Dialysis
What is usually in dialysate?
-bicarbonate -calcium -sodium -chloride -bacteria
What are nursing care considerations with dialysis?
-daily weight -BMP results + trends -patients diet -patients access -scheduling
What are s/sx of peritonitis?
-fever -diarrhea -vomiting ** most common
What is the purpose of dialysis?
-function as our kidneys -fluid balance -electrolyte balance -waste removal: creatinine, BUN, metoprolol overdose
What are the cons of peritoneal dialysis?
-glucose: hyperglycemia + hypertriglycerides -site infection -peritonitis: peritoneal cavity is infected -hernia -pain -bleeding -pulmonary complications: increase fluid in peritoneal cavity = pressure on diaphragm = atelectasis -protein loss
How does hemodialysis work?
-pulls small amounts of pt blood into a dialyzer -filters blood -dialyzer is a membrane -waste is removed + purified blood returned back into body -heparin in the machine to prevent clots
What are the pros of peritoneal dialysis?
-requires less special equipment -more patient freedom r/t not having to go in to get dialysis
How does peritoneal dialysis work?
1. in: from dialysis bag into peritoneal cavity 2. dwell: mix with patients blood through a permanent catheter 3. out: out of peritoneal cavity into dialysis bag
What medication helps with anemia?
Aranesp
Is an anastomosis between an artery and vein, allowing arterial blood to flow through the vein.
Arteriovenous fistula
Is a 'bridge' between the arterial and venous blood supplies, made of synthetic materials.
Arteriovenous graft
What medication reduces dyslipidemia?
Atorvastatin
What medication helps with hypertension in diabetic patients?
Benzapril + losartan
How does dialysis work?
Dialysate fluid moves across a semipermeable membrane by osmosis to replenish blood with electrolytes the body needs at that time and remove waste products
What medication helps with pruritus?
Diphenhydramine
What type of catheter is used with hemodialysis?
HD catheter -can only be used for hemodialysis -high infection rate -large bore = risk for bleeding at site
Is a 'bridge' that bypasses the venous system to provide flow directly to the heart.
HeRo graft
A common complication is hypotension related to rapid removal of vascular volume.
Hemodialysis
The dialysate stays in a container and bathes the outside of the fibers of the dialyzers.
Hemodialysis
The dialysis is performed through double lumen catheters or two large bore needles.
Hemodialysis
The dialysis solutions vary, but usually uses dextrose solution.
Hemodialysis
The difference between the last post-dialysis weight and the present pre-dialysis weight determines the volume of fluid to be removed.
Hemodialysis
What medication reduces hyperkalemia?
IV insulin in glucose
What medication helps with constipation?
Lactulose
What medication helps with edema of the feet and hands?
Lasix
The catheter used for dialysis has one or two cuffs, placed surgically, and may be used immediately after placement.
Peritoneal dialysis
The dialysis happens in 3 phases: inflow, dwell, and drain.
Peritoneal dialysis
The most common complication is infection caused by skin flora.
Peritoneal dialysis
What is peritoneal dialysis?
Peritoneal membrane is a substitute for the kidneys -waste products move across membranes from blood into fluid by osmosis which is then drained back into a bag
What type of catheter is used with peritoneal dialysis?
Permanent catheter
What is continuous renal replacement therapy?
Similar to hemodialysis -pulls smaller volume of blood over 24 hr to mimic actions of the kidneys
What is dialysis?
The movement of fluid and molecules across a semipermeable membrane from one compartment to another
What should you monitor every 30 minutes during dialysis?
Vitals -hypotension is common
When is continuous renal replacement therapy done?
When patients are too sick to have hemodialysis done ex. flu season: hemodialysis patient has to be admitted to have CRRT until flu season is over
What medication helps with renal osteodystrophy?
calcitriol