movement?

Question 28

what are the major disadvantages that come along with an av fistula? (5) duration ? risk factors? 3 conditions that can occur?

Answer 28

can not be used immediately, takes time for it to mature needle insertions constantly - risk for infiltration and a hematoma forming aneurysms heart failure arterial steal syndrome

Question 29

how can an aneurysm occur for this patients having an av fistula?

Answer 29

it can form without regular site rotation

Question 30

how can heart failure occur for these patients having an av fistula?

Answer 30

the incerased blood flow in the venous system can strain the heart significantly

Question 31

how does arterial steal syndrome occur? ( distal ischemia )

Answer 31

when too much blood is diverted to the vein and arterial perfusion to the hand is compromised

Question 32

what are some signs and symptoms for a patient having steal syndrome?

Answer 32

numbness and tingling of fingers poor capillary refill pain distal to access site

Question 33

why would we use an internal av graft?

Answer 33

its usually used for chronic dialysis patients who do not have adequate blood vessels for the creation of a fistula

Question 34

how long does it take for a graft to be used or reach full maturity? what can help reach maturity faster?

Answer 34

2 weeks squeezing a ball, flexing hand motion

Question 35

what is the patho behind an av graft ? (avg)

Answer 35

synthetic material surgically placed under the skin to form a bridge between artery and vein ( brachial and antecubital )

Question 36

how often are we asessing a patients vital signs when they are having hemodialysis?

Answer 36

30-60minutes

Question 37

remember why is heparin added to the solution and patient before hemodialysis?

Answer 37

to aid in the prevention of clots

Question 38

what do we use to prime the blood or dialyzer to eliminate air for the patient ?

Answer 38

SALINE!

Question 39

a major complication behind hemodialysis is called what? other than steal syndrome

Answer 39

dialysis disequilibrium syndrome

Question 40

what is dialysis disequilibrium syndrome ?

Answer 40

neurologic changes during or immediately following HD, a result of cerebral edema

Question 41

what are some risk factors for dialysis disequilibrium syndrome ?

Answer 41

age high bun elevated co2 pre-exising neurologic condition hyponatremia hypertensive crisis

Question 42

dialysis disequilibrium syndrome symptoms?

Answer 42

restlessness, disorietnation vomiting headache blurred vision

Question 43

how do we manage dialysis disequilibrium syndrome ? what if cerebral edema occurs?(2)

Answer 43

slow speed of dialysis mannitol or hypertonic solution can be given

Question 44

hypotension is also a very common thing to happen for patients with hemodialysis, how can we help avoid this? symptoms of hypotension ?

Answer 44

decreasing the volume of fluid remove and IV NSS light-headed, nausea, seizures, vision changes, chest pain

Question 45

muscle cramps is also very common to occur what are the causes ? what is the treatment ?

Answer 45

decreased bp, hypoveolmia, low sodium decrease ultrafilitration and iv fluids

Question 46

how do we remember if the hemodialysis is patent? we feel for what we hear for what?

Answer 46

we palpate, feel, for thrill we hear a bruit

Question 47

something to add here is when do we start dialysis for patients?

Answer 47

when patients uremia can no longer be adequately treated GFR <15ml/min.1.73m^2

Question 48

how is peritoneal access obtained?

Answer 48

inserting a cath through the anterior abdominal wall

Question 49

what are the 3 phases of peritoneal dialysis?

Answer 49

1. inflow (2-3L over 10mins ) 2. dwell (eqilibration) 20-30mins-8 hours 3. Drain (15-30mins)

Question 50

patients with a perioneal dialysis can have complications like exit site infection ( symptoms and treatment )? hernia ( cause and treatment ) lower back problems ( cause and treatment ) bleeding ( caused and treatment )?

Answer 50

redness, tenderness, drinage antibiotcs increased intrabdominal pressure from dialysate hernia repair intraperitoneal infusion increases pressure binders and exercise common with initial cath placement check for bleeding, bp, h&h

Question 51

the biggest complication with peritoneal dialysis is what?

Answer 51

peritonitis

Question 52

what is peritonitis?

Answer 52

exit site or tunnel infection

Question 53

what are signs and symptoms of peritonitis?

Answer 53

abdominal pain rebound tenderness cloudy effluent with increased WBC fever diarrhea, vomiting distention

Question 54

how do we treat peritonitis?

Answer 54

anti-biotics

Question 55

another big complication of peritonal dialysis is what and why?

Answer 55

pulmonary complication - as we fill the abdomen up with fluid, that can put pressure on the diaphragm and cause us to have complications with breathing

Question 56

what are some symptoms of pulmonary compliactions?

Answer 56

decreased lung expansion -> atelectasis, pneumonia, or bronchitis

Question 57

treatment for these pulmonary complications?

Answer 57

elevate HOB, reposition and deep breathing