Renal/DKA

Question 1

Diffusion:

Answer 1

movement of solutes from an area of greater concentration to an area of lesser concentration

Question 2

Osmosis:

Answer 2

movement of fluid from an area of lesser concentration of solutes to an area of greater concentration (Glucose in dialysate creates osmotic gradient to pull fluid from the blood)

Question 3

Ultrafiltration:

Answer 3

Water and fluid removal
Results when there is an osmotic gradient or pressure gradient across the membrane
PD: Glucose in dialysate
HD: Pressure in gradient
Excess fluid moves into dialysate

Question 4

Hemodialysis:

Answer 4

(Acute overdose, severe edema, hepatic coma, severe metabolic acidosis, burns, transfusion reactions, rhabdomyolysis)

Similar to natural diffusion
Circulates blood through semi permeable tubing through a dialysate

3 Big Pulls: Urea, Creatinine, K+
Water (ultrafiltration) fluid volume control
Access: AV Shunt, Grafts, Vascular

Question 5

CRRT:

Answer 5

(Severe HF with FVO, increased ICP, Post resuscitation (ROSC)/ targeted temp management, AKI secondary to liver failure, late presenting AKI, sepsis and mods)

Same as hemodialysis, but occurs at a softer rate
Minimize hypotension and electrolyte shifts

Types:
MOST COMMON: (SCUF) Slow continuous ultrafiltration: fluid removal, no waste removal, no fluid replacement
(CVVH) Continuous venovenous hemofiltration: fluid and some waste removal, some replacement fluid
(CVVHD) Continuous venovenous hemodialysis: some fluid and MAX waste removal
(CVVHDF) Continuous venovenous hemodiafiltration: MAX fluid and waste removal

Question 6

Peritoneal Dialysis:

Answer 6

Insert a catheter through the anterior abdominal wall

3 phases:
-Inflow (fill): 2-3L over 10 minutes
-Dwell (equilibration): 20 to 30 min ~ 8 hours
-Drain 15-30 minutes (watch for cloudy or blood)

Dextrose is used as an osmotic agent
Patient can do it in their homes or in the acute care setting

Question 7

IV regular insulin drip

Answer 7

0.1 U/kg/hr to correct hyperglycemia

Question 8

Safe BG drop

Answer 8

36-54 mg/dl/hr drop in BG will avoid complications (cerebral edema)

Question 9

Can transition to SubQ from insulin drip when:

Answer 9

BG <250
pH: > 7.3
HCO3 > 15
*NaCl 0.9% or 0.45%; add 5%-10% dextrose when BG approaches 250

Question 10

Interventions for DKA Metabolic Acidosis

Answer 10

Assess respiratory compensation and LOC
Usually corrected by fluids and insulin
Bicarb only if pH is less than 7.0, administered by infusion until pH is 7.1

Monitor:
BG, urine output and ketones
IV fluids, insulin therapy, Electrolytes (especially K+)
Assess renal status (could go into AKI), cardiopulmonary status, LOC

Question 11

Hemodialysis Nursing interventions

Answer 11

Effective, done at besides in ICU over 3-4 hours,

Weigh patient daily, Monitor labs, Don’t give water soluble meds before treatment, hold antihypertensives, do not give 6 hours before treatment, Assess access (AV shunt) frequently

Question 12

Hemodialysis complications

Answer 12

Hypotension (preexisting hypovolemia/ rapid fluid removal, too much removed), Dysrhythmias due to rapid shift in K+, potential for decrease in arterial O2, dialysis disequilibrium syndrome, bleeding

Question 13

CCRT complications

Answer 13

Infection, bleeding

Question 14

PD complications

Answer 14

infection, hernia, bleeding, pulmonary complications