Renal Replacement Therapies Flashcards
Dialysis
Artificial processes for removing waste and water from the body when kidneys no longer functioning
Who needs dialysis ?AEIOU
Aside base probs
Electrolyte probs
Intoxications
Overload of fluids
Uremic symptoms
Methods of dialysis
Hemodialysis HD
Peritoneal dialysis PD
Hemodialysis
Obtaining vascular access is one of the most difficult probs
Uremic systems
Sob, loss of apetite, muscle cramps, n&v unexplained weight loss (muscle wasting), cognitive dysfunction, itching
Types of access
Arteriovenous fistulas and grafts
Temporary vascular access
Fistulas
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
Why would you go get a graft or fistula
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
Hemodialysis complications
Hypotension
Muscle cramps
Loss of blood
Hepatitis
Systemic infection
Dialysis dementia
Disequilibrium syndrome
Av fistula complication
How often you change central line dressing
Weekly or prn
Why would hemodialysis cause hypotension and losing weight
Losing volume
Be careful and monitor for these things. Especially first time they come back up weak and hypotensive,
Why do muscle cramps happen in hemodialysis
Rapid change in electrolyte system
Why would her b or c be a risk
Unclean machines
Why does dialysis dementia happen in hemodialysis
So much waste in body goes down so it can cause confusion
Nursing interventions hemodialysis
Helps the pt maintain a health self image
Return the pt to the highest level of function possible (including returning to work)
What happens when av fistula complication happens
Put in a new one or keep a temp line in
1 cause of death for hemodialysis pt
Stroke, heart attack
(Blood clots and a lot of stress on heart )
Another issue of hemodialysis with mental health
Suicide and depression
Continuous renal replacement therapy
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 )
CRRt can be used with
HD
What pt should not used CRRT or is not ideal
Hyperkalemia (pull off slower) Pericarditis (heart conditio)
Peritoneal dialysis
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
What is something that we monitor for PD
Make sure what we are putting in is coming out
Three phases of pad cycle
Inflow
Dwell
Drain
Inflow (fill)
Put substances into abdominal cavity 2-3 L . Takes about 10 min if pt starts feeling pain you can slow it down
Dwell (equilibration)
Takes 4-6 hours leave substance in there before draining
Drain
Takes 15-30 minutes
the whole process of PD is called
Exchange (make sure what you are putting in that is coming out)
To help facilitate the drain phase what can we do ?
Lightly palpate abdomen or have pt change positions can help drain it out
PD contraindications
History of multiple abdominal surgeries
Chronic abdominal conditions
Recurrent hernias
Obesity
Pre existing back problems
Severe COPD
All put pressure
PD complication
Exit site infection
Peritonitis
Hernias
Lower back probs bleeding
Pulmonary (atelectasis, pneumonia, bronchitis)
Protein loss
Nursing interventions PD
Vitals
Daily weights
Nutrition(
Lab values potassium , bun , creatine, sodium wbcs)
What lab values should we watch for PD
Potassium BUN creatine sodium WBC
HD what are we assessing
Neuro assessment
Feel for a thrill and listen for a bruit (pre-dialysis)
Post dialysis - vitals/hypotension
PD what are we assessing
Abdominal girth, monitor outflow
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
Renal transplant contraindications
Malignancies(advance cancers)
Refractory/untreated cardiac diasease
Chronic respiratory failure
Extensive vascular disease
Chronic infection
Unresolved psychosocial disorders
Renal transplant complication
Rejection
Infection
HIV and Hepatitis pt
Can still get a transplant
Goal of renal transplantation
Suppress immune system so much it wont reject kidney
But not suppress it enough to cause infection
Cyclosporine (calcineurin inhibitors) renal transplant
Helps prevent rejection
Cytotoxic (anti proliferation drugs)
Acts on t and B cells in body to prevent rejection
One thing about drugs that are meant to prevent. Rejection of kidney
They need to be taken as directed and timely
Immunosuppressive therapy renal transplant
Prednisone (corticosteroids)
Cyclosporine
Cytoxic
Anti bodies to help suppress therapy
Monoclonal
Polyclonal
Mycophenolate
Tacrolimus
Mycophenolate
Help with suppressing immunuesystem
First line drug choice in preventing rejection
Low toxicity to liver and kidneys
Rejection
Hyper acute
Acute occurs
Chronic process
Hyper acute
No cure
Onset 48 hours
Malaise high fever
Graft tenderness
Organ must be removed to stop s/s
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)
Chronic rejection
Occurs over months or years
Irreversible
Increase BUN , creatine, imbalances in protein urea electrolytes , fatigue,
Goal to renal transplant
Prevent infection
S/s of infection
Fever/chills
Tachypnea
Tachy cardia
Increase or decrease in WBCs indicating Leukocytosis or leukopenia
