Renal Replacement Therapy (RRT)

Question 1

Renal Replacement Therapy : ?

Answer 1

These therapies take over or replace the kidney function

Question 2

When Is Renal Replacement Therapy started ?

Answer 2

• When BUN & Creatinine levels can’t be decreased
• FVE is compromising the heart and lungs
• Hyperkalemia and metabolic acidosis can’t be treated successfully

Question 3

In Hemodialysis what is the machine ?

Answer 3

The machine is the glomerulus (filter)

Question 4

How often is Hemodialysis done ?

Answer 4

Done 3-4x per week

so, the client has to watch what they eat and drink between treatments

Question 5

Why are clients on Hemodialysis given anticoagulants during therapy ?

Answer 5

to prevent blood clots from forming

Anticoagulant is usually Heparin (implement bleeding precautions)

Question 6

Before Hemodialysis begins, what do you want to assess for ?

Answer 6

Assess fluid status

Question 7

What is watched constantly during Hemodialysis ?

Answer 7

Electrolytes & Blood pressure

Question 8

Can all clients tolerate Hemodialysis ?

Answer 8

No

Question 9

What clients can’t tolerate Hemodialysis ?

Answer 9

Unstable cardiovascular system CAN’T tolerate hemodialysis

Question 10

Clients getting Hemodialysis must have what ?

Answer 10

Vascular access

Question 11

What Is happening with Hemodialysis ?

Answer 11

Blood is being removed, cleansed, and then returned at a rate of 300 to 800 mL/min

Question 12

What is a Vascular access ?

Answer 12

A site where they have access to a Large blood vessel because very rapid blood flow is essential for Hemodialysis

Question 13

What are types of Access ?

Answer 13

• AVF (arteriovenous fistula)

- AVG (arteriovenous graft)

Question 14

What is an AVG (arteriovenous graft) ?

Answer 14

A synthetic graft to join the vessels

Question 15

where is an AVF (arteriovenous fistula) located ?

Answer 15

In the forearm with an anastomosis between an artery and a vein

Question 16

What do both vascular accesses (AVF & AVG) require for placement ?

Answer 16

Both require surgery

Question 17

The vascular accesses sites take how long to be ready for repeated venipunctureus ?

Answer 17

The access site takes weeks to mature & be ready for repeated venipunctures

Question 18

During dialysis how many needles are inserted into the vascular space ?

Answer 18

two needles

Question 19

Why are two needles needed with hemodialysis ?

Answer 19

• One needle will allow blood to be pulled from the circulation and sent to the hemodialysis machine
• The other needle is used to return the filtered blood to the client’s circulation

Question 20

With Hemodialysis, the _________ end of the access will remove the blood and the return is through the low pressure ___________ end ?

Answer 20

• Arterial

- Venous

Question 21

With Hemodialysis, what locations are used for temporary access ?

Answer 21

The internal jugular or Femoral vein is often used for catheter placement

Question 22

Is Surgery required for temporary vascular access ?

Answer 22

No

Question 23

You do not use a client’s vascular access for what ?

Answer 23

For IV access (drawing blood, administering medications, etc)

Question 24

When a client has an alternative vascular access, what Is the associated nursing care for that extremity ?

Answer 24

• No blood pressure
• No needle sticks
• No constriction on that arm at ALL (no watch, purse, etc)

Question 25

What do you assess an access device ?

Answer 25

• To ensure patency

Question 26

How do you assess a vascular access device ?

Answer 26

• Thrill (palpate)
• Bruit (ascultate) –> turbulent blood flow

*Feel the Thrill, hear the Bruit