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NUR 201 Week 8 > Transplantation & Renal Replacement Therapies > Flashcards

Transplantation & Renal Replacement Therapies Flashcards

1
Q
  • Life-sustaining treatment for ESRD
  • Clients w/med problems that inc risks are disqualified
  • Age <2, >70 (assessed case by case)
  • Active, adv, metastatic or untreatable cancer
A
  • Uncorrectable cardiac dz
  • Severe psychosocial problems (chem depend)
  • Chronic infections (HIV, hep C)
  • Coagulopathies & some immune d/o’s
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2
Q
  • Donors - may be living (related or unrelated)
  • Non-heart beating
  • Cadaver
  • Improved immuno-suppressants have inc’d graft survival in the US to ~95%
A

! Organs from living RELATED donors have the highest rate of success; 90%

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3
Q

Preop/Postop Care

  • Routine preop & postop care w/the add’n of mental & emotional needs, compliance, r/t lifelong immunosuppression therapies
  • Postop rx’s incl immunosuppressant rx therapies
A
  • Close attn to urine output, s/s infection
  • Monitor for REJECTION
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4
Q

Rejection - Hyperacute

  • Occurs within 48 hrs >surg with s/s of
    > Fever, HTN
    > Pain @ the transplant site
    > Treatment is immediate removal of the donor kidney
A
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5
Q

Rejection - ?

  • Occurs within 1 week to 2 years >surgery
    ! This is reversible !

S/S
> Oliguria, anuria, low-grade fever, HTN, tenderness over transplanted kidney, lethargy, azotemia, & fluid retention

Treatment: involves increased doses of immunosuppressive drugs

A

Acute

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6
Q

Rejection - ?

  • Occurs gradually over months to yrs

S/S
> Gradual return of azotemia, fluid retention, electrolyte imbalances, & fatigue

Treatment: conservative until dialysis is required

A

Chronic

  • This just bought the pt addl time for improved quality of life
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7
Q

Other complications

  • Acute tubular necrosis (ATN)
  • Renal artery stenosis
  • Thrombosis
  • Infection
A

Key Points

  • Life-sustaining treatment for ESRD (NOT a cure)
  • Candidate selection criteria
  • Donors
  • Preoperative care
  • Immunologic studies
  • Surgical team
  • Operative procedure
  • Postop care
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8
Q
A
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9
Q

?

Is the movement of fluid/molecules across a semipermeable membrane from 1 compartment to another

Used to correct fluid/electrolyte imbalances & to remove waste products in renal failure

Treat drug overdoses

A

Dialysis

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10
Q

2 methods of dialysis are available

  1. Peritoneal dialysis (PD)
A
  1. Hemodialysis (HD)
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11
Q
  • Begun when pt’s uremia can no longer be adequately managed conservatively
  • Initiated when GFR (or CC) is <15 mL/min
A
  • ESKD treated w/dialysis b/c
    > There is a lack of donated organs

> Some pts are physically or mentally unsuitable for transplantation

> Some pts do not want transplants

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12
Q

Diffusion

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

> Substances of low molecular weight can pass from the dialysate into a pt’s blood, & so the purity of the water used for dialysis is monitored & controlled

A

Osmosis

  • Movement of fluid from an area of lesser concentration of solutes to an area of greater concentration
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13
Q

Ultrafiltration

  • Water & fluid removal
  • Results when there is an osmotic gradient across the membrane
A
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14
Q

Peritoneal Dialysis

  • Peritoneal access is obtained by inserting a catheter through the anterior abdominal wall
  • Technique for catheter placement varies
  • Usually done via surgery
A
  • After catheter inserted, skin is cleaned w/antiseptic solution & sterile dressing applied
  • Connected to sterile tubing system
  • Secured to abdomen w/tape
  • Catheter irrigated immediately
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15
Q
  • After initial insertion of PD catheter, ideally, there’s a 7-14 day waiting period for use
  • 2-4 wks >implantation, exit site should be clean, dry, free of redness/tenderness
A
  • Once site is healed, pt may shower & pat dry
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16
Q

Dialysis Solutions & Cycles

  • Available in 1- or 2-L plastic bags w/glucose concentrations of 1.5%, 2.5%, & 4.25%
  • Electrolyte composition similar to that of plasma
A
  • Solution warmed to body temperature
17
Q

3 phases of PD cycle

  1. Inflow
  2. Dwell
  3. Drain/Outflow

1 cycle is called an exchange

A
18
Q

?

Is the prescribed amt of sol’n infused through established catheter over ~10 min

After sol’n infused, inflow clamp closed to prevent air from entering tubing

A

Inflow

19
Q

?

Also known as equilibration

Diffusion & osmosis occur between pt’s blood & peritoneal cavity

Duration of time varies, depending on method

A

Dwell

20
Q

?

Lasts 15-30 minutes

May be facilitated by gently massaging abdomen or changing position

A

Drain

21
Q

What is the most effective osmotic agent currently available?

A

Glucose

! Dextrose remains most commonly used osmotic agent avail in PD sol’ns

22
Q

Automated Peritoneal Dialysis - APD

  • Cycler delivers the dialysate
  • Times & controls fill, dwell, & drain
    > Most popular (lets pts accomplish dialysis while they sleep)
A

Continuous ambulatory peritoneal dialysis (CAPD)

  • Manual exchange w/1.5-3L of peritoneal dialysate @ least 4x/day w/dwell times avg 4 hrs
23
Q

PD - Complications

! Exit site infection (from S. aureus or S. epidermis)

! Peritonitis (d/t improper technique in making or breaking connections for exchanges)

! Hernias (b/c inc intraabdominal pressure 2nd to dialysate infusion)

A

! Aggravate lower back problems

! Bleeding [intraperitoneal]

! Pulmonary complications [atelectasis, pneumonia, bronchitis]

! Protein loss (~0.5 g/L of dialysate drainage but as high as 10-20 g/day)

24
Q

Peritonitis - Manifestations

> Cloudy dialysate outflow (effluent) [is the earliest indication]
Fever, abd tenderness/pain
Gen malaise, N/V

A
  • Send a specimen out for C&S, Gram stain, & cell count to ID

Pain during the inflow of dialysate is common when pts 1st started on PD therapy (warm bags)

25
Q

PD - Effectiveness & Adaptation

  • Short training program
  • Independence
  • Ease of traveling
  • Fewer dietary restrictions
  • Greater mobility than w/HD
A
26
Q

Hemodialysis - Dialyzers

  • Long plastic cartridges that contain thousands of parallel hollow tubes or fibers
  • Fibers are semipermeable membranes
A
  • 2 needles placed in fistula or graft
  • 1 needle is placed to pull blood from the circulation to the HD machine
  • The other needle is used to return the dialyzed blood to the pt

> Heparin is added to the blood as it flows into the dialyzer b/c any time blood contacts a foreign substance, it has a tendency to clot

27
Q

HD - Procedure

  • Dialyzer/blood lines primed w/saline sol’n to eliminate air
  • Terminated by flushing dialyzer w/saline to remove all blood
  • Needles removed & firm pressure applied
A
  • Before treatment, RN should complete assessment of fluid status, cond of access, temp, & skin cond
  • During treatment, RN should be alert to changes in cond & measure VS every 30-60 min
28
Q

HD - Post Dialysis Care

  • Hypotension (d/t hypovolemia, dec CO, & dec SVR)
  • Muscle cramps
  • N/V, HA, dizziness
  • Loss of blood
  • Hepatitis
A
  • Dialysis Disequilibrium Syndrome (mild to moderate)
  • Cardiac events > cardiac arrest
29
Q

HD - Effectiveness & Adaptation

  • Cannot fully replace normal functions of kidneys
  • Can ease many of the symptoms
  • Can prevent certain complications
A

Dialyzable Drugs

  • Aminoglycosides, anti-TB, antiviral, antifungal, anticonvulsants, cephalosporins, penicillins, misc
30
Q

HD - Vascular Access Sites

  • Obtaining vascular access is 1 of the most difficult problems
A
  • Arteriovenous (AV) fistulas & grafts
  • Temporary vascular access
31
Q
  • Normally, a thrill can be felt by palpating the area of anastomosis, & a bruit (rushing sound) can be heard w/a stethoscope (bruit & thrill are created by arterial blood moving @ a high velocity through vein)

Vascular Access Catheter

A

Caring for the Pt w/an AV Fistula or AV Graft

32
Q

Vascular Access Complications

  • Thrombosis, stenosis
  • Infection
  • Aneurysm formation
  • Ischemia
A

HF (b/c shunting of blood directly from arterial system to venous system through a fistula can cause HF in pts w/limited cardiac function)

NUR 201 Week 8 (5 decks)

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