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Module 4 > Renal Replacement Therapies > Flashcards

Renal Replacement Therapies Flashcards

1
Q

Dialysis

A

Artificial processes for removing waste and water from the body when kidneys no longer functioning

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2
Q

Who needs dialysis ?AEIOU

A

Aside base probs
Electrolyte probs
Intoxications
Overload of fluids
Uremic symptoms

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3
Q

Methods of dialysis

A

Hemodialysis HD
Peritoneal dialysis PD

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4
Q

Hemodialysis

A

Obtaining vascular access is one of the most difficult probs

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5
Q

Uremic systems

A

Sob, loss of apetite, muscle cramps, n&v unexplained weight loss (muscle wasting), cognitive dysfunction, itching

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6
Q

Types of access

A

Arteriovenous fistulas and grafts
Temporary vascular access

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7
Q

Fistulas

A

Good for long term

Let heal for at least 3 months before you can use it until then they will start with a temporary line

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8
Q

Why would you go get a graft or fistula

A

Less chance of infection .. long term use of it , skin will keep it clean vs temporary lines will be dangling down and can get dirty

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9
Q

Hemodialysis complications

A

Hypotension
Muscle cramps
Loss of blood
Hepatitis
Systemic infection
Dialysis dementia
Disequilibrium syndrome
Av fistula complication

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10
Q

How often you change central line dressing

A

Weekly or prn

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11
Q

Why would hemodialysis cause hypotension and losing weight

A

Losing volume

Be careful and monitor for these things. Especially first time they come back up weak and hypotensive,

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12
Q

Why do muscle cramps happen in hemodialysis

A

Rapid change in electrolyte system

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13
Q

Why would her b or c be a risk

A

Unclean machines

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14
Q

Why does dialysis dementia happen in hemodialysis

A

So much waste in body goes down so it can cause confusion

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15
Q

Nursing interventions hemodialysis

A

Helps the pt maintain a health self image
Return the pt to the highest level of function possible (including returning to work)

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16
Q

What happens when av fistula complication happens

A

Put in a new one or keep a temp line in

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17
Q

1 cause of death for hemodialysis pt

A

Stroke, heart attack
(Blood clots and a lot of stress on heart )

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18
Q

Another issue of hemodialysis with mental health

A

Suicide and depression

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19
Q

Continuous renal replacement therapy

A

For acutely ill with AKI or severe fluid overload

(Clinically unstable and can’t handle a rapid dialysis like HD , going to pull off slowly 18-24 hours )

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20
Q

CRRt can be used with

A

HD

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21
Q

What pt should not used CRRT or is not ideal

A

Hyperkalemia (pull off slower) Pericarditis (heart conditio)

22
Q

Peritoneal dialysis

A

Catheter inserted through the anterior abdominal wall
Intermittent or continuous (capd)

Recommend no baths
Daily catheter care depends
Want to keep gauze pad so its not retaining moisture

23
Q

What is something that we monitor for PD

A

Make sure what we are putting in is coming out

24
Q

Three phases of pad cycle

A

Inflow
Dwell
Drain

25
Q

Inflow (fill)

A

Put substances into abdominal cavity 2-3 L . Takes about 10 min if pt starts feeling pain you can slow it down

26
Q

Dwell (equilibration)

A

Takes 4-6 hours leave substance in there before draining

27
Q

Drain

A

Takes 15-30 minutes

28
Q

the whole process of PD is called

A

Exchange (make sure what you are putting in that is coming out)

29
Q

To help facilitate the drain phase what can we do ?

A

Lightly palpate abdomen or have pt change positions can help drain it out

30
Q

PD contraindications

A

History of multiple abdominal surgeries
Chronic abdominal conditions
Recurrent hernias
Obesity
Pre existing back problems
Severe COPD

All put pressure

31
Q

PD complication

A

Exit site infection
Peritonitis
Hernias
Lower back probs bleeding
Pulmonary (atelectasis, pneumonia, bronchitis)
Protein loss

32
Q

Nursing interventions PD

A

Vitals
Daily weights
Nutrition(
Lab values potassium , bun , creatine, sodium wbcs)

33
Q

What lab values should we watch for PD

A

Potassium BUN creatine sodium WBC

34
Q

HD what are we assessing

A

Neuro assessment
Feel for a thrill and listen for a bruit (pre-dialysis)
Post dialysis - vitals/hypotension

35
Q

PD what are we assessing

A

Abdominal girth, monitor outflow

36
Q

Renal transplantation

A

Very successful
Only 4% of people have gotten these
Best forCKD
Life long medication
Can live a much better life than dialysis pt

37
Q

Renal transplant contraindications

A

Malignancies(advance cancers)
Refractory/untreated cardiac diasease
Chronic respiratory failure
Extensive vascular disease
Chronic infection
Unresolved psychosocial disorders

38
Q

Renal transplant complication

A

Rejection
Infection

39
Q

HIV and Hepatitis pt

A

Can still get a transplant

40
Q

Goal of renal transplantation

A

Suppress immune system so much it wont reject kidney
But not suppress it enough to cause infection

41
Q

Cyclosporine (calcineurin inhibitors) renal transplant

A

Helps prevent rejection

42
Q

Cytotoxic (anti proliferation drugs)

A

Acts on t and B cells in body to prevent rejection

43
Q

One thing about drugs that are meant to prevent. Rejection of kidney

A

They need to be taken as directed and timely

44
Q

Immunosuppressive therapy renal transplant

A

Prednisone (corticosteroids)
Cyclosporine
Cytoxic

45
Q

Anti bodies to help suppress therapy

A

Monoclonal
Polyclonal
Mycophenolate
Tacrolimus

46
Q

Mycophenolate

A

Help with suppressing immunuesystem
First line drug choice in preventing rejection
Low toxicity to liver and kidneys

47
Q

Rejection

A

Hyper acute
Acute occurs
Chronic process

48
Q

Hyper acute

A

No cure
Onset 48 hours
Malaise high fever
Graft tenderness
Organ must be removed to stop s/s

49
Q

acute rejection

A

First 6 months after transplant
Reversible
Increase immunosuppressive therapy or steriods

(1 wk to 2 yr oliguria, Anuria, increase temp , increase bp , flank tenderness
Lethargy , increase BUN ,K, creatine, fluid retention not uncommon to have one episode)

50
Q

Chronic rejection

A

Occurs over months or years
Irreversible

Increase BUN , creatine, imbalances in protein urea electrolytes , fatigue,

51
Q

Goal to renal transplant

A

Prevent infection

52
Q

S/s of infection

A

Fever/chills
Tachypnea
Tachy cardia
Increase or decrease in WBCs indicating Leukocytosis or leukopenia

Module 4 (47 decks)

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