Term
| Symptoms indicating acute urge for dialysis |
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Definition
Encephalopathy
Uncontrolled hyperkalemia
Pericarditis
Pulmonary edema
Increasing acidosis
Medications or toxins |
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Term
| Types of renal replacement therapies |
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Definition
- Hemodialysis (acute, chronic)
- Continuous Renal Replacement Therapy (ICU only)
- Peritoneal Dialysis
- Kidney transplant |
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Term
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Definition
- 2-4 hrs, 3 times a week
- Takes pts blood, filters it through aritifial kidney then filters it back to the body |
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Term
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Definition
- Diffusion: urea, creatinine, K, phosphate move from blood to dialysate, RBC, WBC, plasma stay
- Osmosis: glucose in the dialysate pulls excess fluid from blood
- Ultrafiltration: pressure gradient is created that forces extra fluid into the dialysate |
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Term
| Care of patient on dialysis |
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Definition
- Monitor for hemodynamic instability bc of h2o removed: HR, BP, dizziness, diaphoresis, nausea
- Watch for bleeding from heparin
- Give meds after dialysis
- May want to hold anti HTN before dialysis |
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Term
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Definition
- Surgically attach an artery and vein to allow arterial flow through the vein to provide rapid blood flow necessary for dialysis
- Vein becomes enlarged and tough
- Fistula has to mature for 2-3 months
- Preferred access bc last longest and has least complications |
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Term
| Precautions with AV fistula |
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Definition
- It's a supervein that protrudes through the arm, listen for bruits and feel for thrills (if you don't hear them something is wrong)
- No blood pressure or sticks on the arm
- Can last for years if not compromised |
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Term
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Definition
- Synthetic self-sealing graft that connects the artery and the vein
- Should be used for pts with poor vessels (diabetics, IV drug abuse)
- Needs to heal for 2-3 weeks before use
- Higher rate of clotting off and infection but easier for MD to put in |
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Term
| Care of pt with AV fistula or graft |
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Definition
- No BP or venipuncture in affected arm
- Palpate for thrill, auscultate for bruit
- Monitor circulation distal to graft
- Monitor for aneurysm
- Pt may have multiple old non-functioning grafts, clarify accessible one |
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Term
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Definition
- Special large-volume high flow catheters
- Use for temporary acute dialysis or if pt isn't candidate for AV graft or shunt
- DON'T FLUSH
- Monitor site closely for infection
- Only dialysis nurse should access it |
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Term
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Definition
- Uses peritoneum as semipermeable membrane and caps as blood supply
- Used by 10% of pts
- Put in dialysate, dwell for 4-6 hrs, then drain
- 4-5 times a day, last one at bedtime for overnight dwell |
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Term
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Definition
| Hook up to cycler at night and it will automatically run 4+ exchanges during the night |
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Term
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Definition
- Patient or family can do it but need a doctor order
- Major concern: peritonitis=risk for infection
- Monitor catheter exit site for infection |
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Term
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Definition
- Continuous process: more similar to actual renal clearance of waste
- No machinery required
- Slower exchange, less likely to become hemodynamically unstable
- Allows more freedom re diet as dialysis is continuous
- Allows more freedom (travel) as you don't need a dialysis center and machine |
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Term
| Complications of transplantation |
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Definition
- Hyperacute rejection: immediate post op, need to remove kidney
- Acute rejection: days to months, can be reversible with strong immunosuppresant, not unusual
- Chronic rejection: months to years, usually irreversible
- Infection due to immunosuppression
- CV disease: increased BP
- Cancers from immunosuppression
- Corticosteroid related symptoms |
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