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Nephrology > RRT > Flashcards

RRT Flashcards

1
Q

what eGFR to start predialysis counselling

A

30

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2
Q

what eGFR to consider transplant

A

<=15

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3
Q

types of transplant donor

A

living or deceased

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4
Q

CIs to transplant (4)

A 
high BMI
heart problems
warfarin/DOACs
cancer
poor compliance with appointments/meds
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5
Q

what risk important risk is there after transplant and why?

A

MALIGNANT MELANOMA due to immunosuppressants. must wear sunscrean (prescribed) and cover in the sun
(can also get other Ca bc of immunosuppressants)

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6
Q

what scan is needed before going on transplant list

A

myocardial perfusion scan (myoview) - identifies areas of myocardium where ischaemia is inducible under stress

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7
Q

average lif expectancy after starting dialysis

A

4 yr

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8
Q

how much fluid goes into peritoneal cavity in peritoneal dialysis

A

2-2.5 L (fluid is prescribed)

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9
Q

how many times a day do pts need to dialyse in PD

A

3-4, each 30 mins. can also use automatic machine that does it at night

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10
Q

other things to know about PD

A

a home, tube always in situ, machine is portable

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11
Q

risk in PD

A

PERITONITIS!!!

must have v clean room for it, great handwashing. if tube touches bed with cap off need to have IV abx

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12
Q

CIs PD

A 
weight
previous abdo surgery
stomas
ostomies
social - unclean house
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13
Q

symptoms which mean dialysis should be considered

A 
fluid overload incl SOB sx
vomiting
itching
fatigue
ALL OF THESE ARE V COMMON Sx - remember them!!
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14
Q

electrolyte imbalances which mean pt may need to start on dialysis

A

urea
ca
k

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15
Q

dietary restrictions in both types of dialysis

A

PD - fewer restrictions and can pee so can drink more fluid (benefit to many pts)
HD - 1L fluid, watch K, phosphate (and salt!)

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16
Q

average wait for transplant

A

3.5 yr

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17
Q

how long between making fistula and using it

A

1 year

18
Q

how long for haemo

A

3.5 hr 3 times a week

19
Q

what line is an alternative to a fistula

A

tunnel line (not as god bc infection risk). uideally they are temporary

20
Q

which dialysis slows down kidney decline

A

pd

21
Q

do pts pass urine in dialysis

A

PD - yes, HD, no

22
Q

sx after dialysis

A

cramps, BP drops, hungry, sweaty, fatigue, dizzy, headache, fluid overload, tremor, confused

23
Q

what can HD cause

A

heart failure?

24
Q

if don’t want transplant or dialysis

A 
conservative care (resond to sx tha concern pt)
there is actually no evidence that >74 yo are better to have idlaysis than conservative care
25
Q

food with K in

A 
rhubarb
banana
tomatoes (including tinned!!! no curry or spag bowl!!)
mushrooms
jacket potatoes
beer
26
Q

food with phoshate in

A

dairy
eggs
shellfish

27
Q

what does dialysis remove

A 
fluid
ca
urea
k
cr
phosphate
28
Q

why must phosphate be managed

A

low -> bone problems, high -> cardiac problems. if kidney failure, phosphate is not excreted -? HYPERphosphataemia

29
Q

how to manage hyperphosphataemia

A

dialysis
phosphate binders
diet

30
Q

nb phos and ca don’t cause acute problems

A

just chronic ones

31
Q

what does peritoneal fluid contain

A

dextrose
electrolytes (mg cl k na ca)
lactate
bicarb

32
Q

sx peritonitis (EMERGENCY!!)

A

cloudy fluid
abdo pain + tenderness
gnerally unwell
increased temp

33
Q

abx for peritonitis

A

vancomycin

34
Q

why is fistula/tunnel line important

A

IT IS THEIR LIFELINE (don’t use for general access unless it is an emergency)

35
Q

where does a tunnel line sit

A

R atrium

36
Q

what weekly IM injection is needed in ESRD

A

erythropoetin

37
Q

other drugs that pts might need

A 
activated vit d
IV irons (cannot give oral bc already constipated from low fibre diet)
38
Q

acute reasons to dialyse (6)

A
  • refractory hyperkalemia
  • volume overload
  • intractable acidosis
  • uraemic encephalopathy
  • pericarditis, or pleuritis;
  • removal of certain toxins
39
Q

complications HD

A
  • hypovol -> hypotension, camps, nausea, headache, chest pain, fever, rigors
  • infection at access point
40
Q

complications PD

A
  • peritonitis
  • herniation of abdo wall
  • infection at access point
41
Q

sx transplant rejection

A

PAIN / Sx of kidney failure

42
Q

transplant inmmunosuppressant

A

tacrolimus!! - calcineurin inhibitor

Nephrology (5 decks)

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