Term
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Definition
movement of fluid and molecules across a semipermeable membrane from one compartment to another
technique in which substances move from the blood through a semipermeable membrane and into a dialysis solution |
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Term
| why is dialysis important? |
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Definition
| It can correct fluid and electrolyte imbalances, remove waste, and treat drug overdoses |
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Term
| what kind of membrane is used in hemodialysis? |
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Definition
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Term
| what kind of membrane is used in periotoneal dialysis? |
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Definition
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Term
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Definition
| patients that can no longer be managed conservatively or when acute patients have complications (ex. hyperkalemia, etc) |
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Term
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Definition
| diffusion, osmosis, and ultrafiltration |
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Term
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Definition
| movement of solutes to an area of lesser concentration |
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Term
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Definition
| movement of fluids to an area that is more concentrated with solutes |
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Term
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Definition
| pressure gradient is created to move fluids across the membrane |
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Term
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Definition
the peritoneum is used as a semipermeable membrane for dialysis.
catheter is inserted into the abd wall and into the peritoneal cavity
dacron cuffs @ subcut tissue & peritoneal anchors=anchors and prevent bacteria from migrating |
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Term
| how is peritoneal dialysis inserted? |
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Definition
| surgically or laparoscopically |
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Term
| Who is a good candidate for peritoneal dialysis? |
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Definition
*hemodynamically unstable
*cant tolerate systemic anticoagulation
*lack vascular access (inadequate vessels for HD)
*use while waiting for Arterialvenous (av) fistulas to mature
*Diabetic pts do better with this bc better control of blood glucose with intraperiotneal insulin; avoids risk of hemorrhage from heparin used in HD |
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Term
| Diabetics do better with PD or HD? Why? |
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Definition
| PD offers better control of blood glucose with intraperitoneal insulin |
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Term
| Peritoneal dialysis (PD) is contraindicated in pts with... |
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Definition
multiple abd surgerie or pathlogies (pancreatitis, diverticulitie, scarring)
recurrent abd wall or inguinal hernias=increased pressure from dialysate can complicate hernias
excessive obesity
vertebral disease/back problems=increased pressure
severe COPD=dialysate pushes on diaphragm |
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Term
| Peritoneal dialysis cycle in detail |
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Definition
*1-2 L of dialysate is infused by gravity over 10-20 min aka FILL
*dialysate DWELLS in cavity for specified time by MD. osmosis and diffusion occurs. may be 10,20,30 min or hrs per MD
*fluid DRAINS out of body by gravity into bag. contains dialysate, excess water, electrolytes, and waste |
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Term
| periotoneal dialysis cycle |
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Definition
FILL, DWELL, DRAIN=ONE CYCLE
**MD orders number and frequency of exchanges |
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Term
| dialysate additive GLUCOSE |
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Definition
| more hyperonic the glucose, the more fluid pulled off. MD orders concentration |
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Term
| dialysate additive HEPARIN |
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Definition
| prevents fibrin clot formation in tubing |
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Term
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Definition
| so dialysate does not pull off too much potassium |
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Term
| dialysate additive ANTIBIOTICS |
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Definition
if suspected or confirmed peritonitis
**what color is dialysate? |
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Term
| dialysate additive INSULIN |
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Definition
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Term
| CAPD continuous ambulatory peritoneal dialysis |
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Definition
| patient manually performs exchanges 4 times a day, with dwell times of 4-8-10 hs. Usually ~2 L |
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Term
| APD automated peritoneal dialysis |
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Definition
| automated cycling machine (cycler) is programmed to provide for dialysate fill, dwell, and drain according to preset times and volumes. allows pt to cycle only at night or 3x/week instead of daily |
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Term
| complications of periotoneal dialysis |
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Definition
peritonitis
protein loss
exit site infection
pulmonary complications
hernias
back problems
outflow problems |
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Term
| how do you prevent peritonitis in periotneal dialysis? |
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Definition
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Term
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Definition
| patients blood is removed from the body and passes through a cartridge that has a synthetic semipermeable membrane that acts as an artificial kidney |
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Term
| how often do you perform hemodialysis |
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Definition
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Term
| what is needed for hemodialysis? |
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Definition
| large amount of blood flow--->surgical revision of blood vessels to provide access |
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Term
| long term vascular access options in hemodialysis |
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Definition
external shunt
internal arteriovenous (AV) fistula
internal synthetic graft |
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Term
| Internal AV fistula/shunt |
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Definition
anastamosis is created between an artery and a vein
*fistula provides arterial blood flow thru vein |
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Term
| what happens to the AV shunt over time in HD? why is this significant? |
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Definition
| the vein dilate and becomes tougher over time due to the increased pressure of the arterial blood in the vein; this now large vessel has enough blood flow to perform HD and is tough enough for multiple punctures |
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Term
| how long does an internal AV shunt/fistule need to mature (dilate and toughen)? |
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Definition
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Term
| complication of internal AV shunt |
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Definition
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Term
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Definition
| synthetic graft forms a bridge between the arterial and venous blood supplies |
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Term
| common occurrence with internal synthetic grafts (2) |
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Definition
| clot formation and infections (need 2-4 weeks to heal) |
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Term
| what can internal synthetic graft causee??? why??? |
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Definition
| GRANGRENE--->SURGERY; steal syndrome |
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Term
| INTERNAL SYNTHETIC GRAFTS ARE... |
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Definition
| SELF HEALING=CLOSE OVER PUNCTURE SITES ONCE NEEDLES ARE REMOVED |
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Term
| steal syndrome: define and what does it occur in |
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Definition
| internal synthetic grafts; ischemia distal to the graft bc the arterial blood is being shunted into the vein---->gangrene |
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Term
| care of permanent vascular access sites!! KNOW!!! |
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Definition
DO NOT perform anything on affected extremity
*thrills palpable at arterial, middle, and venous segments
*auscultate for bruit normal=contiuous,soft,low pitched,
bad=high pitches harsh discontinuous
assess distal pulses/circulation
bleeding @insertion |
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Term
| AV EXTERNAL shunt care...these always need...? |
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Definition
| keep clamps handy on the dressing |
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Term
| Pt. teaching for permanent acces sites |
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Definition
do not carry heavy objects or compress extremities
avoid constrictive clothing
report numbness, coldness, pain, any chngesin
report if access suddenly bulge
do not sleep on top of extremity |
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Term
| when is temporary access used? |
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Definition
until permanent accesses have matured
in emergency situations when HD can not wait for permanent access |
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Term
| temporary access sites for emergency HD |
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Definition
| sublcavian, internal jugular, femoral veins |
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Term
| differences in HD catheters |
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Definition
| 2 lumens with internal septum separating two segments |
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Term
| DO NOT do this with HD catheters!! |
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Definition
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Term
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Definition
| heparin is injected into the lumen after dialysis and REMOVED prior to next use...NOT FLUSHED |
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Term
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Definition
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Term
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Definition
| two needles are placed in the fistula or graft when HD is started. blood pump is used to send "arterial" blood to dialyzer, patients blood is returned thru a second needle creaeting a continuous cycleing of blood--->READ IN TEXTBOOK |
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Term
| when is dialysate composition altered? |
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Definition
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Term
| herparin is added to patients blood to prevent clotting in the tubing and dialyzer membrane...give example |
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Definition
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Term
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Definition
| reverses anticoagulation effects of heparin |
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Term
| what does duration and frequency of HD depend on? |
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Definition
| amount of wastes, amount of fluid, clearance capacity of dialyzer |
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Term
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Definition
| patient's weight, VS, have you received meds? |
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Term
| Should meds be held in HD? |
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Definition
| some MDs hold all, some give all, some hold BP meds |
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Term
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Definition
*disequilibrium syndrome
*hypotension
*muscle cramps d/t K loss
*Loss of blood
Hepatitis B & C
Sepsis |
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Term
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Definition
unsteady, keep in bed
READ IN BOOK |
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Term
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Definition
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Term
| CRRT Continuous Renal Replacement Therapy |
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Definition
used in ARF as an adjuvant or alternative therapy
*performed at bedside with few IV poles,filter, and replacement fluids
*in ICU |
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Term
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Definition
give pt normal renal function and eliminates dialysis need
*trade dialysis for meds |
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Term
| not a good candidate for transplant if... |
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Definition
*psych disorders
*malignancies
*cardiac failure
*respiratory failure
*chronic infection
*extensive vascular disease
sever DM, hyperparaythyroid disease |
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Term
| where can organs come from? |
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Definition
living related donors
living unrelated donors
cadaver donors->brain dead
paired organ donation |
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Term
| Why are live donors better? |
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Definition
pt and graft survival rates better
kidney is immediately available
recipient is in best possible condition bc it is elective
kidney usually functions immediately bc minimal cold time |
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Term
| Histocompatibility studies include |
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Definition
ABO blood group
HLA antigens
crossmatch=serum from recipient with donor cells |
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Term
| what is removed from donor prior for kidney transplant? |
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Definition
| nephrectomy on donor removing kidney, renal artery, renal vein, and ureter |
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Term
| where is kidney placed in recipient? |
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Definition
| extraperitoneally in right anterior ileac fossa |
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Term
| what about the vines and ureter? |
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Definition
| renal artery and vein are attached to the iternal iliac artery and vein; ureter is tunneled trhough the bladder into the bladder cavity and sutured in place |
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Term
| What do you do after new kidney is in place? |
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Definition
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Term
| What to expect from new kidney |
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Definition
urine production
*may need dialysis until kidney starts to work
*some cadaveric kidneys develop ATN during cold time
RNs must label and protect dialysis sites
*pts need to know the kidney needs time to work |
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Term
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Definition
HOURLY I&O
ML/ML hourly fluid replacement
diuresis slows down as BUN & Creatinine normalize
electrolyte replacement
avoid dehydration bc it can injure new kidney |
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Term
| Bad sign for new kidney and what it may mean |
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Definition
| UOP drops suddenly->dehydration, rejection, obstruction |
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Term
| special considerations for new kidney |
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Definition
| cath present for 3-5 days to allow anastamosis to heal |
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Term
| what is one possible cause of obstruction in new kidney |
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Definition
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Term
| DO NOT perform this on a pt with post renal transplant without an order |
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Definition
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Term
| immunosuppressive therapy |
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Definition
adequately suppress immune response but also prevent infections
*pt on maintenance meds |
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Term
| immunosuppressive meds (5) |
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Definition
corticosteroids
*cyclosporine
*ATG
*ALG
*monoclonal antibodies |
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Term
| how do monoclonal antibodies work? |
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Definition
| prevent & treat acute rejections. interferes with t lymph function a few min after infusion |
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Term
| most common and most threatening complication of renal transplantation |
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Definition
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Term
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Definition
antibody mediated
*minutes to hours
pt has already formed antibodies that immediately attack kidney
*MUST TAKE OUT
*exposed to foreign antigens from previous pregnancie, blood transfusions, etc.. |
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Term
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Definition
*4 days to 4 months after transplant
*cytotixic T cells are created that attack new kidney
*usually REVERSIBLE with immunosuppressive meds |
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Term
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Definition
looks like renal failure
*increasing BUN and creatinine
*fever
*weigh gain
*decreased UOP
*increased BP
*tenderness over new kidney |
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Term
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Definition
*MO to YEARS AFTER TRANSPLANT
*NO THERAPY MUST RETRANSPLANT/DIALYSIS
*T & B cells invade kidney and damage it
*silent->proteinuria, HTN, increasing creatinine |
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Term
| complications of renal transplant |
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Definition
*infection
*HTN
*malignancies
*vascular disease
*renal artery stenosis
*aseptic bone necrosis |
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