Renal replacement therapies

Question 1

Dialysis

Answer 1

1. Peritoneal dialysis
   - Continuous Ambulatory Peritoneal Dialysis
   - Automated Peritoneal Dialysis
2. Hemodialysis

Question 2

Indications for Dialysis Therapies

Answer 2

1. Uremia (high level of nitrogen waste)
2. Persistent hyperkalemia
   3 .Uncompensated metabolic acidosis
3. Fluid volume excess
4. Uremic pericarditis/Uremic encephalopathy

Question 3

Peritoneal dialysis

Answer 3

Peritoneal membrane: Dialyzing surface Peritoneal dialysis: Process of diffusion and osmosis
Warmed sterile dialysate:
- Instilled into the peritoneal cavity via a permanent indwelling catheter
- May include heparin, potassium, and antibiotics
- Metabolic waste products and excess electrolytes diffuse into dialysate
- Fluid is drained by gravity into a sterile bag

Question 4

Complications of peritoneal dialysis

Answer 4

1. Peritonitis
2. Bleeding
3. Leakage
4. Abdominal hernias

Question 5

PD: advantages

Answer 5

Easy to learn; can be done at home; no machine needed;hemodynamic tolerance; better BP control; less dietary and fluid restrictions; more freedom (traveling)

Question 6

PD: disadvantages

Answer 6

Time consuming; protein wasting; excessive glucose load - hyperlipidemia; sterile technique; permanent catheter; weight gain; peritonitis risk; peritoneum injury risk; not for pts with many abdom. surgeries; chronic back pain; hernia

Question 7

Caring for patient with PD

Answer 7

1. Mask yourself and patient; wash hands
2. Sterile gloves - remove dressing
3. Assess: for infection
4. Use aseptic technique: three swabs for cleaning; 4x4 gauze.

Question 8

Hemodialysis

Answer 8

• Uses the principles of diffusion and ultrafilteration
• Removes excess fluids and waste products
• Restores chemical and electrolyte balance
• Involves passing the client’s blood through an artificial
  semi-permeable membrane

Question 9

Types of vascular access for hemodialysis - permanent

Answer 9

1. AV fistula : internal anastomosis of an artery to a vein ; forearm; initial use: 2-4 month or longer
2. AV graft: synthetic vessel tubing tunneled beneath the skin ( artery + vein) ; forearm, upper arm, inner thigh; 1-2 wk
3. Dual -lumen hemodialysis catheter: surgically tunneled, with a barrier cuff; subclavian vein; immediately post op ( x-ray confirmation ).

Question 10

Types of vascular access for hemodialysis- temporary

Answer 10

1. Hemodialysis catheter (dual- or triple lumen)
2. AV shunt ( relatively uncommon)
3. Subcutaneous device

Question 11

To check potency

Answer 11

Palpate for the thrill; auscultate for the bruit

Question 12

Caring for patient undergoing hemodialysis

Answer 12

1. Weigh pt before and after.
2. Know pts dry weight
3. Hold meds: antihypertensives
4. Measure BP, HR, RR, T
5. Orthostatic hypotension
6. Assess vascular access site
7. Observe for bleeding
8. Level of consciousness, headache, N&V

Question 13

Caring for client with AV fistula

Answer 13

1. Do not take BP on that arm
2. No venipunctures, IV lines
3. Palpate for thrills, auscultate for bruits
4. Assess distal pulses and ciculation
5. Elevate extremity post op
6. ROM exercise
7. Bleeding at needle insertion site
8. Instruct: not to carry heavy objects
9. Not to sleep on extremity with body weight

Question 14

Hemodialysis : complications

Answer 14

1. Disequilibrium syndrome
2. Muscle cramps
3. Hemorrhage
4. Air embolus
5. Hypotension , anemia - hemodynamic complications
6. Cardiac dysrhythmias

Question 15

Renal transplantation

Answer 15

1. The surgical insertion of a functioning kidney.
2. The most successful of all transplantation procedures
3. Most transplanted kidneys are harvested from a cadaver or living relative
4. Involves major surgery

Question 16

Nursing care of the client having kidney transplant

Answer 16

Preop. care: immunosuppressive drugs
Postop. care: potency of urinary catheter; measure urinary output - acute tubular necrosis ( early complication); diuresis may occur; replace fluids; diuretics to promote postop. diuresis; remove catheter within 2-3 days; encourage to void every 1-2 hours ; serum electrolytes; renal function test; serum creatinine, BUN;

Question 17

S/S of Transplant Rejection: Acute

Answer 17

1. Acute: 1 week - 2 years postop.; oliguria, anuria; temperature > 37.8 C; high BP; flank tenderness; lethargy; low sp. gravity; fluid retention. TX: increase doses of immunosuppresive drugs.

Question 18

S/S of Transplant Rejection: Chronic

Answer 18

2. Chronic: gradual over months to years; gradual increase in BUN and creatinine; electrolytes imbalances; fatigue. TX: conservative managements until dialysis is required.

Question 19

S/S of Transplant Rejection: Hyperacute

Answer 19

3. Hyperacute: within 48 hrs; high T, BP, pain at transplant site; TX: immediate removal of the transplanted kidney

Question 20

Dialysis disequilibrium syndrome

Answer 20

Due to the rapid decrease in fluid volume and BUN; change in urea levels can cause cerebral edema and increased intracranial pressure. S/s: headache, N/V; restlessness, decreased level of consciousness, seizures, coma, death; TX: anticonvulsants and barbiturates

Question 20

Nursing Diagnoses

Answer 20

1. Imbalanced nutrition: Less than body requirements
2. Excess fluid volume
3. Decreased cardiac output
4. Risk for infection
5. Risk for injury
6. Fatigue
7. Anxiety