Questions and Answers
What occurs when waste products associated with decreased kidney function build up in the blood?
Uremia
Which of the following is NOT a symptom of uremia?
Match the stages of Chronic Kidney Disease with their descriptions:
Stage 1 = Normal pero below normal GFR Stage 2 = Mild loss of kidney function (GFR 89% to 60%) Stage 3a = Mild to moderate kidney function loss (GFR 59% to 45%) Stage 3b = Moderate to severe kidney function loss (GFR 44% to 30%) Stage 4 = Severe loss of kidney function (GFR 29% to 15%) Stage 5 = Kidney failure (GFR lower than 15%)
One of the kidney functions is to control ______.
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Dialysis is a procedure used to provide an artificial replacement for lost kidney function due to renal failure.
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What are the four main types of renal replacement therapy used in dialysis?
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What process involves movement from higher concentration to lower concentration to remove toxins and wastes in hemodialysis?
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What is a common indication for dialysis in patients with acute kidney injury related to electrolyte abnormality?
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What is the purpose of a Tenckhoff catheter?
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What is the size of the AV fistula needle used in hemodialysis?
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What are the two types of catheters used in dialysis?
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Vein catheterization allows for immediate access to the femoral or subclavian vein.
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What is not a blood-related complication of dialysis?
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The type of dialysis that uses the peritoneal membrane is called ______.
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List one nursing consideration before dialysis.
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Match the following types of peritoneal dialysis with their characteristics:
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What substance is used in hemodialysis to aid in clotting?
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Hypotension is a common complication of dialysis.
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Study Notes
Erythropoietin and Uremia
- Uremia arises from waste accumulation in blood due to reduced kidney function.
- Symptoms include cognitive dysfunction, fatigue, shortness of breath from fluid retention, loss of appetite, muscle cramps, nausea, vomiting, itching, and unexplained weight loss.
- Characteristic features are uremic fetor (ammonia buildup odor) and uremic frost (crystallized sweat).
Kidney Functions: "A WET BED"
- A: Acid-base balance
- W: Water balance
- E: Electrolyte balance
- T: Toxin removal
- B: Blood pressure control
- E: Erythropoietin production
- D: Vitamin D metabolism
Stages of Chronic Kidney Disease
- Stage 1: Normal GFR but below normal range.
- Stage 2: Mild kidney function loss; GFR ranges from 89% to 60%.
- Stage 3a: Mild to moderate function loss; GFR between 59% and 45%.
- Stage 3b: Moderate to severe function loss; GFR from 44% to 30%.
- Stage 4: Severe function loss; GFR ranges from 29% to 15%.
- Stage 5: Kidney failure with GFR lower than 15%.
Dialysis
- Provides artificial replacement for kidney function loss due to renal failure.
- Renal Replacement Therapy (RRT) includes four main types: Hemodialysis (HD), Peritoneal Dialysis (PD), Hemofiltration (HF), and Hemodiafiltration (HDF).
Principles of Hemodialysis
- Diffusion: Moves toxins from blood (high concentration) to dialysate (low concentration); rapid procedures may cause hypotension or shock; typically lasts 4 to 6 hours.
- Osmosis: Removes excess water from blood; water moves from higher solute concentration in blood to lower concentration in dialysate.
- Ultrafiltration: Water moves from high pressure to low pressure via suctioning through the dialysis membrane.
Indications for Dialysis
-
Acute Kidney Injury:
- Metabolic acidosis not manageable with Sodium Bicarbonate.
- Electrolyte imbalances such as hyperkalemia with AKI.
- Unresponsive fluid overload to diuretics.
- Intoxication with dialysable drugs like lithium or aspirin.
- Uremia complications including pericarditis and encephalopathy.
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Chronic Indications:
- Symptomatic renal failure.
- Significantly low GFR.
Hemodialysis
- Involves blood pumping from an arteriovenous (AV) fistula to the dialyzer.
- Waste products filter through an artificial membrane into dialysate.
- AV fistula needle size used is 16 gauge.
Access Methods
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AV Graft/Shunt:
- Cannula placed surgically between large vein and artery.
- Offers easy access but risks infection and clotting.
- Erosion of skin may occur at insertion site; maturation takes 2-3 weeks.
-
AV Fistula:
- Anastomosis between large artery and vein creates a single vessel for blood withdrawal and return.
- Benefits include better activity range than AV shunt; maturation takes 2-3 months.
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Vein Catheterization:
- Immediate access via femoral or subclavian vein.
- Catheter has two openings: arterial (red for drawing blood) and venous (blue for returning cleaned blood).
Catheter Types
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Non-Tunneled Catheters:
- Used for emergencies/up to 3 weeks.
- Directly placed into the right atrium, higher infection risk.
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Tunneled Catheters:
- Suitable for long-term access (over 3 weeks).
- Catheter tunnels under skin; involves two incision sites.
Nursing Considerations
-
Before Dialysis:
- Document weight to manage fluid removal.
- Obtain baseline vital signs to monitor for potential complications.
- Review medication history, avoiding hypertensives and sedatives to reduce hypotension risk.
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During Dialysis:
- Monitor vital signs every 30 minutes (every 15 if abnormal).
- Ensure proper body alignment; semi-fowler’s position is optimal.
- Watch for nausea/vomiting (indicator of Dialysis Disequilibrium Syndrome).
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After Dialysis:
- Check patient’s weight for fluid balance.
- Observe for bleeding and assess status of the fistula.
- Monitor for complications: blood-related, dialysate-related, and patient-related issues.
Complications
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Blood-Related Issues:
- Air in blood circuit leading to embolism.
- Potential for blood loss or access recirculation (stenosis/thrombosis).
- Risk of clotting and infiltration at the needle site.
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Dialysate-Related Issues:
- Temperature extremes leading to hypothermia or hyperthermia.
- Risks of hemolysis and crenation due to hypertonic dialysate.
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Patient-Related Issues:
- Hypotension, hypertension, muscle cramps, and headaches.
- Fistula or graft infection, thrombosis, and potential cardiac complications.
- Central venous catheter infections and the risk of seizures or anaphylaxis.
Dialysis Procedures
- Reverse osmosis (RO) water is utilized in hemodialysis.
- Blood lines color-coded: arterial (red) and venous (blue).
- Turn on the machine for safety checks and assessment of the extracorporeal circuit's integrity.
Peritoneal Dialysis
- Utilizes the peritoneal membrane for filtering.
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Types:
- Automated PD: Home-use, reduces peritonitis risk.
- Intermittent PD: Manual or automated, mixes osmotic pressure with dialysis.
- Continuous Ambulatory PD: Common, manual, lasts 4-8 hours, portable.
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Description
This quiz explores the concepts of erythropoietin and uremia, including their symptoms and effects on kidney function. Test your knowledge on how waste products build up in the blood and the resulting complications. Additionally, understand kidney functions represented by the acronym A WET BED.
