T6: Dialysis Flashcards
dialysis
a procedure to remove waste products from the blood of patients whose kidneys no longer function
when is dialysis initiated
when GFR is <15
Why is ESRD treated with dialysis?
-There is a lack of donated organs
-Some patients are physically or mentally unsuitable for transplantation
-Some patients do not want transplants
diffusion
Movement of solutes from an area of greater concentration to an area of lesser concentration
osmosis
Movement of fluid from an area of lesser concentration of solutes to area of greater concentration
Ultrafiltration
-Water and fluid removal
-Results when there is an osmotic gradient or pressure gradient across membrane
-Excess fluid moves into dialysate
Hemodialysis: Vascular Access Sites
-Arteriovenous fistulas and grafts
-Temporary vascular access
what do we assess for with an AV fistula
bruit (rushing sound) and thrill (buzzing sensation)
what is part of the assessment for a fistula
-cap refill
-check not numbness and tingling
-bruit and thrill
Arteriovenous fistula created by
anastomosing an artery and vein.
HeRO Graft (Hemodialysis Reliable Outflow
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.
dialyzers
§Plastic cartridge that contain thousands of parallel hollow tubes or fibers
§Fibers are semipermeable membranes
procedure for hemodialysis: needles
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
what is used to prevent clotting in hemodialysis
heparin
what levels do we need to watch when giving heparin
PTT
what information must the nurse have before giving dialysis
*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.
hemodialysis procedure: termination
-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
during treatment take VS every
30-60 minutes
Hemodialysis: Complications/Effectiveness
-Hypotension
-Muscle cramps
-Loss of blood
-Hepatitis
-Cannot fully replace normal functions of kidneys
-Can ease many of symptoms
-Can prevent certain complications
Epogen
may be given for anemia in pateints with dialysis
HINT HINT what type of dialysis do we use for AKI
Continual Renal Replacement Therapy (CRRT)
HINT HINT Continual Renal Replacement Therapy (CRRT)
-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
Continual Renal Replacement Therapy (CRRT) contraindications
contraindicated if a patient has life-threatening manifestations of uremia (hyperkalemia, pericarditis) that require rapid treatment.
infusion of replacement fluid in Continual Renal Replacement Therapy (CRRT) is determined by
-degree of fluid and electrolyte imbalance
CRRT versus HD
-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
Ultrafiltrate should be
clear yellow
§Specific nursing interventions
-Obtain weights
-Monitor and document laboratory values daily
-Assess hourly
-Intake and output
-Vital signs
-Hemodynamic status
-Care for site to prevent infection
Wearable Artificial Kidney (WAK)
*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.
