T6: Dialysis

Question 1

dialysis

Answer 1

a procedure to remove waste products from the blood of patients whose kidneys no longer function

Question 2

when is dialysis initiated

Answer 2

when GFR is <15

Question 3

Why is ESRD treated with dialysis?

Answer 3

-There is a lack of donated organs
-Some patients are physically or mentally unsuitable for transplantation
-Some patients do not want transplants

Question 4

diffusion

Answer 4

Movement of solutes from an area of greater concentration to an area of lesser concentration

Question 5

osmosis

Answer 5

Movement of fluid from an area of lesser concentration of solutes to area of greater concentration

Question 6

Ultrafiltration

Answer 6

-Water and fluid removal
-Results when there is an osmotic gradient or pressure gradient across membrane
-Excess fluid moves into dialysate

Question 7

Hemodialysis: Vascular Access Sites

Answer 7

-Arteriovenous fistulas and grafts
-Temporary vascular access

Question 8

what do we assess for with an AV fistula

Answer 8

bruit (rushing sound) and thrill (buzzing sensation)

Question 9

what is part of the assessment for a fistula

Answer 9

-cap refill
-check not numbness and tingling
-bruit and thrill

Question 10

Arteriovenous fistula created by

Answer 10

anastomosing an artery and vein.

Question 11

HeRO Graft (Hemodialysis Reliable Outflow

Answer 11

special bridge access that is used when other access options are exhausted
-bypasses the venous system to provide blood flow directly from a target artery to the heart.

Question 12

dialyzers

Answer 12

§Plastic cartridge that contain thousands of parallel hollow tubes or fibers
§Fibers are semipermeable membranes

Question 13

procedure for hemodialysis: needles

Answer 13

Two needles placed in fistula or graft:
-One needle is placed to pull blood from circulation to HD machine
-Other needle is used to return dialyzed blood to the patient

Question 14

what is used to prevent clotting in hemodialysis

Answer 14

heparin

Question 15

what levels do we need to watch when giving heparin

Answer 15

PTT

Question 16

what information must the nurse have before giving dialysis

Answer 16

*assess fluid status (weight, BP, peripheral edema, lung and heart sounds), condition of vascular access, and temperature.
*The difference between the last postdialysis weight and the present predialysis weight determines the ultrafiltration or the amount of weight (from fluid) to be removed.

Question 17

hemodialysis procedure: termination

Answer 17

-Dialyzer/blood lines primed with saline solution to eliminate air
-Terminated by flushing with saline to return all blood to patient
-Needles removed and firm pressure applied

Question 18

during treatment take VS every

Answer 18

30-60 minutes

Question 19

Hemodialysis: Complications/Effectiveness

Answer 19

-Hypotension
-Muscle cramps
-Loss of blood
-Hepatitis
-Cannot fully replace normal functions of kidneys
-Can ease many of symptoms
-Can prevent certain complications

Question 20

Epogen

Answer 20

may be given for anemia in pateints with dialysis

Question 21

HINT HINT what type of dialysis do we use for AKI

Answer 21

Continual Renal Replacement Therapy (CRRT)

Question 22

HINT HINT Continual Renal Replacement Therapy (CRRT)

Answer 22

-Means by which uremic toxins and fluids are removed
-Acid-base status/electrolyte are adjusted slowly and continuously (24 hours)
-Can be used in conjunction with HD

Question 23

Continual Renal Replacement Therapy (CRRT) contraindications

Answer 23

contraindicated if a patient has life-threatening manifestations of uremia (hyperkalemia, pericarditis) that require rapid treatment.

Question 24

infusion of replacement fluid in Continual Renal Replacement Therapy (CRRT) is determined by

Answer 24

-degree of fluid and electrolyte imbalance

Question 25

CRRT versus HD

Answer 25

-Continuous rather than intermittent
-Fluid volume can be removed over days versus hours
-Solute removal by convection (no dialysate required) in addition to osmosis and diffusion
-Less hemodynamic instability
-Does not require constant monitoring by HD nurse
-Does not require complicated HD equipment

Question 26

Ultrafiltrate should be

Answer 26

clear yellow

Question 27

§Specific nursing interventions

Answer 27

-Obtain weights
-Monitor and document laboratory values daily
-Assess hourly
-Intake and output
-Vital signs
-Hemodynamic status
-Care for site to prevent infection

Question 28

Wearable Artificial Kidney (WAK)

Answer 28

*dialysis machine that can be worn on the body. The carrier resembles a tool belt. The device connects to a patient via a catheter. Like conventional dialysis machines, it is designed to filter the blood of ESRD patients.