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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
Inflow (fill)
Put substances into abdominal cavity 2-3 L . Takes about 10 min if pt starts feeling pain you can slow it down
26
Dwell (equilibration)
Takes 4-6 hours leave substance in there before draining
27
Drain
Takes 15-30 minutes
28
the whole process of PD is called
Exchange (make sure what you are putting in that is coming out)
29
To help facilitate the drain phase what can we do ?
Lightly palpate abdomen or have pt change positions can help drain it out
30
PD contraindications
History of multiple abdominal surgeries Chronic abdominal conditions Recurrent hernias Obesity Pre existing back problems Severe COPD All put pressure
31
PD complication
Exit site infection Peritonitis Hernias Lower back probs bleeding Pulmonary (atelectasis, pneumonia, bronchitis) Protein loss
32
Nursing interventions PD
Vitals Daily weights Nutrition( Lab values potassium , bun , creatine, sodium wbcs)
33
What lab values should we watch for PD
Potassium BUN creatine sodium WBC
34
HD what are we assessing
Neuro assessment Feel for a thrill and listen for a bruit (pre-dialysis) Post dialysis - vitals/hypotension
35
PD what are we assessing
Abdominal girth, monitor outflow
36
Renal transplantation
Very successful Only 4% of people have gotten these Best forCKD Life long medication Can live a much better life than dialysis pt
37
Renal transplant contraindications
Malignancies(advance cancers) Refractory/untreated cardiac diasease Chronic respiratory failure Extensive vascular disease Chronic infection Unresolved psychosocial disorders
38
Renal transplant complication
Rejection Infection
39
HIV and Hepatitis pt
Can still get a transplant
40
Goal of renal transplantation
Suppress immune system so much it wont reject kidney But not suppress it enough to cause infection
41
Cyclosporine (calcineurin inhibitors) renal transplant
Helps prevent rejection
42
Cytotoxic (anti proliferation drugs)
Acts on t and B cells in body to prevent rejection
43
One thing about drugs that are meant to prevent. Rejection of kidney
They need to be taken as directed and timely
44
Immunosuppressive therapy renal transplant
Prednisone (corticosteroids) Cyclosporine Cytoxic
45
Anti bodies to help suppress therapy
Monoclonal Polyclonal Mycophenolate Tacrolimus
46
Mycophenolate
Help with suppressing immunuesystem First line drug choice in preventing rejection Low toxicity to liver and kidneys
47
Rejection
Hyper acute Acute occurs Chronic process
48
Hyper acute
No cure Onset 48 hours Malaise high fever Graft tenderness Organ must be removed to stop s/s
49
acute rejection
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
Chronic rejection
Occurs over months or years Irreversible Increase BUN , creatine, imbalances in protein urea electrolytes , fatigue,
51
Goal to renal transplant
Prevent infection
52
S/s of infection
Fever/chills Tachypnea Tachy cardia Increase or decrease in WBCs indicating Leukocytosis or leukopenia

Module 4 (47 decks)

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