ch 47 Dialysis
A nurse is attending to a post-renal transplant patient. The nurse finds that the patient's urine output is very high. What are the reasons for this diuresis? Select all that apply. Correct 1 Initial renal tubular dysfunction 2 Rejection of the transplanted kidney Correct 3 The abundance of fluids administered 4 High blood sugar levels of the patient Correct 5 The new kidney's ability to filter blood urea nitrogen (BUN)
Diuresis is common after transplantation of the kidneys. The new kidney has an improved ability to filter BUN, which acts as an osmotic diuretic, thus increasing urine output. The fluids given during the surgery may also cause an increase in urine output. Initial renal tubular dysfunction may inhibit the kidney from concentrating the urine normally, which may also lead to increased urine output. Rejection of the kidney leads to decreased or no urine output. High blood sugar levels may increase the urine output, but not drastically.
A nurse is caring for a patient with chronic renal failure who is on peritoneal dialysis. During the exchange, more than 45 minutes have passed, but the dialysate has not drained completely. Which nursing interventions would be appropriate to facilitate drainage? Select all that apply. Correct 1 Give an abdominal massage. Correct 2 Turn the patient from side to side. 3 Promote deep breathing and coughing. 4 Give the patient a glass of water to drink. 5 Periodically rotate and reposition the catheter.
Drainage of the dialysate fluid can be facilitated by abdominal massage and turning the patient from side to side. These activities will change the position of the catheter, thereby freeing the drainage holes, which may be obstructed. Intake of fluids may prevent dehydration; however, this has no effect on the drainage of dialysate from the peritoneal cavity. Deep breathing and coughing are advised to promote pulmonary ventilation; however, these activities do not have any effect on the process of peritoneal dialysis. The position of the catheter should be changed by the practitioner, if needed.
The nurse is attending to a patient who is undergoing peritoneal dialysis. The nurse assesses the patient is developing symptoms of respiratory distress. What nursing interventions are necessary to prevent further respiratory complications? Select all that apply. Correct 1 Elevate the head of the bed. Correct 2 Frequently reposition the patient. Correct 3 Promote deep-breathing exercises. 4 Place the patient in a low Fowler's position. 5 Increase the rate of infusion of the dialysate.
Elevating the head of the bed can prevent further complications and ease breathing. Decreased areas of ventilation suggest the presence of atelectasis, whereas adventitious sounds may suggest fluid overload, retained secretions, or infection. Frequent positioning will promote equal ventilation to all parts of the lungs. Deep-breathing exercises could help to promote proper expansion of lungs. Rapid infusion would cause more pressure on the diaphragm. The patient should be placed in the semi-Fowler's position for peritoneal dialysis; this allows inflow of fluid while not impinging on the thoracic cavity.
A patient undergoing hemodialysis reports stomach pain to the nurse. Which treatment strategy does the nurse expect to be beneficial to the patient? Select all that apply. Correct 1 Infusion of mannitol solution 2 Infusion of high-dose heparin 3 Infusion of sodium bicarbonate Correct 4 Infusion of normal saline solution 5 Infusion of hypertonic saline solution
Hemodialysis is associated with abdominal muscle cramps. This is caused due to hypovolemia, hypotension, and a high ultrafiltration rate. Therefore the administration of mannitol and normal saline will increase the fluid volume and relieve pain. A high dose of heparin will inhibit clotting and may cause bleeding, leading to hemorrhage. Sodium carbonate and hypertonic saline solution may aggravate the patient's condition.
A patient has end-stage kidney disease and is receiving hemodialysis. During dialysis the patient complains of nausea and a headache and appears confused. On examination, the nurse finds that the blood pressure is very low. What is the priority action by the nurse? Select all that apply. 1 Avoid excess coagulation. Correct 2 Infuse 0.9% saline solution. 3 Transfuse blood, as ordered. 4 Infuse hypertonic glucose solution. Correct 5 Decrease the volume of fluids being removed.
Hypotension is a complication of hemodialysis and may manifest as headache and nausea. The nurse should try to keep the intravascular volume adequate by decreasing the volume of fluids being removed and infusing 0.9% saline solution. Hypertonic glucose solutions are infused if the patient gets muscle cramps. Excess coagulation is avoided if the patient has blood loss. Blood is transfused if the patient has blood loss.
A patient with end-stage kidney disease is to begin continuous ambulatory peritoneal dialysis (CAPD). What are the preparations to be done by the nurse before starting the catheter insertion for this patient? Select all that apply. Correct 1 Note the patient's weight. Correct 2 Obtain a signed consent form. Correct 3 Ask patient to empty the bladder and bowel. 4 Monitor for abnormal cardiac signs and symptoms. 5 Monitor for abnormal respiratory signs and symptoms.
Preparation of the patient for catheter insertion includes emptying the bladder and bowel, weighing the patient, and obtaining a signed consent form. The bladder should be emptied to prevent accidental puncture of the bladder by the needle. Weighing the patient before and after the procedure is important to determine the effectiveness of dialysis. Because it is an invasive procedure, the nurse should explain about the risks and benefits, and informed consent should be obtained. Other factors are not contraindications for CAPD. Monitoring of cardiac and respiratory signs is essential but does not directly affect the procedure.
The nurse is attending to a patient who is receiving hemodialysis for chronic kidney disease. For which complications should the nurse be observant in the patient? Select all that apply. Correct 1 Hypotension 2 Renal calculi Correct 3 Muscle cramps Correct 4 Hepatitis type B 5 Bladder infection
The patient on hemodialysis may have decreased blood pressure due to rapid removal of blood. Hepatitis type B is a blood-borne infection, and hemodialysis poses a high risk for transmission of hepatitis B. Muscle cramps are a common complication of hemodialysis. Factors associated with the development of muscle cramps in hemodialysis include hypotension, hypovolemia, a high ultrafiltration rate (large interdialytic weight gain), and low-sodium dialysis solution. Hemodialysis does not increase the risk of development of renal calculi; people who are on bed rest or have low urine output may be at risk. Bladder infection is not related to dialysis.
A patient with chronic kidney disease is prescribed regular peritoneal dialysis (PD). What should the nurse inform the patient while teaching about PD? 1 Avoid high-protein diets. Correct2 Take potassium supplements. 3 Avoid powdered breakfast drinks. 4 Restrict fluid intake, as in hemodialysis.
The patient undergoing regular peritoneal dialysis (PD) does not need to restrict potassium intake; instead, this patient may be prescribed oral potassium supplementation because of hypokalemia caused by dialysis. The patient need not restrict protein or fluid intake. The patient should include enough protein in the diet to compensate for loss of protein in dialysate. The patient may even take liquid or powdered breakfast drinks in case of inadequate protein intake. Patients on hemodialysis have a more restricted fluid intake than patients receiving peritoneal dialysis (PD).
A patient with chronic kidney disease is on hemodialysis. What should the nurse teach the patient and his or her caregiver? Select all that apply. 1 Avoid cheese, yogurt, and pudding. 2 Ensure interdialytic weight gain is not more than 5 kg. Correct 3 Include gelatin and ice cream as part of the fluid intake. Correct 4 Space out the amount of fluid intake throughout the day. Correct 5 Avoid frequent use of nonsteroidal antiinflammatories (NSAIDS) such as ibuprofen.
The patient with chronic kidney disease on hemodialysis should space his or her limited fluid allotment throughout the day. Foods that are liquid at room temperature, such as gelatin and ice cream, should be included in the total fluid intake. The patient should avoid frequent use of NSAIDS because they can cause further damage to the kidneys. If NSAIDS are taken as prescribed for short periods, they are usually considered safe. Patients do not need to avoid cheese, yogurt, or pudding unless their kidney disease progresses into end-stage kidney disease. Patients are advised to limit fluid intake so that interdialytic weight gain is no more than 1 to 3 kg.
The nurse is attending to a patient who has received a kidney transplant. What parameters would indicate a successful transplant? Select all that apply. Correct 1 High blood pressure is corrected. Correct 2 Blood sodium levels are decreased. 3 Serum potassium levels are elevated. 4 The specific gravity of urine increases. Correct 5 Serum creatinine levels are decreased.
The patient with end-stage kidney disease may have hypertension due to fluid retention; the hypertension is corrected after a successful transplant through adequate urine output. The serum creatinine levels decrease as the transplanted kidney starts eliminating the nitrogenous wastes. After the transplant, the sodium levels should be corrected as the fluid balance returns to normal. As more urine is produced by the transplanted kidney, the specific gravity and concentration of the urine will decrease. Following a transplant, the serum potassium levels are corrected as fluid balance is restored.
