Renal Replacement Therapy Flashcards
Dialysis
Artificial processes for removing waste and water from the body when kidneys no longer function
or near-fatal incidence
not enough kidneys for transplant, not suitable for transplant
Dialysis is used when GFR is
less than 15
What religion would not use a kidney transplant?
Jehovah witness
Who needs Dialysis?
Acid-base problem
electrolyte problems (Potassium)
intoxications
overload of fluids
uremic symptoms
Methods of Dialysis
Hemodialysis (HD)
Peritoneal dialysis (PD)
Hemodialysis
Obtaining vascular access is one of the most difficult problems
Types of Hemodialysis access
Arteriovenous fistulas and grafts (less chance of infection)
Temporary vascular access
The Hemodialysis Dressing should be changed
7 days or PRN
Hemodialysis looks like
double-lumen
How long do you have to wait for the Arteriovenous fistulas and grafts to heal before using long-term?
3 months
Can heparin be used inside the Hemodialysis?
yes with order
HD complications
Hypotension
Muscle cramps
Loss of blood
Hepatitis (rare)
Losing volume and weight
rapid changing electrolytes
Systemic infection
HA
Dialysis dementia
Disequilibrium syndrome
AV fistula complication
Nursing Interventions of HD
Help the patient maintain a healthy self-image
Return the patient to the highest level of function possible
- Including returning to work
Continuous Renal Replacement Therapy
For acutely ill with AKI or severe fluid overload
ICUs
CRRT contraindicated for
rapid treatment for life-threatening manifestations of uremia
Hyperkalemia
Pericarditis
Fluid Overload of toxins
Can CRRT be used with HD?
YES, but not ideal
What is the number 1 cause of death for Dialysis pts?
stroke
death
Peritoneal Dialysis works because
semipermeable membrane in peritoneal cavity
Peritoneal access is
obtained by inserting a catheter through the anterior abdominal wall
PD Catheter placement
Technique for catheter placement varies
Usually done via surgery
Prep for placement includes emptying bladder and bowel
PD pts should not
take baths
when healed shower
I&Os
INT or continous
PD forms
Automated peritoneal dialysis
Continuous ambulatory peritoneal dialysis (CAPD)
Intermittent peritoneal dialysis
3 Phases of PD cycle aka Exchange
Inflow (fill) – insert
Dwell (equilibration) - defusion
Drain
If the pt starts to cramp during PD, then
slow infusion
PD Contraindications
History of multiple abdominal surgeries
Chronic abdominal conditions
Recurrent hernias
Obesity
Pre-existing back problems
Severe chronic obstructive pulmonary disease
Exit site infection
Peritonitis
Hernias
Lower back problems
Bleeding
PD Pulmonary complications
atelectasis
pneumonia
bronchitis
PD loses what electrolyte
protein
Nutrition PD
Vital signs
Daily weights (fluid retainment)
Nutrition
Lab values: K and WBCs
Nursing Interventions HD Fistula
bruit/thrill
neuro assess
post dialysis
V/S
Nursing Interventions CRRT
frequent V/S
fluid assess
Nursing Interventions PD
abdominal girth
monitor outflow
V/S
Pts dialysis needs to have HOB at
30-45 degress
Bruit in Fistula sounds like
Good: hum or buzz like a whoosh drum beat
Bad: no or low sound, change noted, different sound from beat
Thrill in Fistula
feel
Renal Transplants are usually
successful
Renal Transplant is not
a cure
Sources of Kidney donors
Cadaver donors with compatible blood type
Blood relatives
Emotionally related living donors
Altruistic living donors (friends)
Paired organ donation
Transplant Contraindications
Malignancies (advanced cancer)
Refractory/untreated cardiac disease
Chronic respiratory failure
Extensive vascular disease
Chronic infection
Unresolved psychosocial disorders
Complications of Renal Transplants
Rejection
Infection
Immunosuppressants of Kidney Transplants
Adequately suppress the immune response to prevent rejection
Maintaining sufficient immunity to prevent infection
Immunosuppressants in Transplants
Corticosteroids
Calcineurin Inhibitors
Cytotoxic
Clonic antibodies
Mycophenolate (Cellcept)
Tacrolimus (Prograf)
Hyperacute Rejection
no cure
malasise, high fever, tender graft
Acute Rejection
First 6 months after transplant
Reversible
Increase immunosuppressive therapy
Is it normal to have at least 1 acute episode of renal rejection?
yes increase immunosuppressants
Chronic Rejection
Occurs over months or years
Irreversible
–proteinuria
Watch for s/s of infection
Fever/chills
Tachypnea
Tachycardia
Increase/decrease in WBCs indicating leukocytosis or leukopenia
Acite Rejection s/s
polyuria anuria
K and creatiine BUN elevated
retention
Chronic s/s
high BP, temp
