Kidney Failure and Management
40 Questions
0 Views

Choose a study mode

Play Quiz
Study Flashcards
Spaced Repetition
Chat to lesson

Podcast

Play an AI-generated podcast conversation about this lesson

Questions and Answers

What is the primary reason to avoid invasive procedures for 4 to 6 hours after dialysis?

  • Increased chance of vascular complications
  • Risk of infection
  • Anticoagulation resulting in bleeding risk (correct)
  • Potential for kidney impairment

    • Which of the following conditions is NOT an indication for dialysis?

  • Chronic liver disease (correct)
  • Drug toxicity
  • Hyperkalemia
  • Acute kidney injury

    • What is one of the key nursing actions before initiating hemodialysis?

  • Assess for lower extremity pulses
  • Perform venipunctures for blood sampling
  • Administer all medications as prescribed
  • Check for informed consent (correct)

    • What complication can occur due to rapid changes in BUN and fluid volume during hemodialysis?

    <p>Disequilibrium syndrome</p> Signup and view all the answers

    What is the most sensitive indicator of fluid balance in renal patients?

    <p>Weight measurement</p> Signup and view all the answers

    Which complication is associated with infections in hemodialysis patients?

    <p>Infection from graft placements</p> Signup and view all the answers

    What nursing action should be taken after the surgical creation of an AV fistula?

    <p>Elevate the extremity to reduce swelling</p> Signup and view all the answers

    What is a common complication of both hemodialysis and graft placements?

    <p>Hypotension</p> Signup and view all the answers

    What GFR level defines Stage 3 of kidney disease?

    <p>GFR 30-59 ml/min</p> Signup and view all the answers

    Which action should be avoided during the pre-procedure phase for a patient with an AV access site?

    <p>Measuring blood pressure</p> Signup and view all the answers

    Which symptom is NOT a common post-dialysis complication to monitor for?

    <p>Increased appetite</p> Signup and view all the answers

    During the intra-procedure phase of dialysis, which aspect should be consistently monitored?

    <p>Presence of air bubbles in blood tubing</p> Signup and view all the answers

    What should be done if there is oozing from the insertion site during dialysis?

    <p>Apply pressure and monitor</p> Signup and view all the answers

    In terms of weight comparison, what does a decrease in weight post-procedure indicate?

    <p>Fluid removal from the procedure</p> Signup and view all the answers

    Which laboratory values should be monitored closely during the post-procedure phase of dialysis?

    <p>BUN and electrolytes</p> Signup and view all the answers

    What is a key action to take during the pre-procedure preparation for a dialysis catheter placement?

    <p>Ensure informed consent is obtained</p> Signup and view all the answers

    What is one of the primary risks of dialysis disequilibrium syndrome?

    <p>Cerebral edema</p> Signup and view all the answers

    Which patient demographic is particularly at risk for dialysis disequilibrium?

    <p>Older adults</p> Signup and view all the answers

    What is a major indication for choosing peritoneal dialysis over other forms?

    <p>Difficulty with vascular access</p> Signup and view all the answers

    Which of the following is NOT a major complication of peritoneal dialysis?

    <p>Urinary tract infection</p> Signup and view all the answers

    What should the expected color of dialysate outflow be in peritoneal dialysis?

    <p>Pale yellow or amber</p> Signup and view all the answers

    What nursing action should be taken if there is poor dialysate outflow?

    <p>Reposition the client</p> Signup and view all the answers

    Which of the following is a common cause of insufficient inflow or outflow during peritoneal dialysis?

    <p>Constipation</p> Signup and view all the answers

    What is an important consideration when warming dialysate for peritoneal dialysis?

    <p>Heating uniformly without overheating</p> Signup and view all the answers

    What is the minimum mean arterial pressure (MAP) that should be maintained to help prevent kidney injury?

    <p>65 mmHg</p> Signup and view all the answers

    Which of the following medications is NOT known to cause nephrotoxicity?

    <p>Aspirin</p> Signup and view all the answers

    What dietary protein intake is recommended for hemodialysis patients per day?

    <p>1.2 gm/kg</p> Signup and view all the answers

    Which is a primary nursing priority to prevent kidney failure in an acute care setting?

    <p>Carefully monitor drug levels</p> Signup and view all the answers

    What is an appropriate potassium restriction for hemodialysis patients?

    <p>2 g/day</p> Signup and view all the answers

    What treatment method may be necessary for severe nephrotoxicity or kidney injury?

    <p>Dialysis</p> Signup and view all the answers

    Which dietary adjustment is NOT applicable to peritoneal dialysis patients?

    <p>Fluid restriction under all circumstances</p> Signup and view all the answers

    What is the purpose of nutrition support in patients with end-stage renal disease (ESRD)?

    <p>Preserve lean body mass and fluid balance</p> Signup and view all the answers

    What is the primary reason for keeping the outflow bag lower than the client’s abdomen during dialysis?

    <p>To ensure smooth drainage by gravity and prevent reflux</p> Signup and view all the answers

    Which medication class must be carefully managed in patients with end-stage renal disease (ESRD)?

    <p>Statins</p> Signup and view all the answers

    What is a key advantage of an AV fistula over an AV graft for vascular access?

    <p>AV fistulas have a lower risk of clotting and infection</p> Signup and view all the answers

    Which of the following complications is commonly associated with dialysis treatments?

    <p>Peritonitis</p> Signup and view all the answers

    How soon after placement can an AV graft typically be used?

    <p>2-4 weeks</p> Signup and view all the answers

    What is a primary benefit of Continuous Ambulatory Peritoneal Dialysis (CAPD)?

    <p>Allows for the patient to manage their own dialysis without a partner</p> Signup and view all the answers

    Which of the following is a common assessment related to AV access for dialysis?

    <p>Inspection for thrill and bruit</p> Signup and view all the answers

    What should be done if inflow or outflow is inadequate during peritoneal dialysis?

    <p>Reposition the client</p> Signup and view all the answers

    Study Notes

    Kidney Failure Prevention

    • Monitor lab values: BUN, creatinine, electrolytes
    • Maintain MAP pressure above 65 mmHg
    • Close I&O recordings
    • Careful IV fluid administrations
    • Monitor drug levels
    • Fluid challenges
    • Diuretic dosing and outputs management

    Nephrotoxic Medications

    • Vancomycin
    • NSAIDs
    • Steroids
    • Gentamycin/Tobramycin
    • Chemotherapy: Cisplatin
    • Cocaine, heroin, Tylenol OD, diuretics, fluoroquinolones, some OTC medications

    MAP Pressure

    • Normal range: 70-100 mmHg
    • Acute care setting acceptable range: 65 mmHg
    • Calculation: MAP = Diastolic BP + 1/3 x (Systolic BP – Diastolic BP)
    • Low MAP: inadequate cardiac output, blood flow to vital organs is compromised
    • High MAP (over 100 mmHg): organ damage due to high pressure against blood vessels

    ESRD Nutrition

    • Purpose: maintain nutritional status, preserve lean body mass, fluid balance, preserve kidney function
    • Hemodialysis:
      • Protein: 1.2 gm/kg/day
      • Sodium: 2-3 gm/day
      • Potassium: 2.03 g/day
      • Calories: 30-35 kcal/kg/day
      • Phosphorus: 0.6-1.2 g/day
      • Iron supplement: if receiving erythropoietin injections
      • Fluids: depends on urine output (600-1000ml/day)
    • Peritoneal dialysis:
      • Protein: 1.2-1.3 g/kg/day
      • Calories: 25-30 kcal/kg/day
      • Sodium: 2-4 g/day
      • Potassium: 2-3 g/day
      • Phosphorus: 0.6-1.2 g/day
      • Calcium: individualized
      • Iron: if taking erythropoietin injections
      • Fluids: unrestricted if weight and BP controlled
    • Kidney specific supplements: Supplena, Nepro, Nova Source
      • Low in phosphorus, sodium, and potassium
      • Given orally or through tube feedings
    • TPN: mixed by physician, pharmacy, and dietician to meet specific patient needs

    Treating Nephrotoxicity

    • Restore fluid volume
    • Adjust medication doses or discontinue medication
    • Steroids: for interstitial nephritis
    • Dialysis: if necessary

    GFR Stages

    • Stage 1: GFR < 90 ml/min
    • Stage 2: GFR 60-89 ml/min
    • Stage 3: GFR 30-59 ml/min
    • Stage 4: GFR 15-29 ml/min
    • Stage 5: GFR < 15 ml/min

    Dialysis Catheter Placement

    • Pre-procedure actions:
      • Informed consent
      • Temporary hemodialysis dual-lumen catheter/subcutaneous device until long-term device is available
      • Assess patency of long-term devices (AV fistula or AV graft): presence of bruit, palpable thrill, distal pulses, circulation
      • Avoid BP measurement, injections, venipuncture, IV catheter insertion in access arm
      • Elevate extremity after AV fistula creation to reduce swelling
      • Assess vital signs, lab values (BUN, creatinine, electrolytes, Hct), and weight
      • Discuss medication withholding with provider until after dialysis
      • Withhold dialyzable medications and medications that lower blood pressure
    • Intra-procedure actions:
      • Monitor for dialysis complications: circuit clotting, air bubbles in blood tubing, dialysate temperature, ultrafiltration regulation, hypotension, cramping, vomiting, bleeding at access site, equipment contamination
      • Monitor vital signs and coagulation studies during dialysis
      • Monitor for bleeding: oozing from insertion site
      • Administer anticoagulants (heparin)
      • Keep protamine sulfate ready to reverse heparin
      • Provide emotional support and offer activities
    • Post-procedure actions:
      • Monitor vital signs and lab values (BUN, creatinine, electrolytes, Hct)
      • Assess for hypotension, access site clotting, headache, muscle cramps, bleeding
      • Monitor for bleeding or infection at access site
      • Assess for disequilibrium syndrome findings
      • Assess for hypovolemia findings (hypotension, dizziness, tachycardia)
      • Avoid invasive procedures for 4-6 hours after dialysis due to bleeding risk
      • Reinforce AV fistula/AV graft precautions
      • Compare pre-procedure weight with post-procedure weight to estimate fluid removal (1 L fluid = 1 kg)

    Dialysis Function

    • Hemodialysis: filters blood using a machine (dialyzer) to remove waste products
    • Peritoneal dialysis: filters body wastes through the peritoneum in the abdomen using varying fluid bags, hours, and treatment methods

    Dialysis Indications and Presentations

    • Renal insufficiency
    • Acute kidney injury
    • Chronic kidney disease
    • Drug toxicity
    • Chronic hyperkalemia
    • Hypervolemia

    Peritoneal Dialysis Catheter Procedure

    Graft/Shunt Placement Complications

    • Clotting: can lead to reduced blood flow, requiring intervention
    • Infection: can lead to sepsis, requiring antibiotics and possibly removal of the graft/shunt
    • Disequilibrium syndrome: rapid decrease in BUN and fluid volume, leading to cerebral edema and increased intracranial pressure
      • Manifestations: nausea, vomiting, altered consciousness, seizures, agitation
      • Risk factors: advanced age, rapid changes in fluid and electrolyte status
    • Hypotension: can be caused by fluid removal during dialysis, requiring careful monitoring and adjustments
    • Anemia: common in patients with ESRD, requiring erythropoietin injections
    • Abdominal cramping: can occur during peritoneal dialysis, requiring positioning adjustments and pain management
    • Infectious diseases: greater risk in patients with compromised immune systems, requiring vigilant monitoring and treatment

    Hemodialysis Pre-procedures (ATI)

    • Informed consent
    • Assess patency of long-term devices (AV fistula or AV graft): presence of bruit, palpable thrill, distal pulses, circulation
    • Avoid BP measurement, injections, venipuncture, IV catheter insertion in access arm
    • Elevate extremity after AV fistula creation to reduce swelling
    • Assess vital signs, lab values (BUN, creatinine, electrolytes, Hct), and weight
    • Discuss medication withholding with provider until after dialysis
    • Withhold dialyzable medications and medications that lower blood pressure

    Weight as an Indicator of Fluid Status

    • 1 lb = 2.2 kg
    • Weight is the most sensitive indicator of fluid loss or gain
    • Standing or sling weight is preferred over bed measurement for renal patients

    Hemodialysis Complications

    • Clotting: leads to reduced blood flow, requiring intervention
    • Infection: can lead to sepsis, requiring antibiotics and possibly removal of the access device
    • Disequilibrium syndrome: rapid decrease in BUN and fluid volume, leading to cerebral edema and increased intracranial pressure
      • Manifestations: nausea, vomiting, altered consciousness, seizures, agitation
      • Risk factors: advanced age, rapid changes in fluid and electrolyte status
      • Nursing actions: slow dialysis exchange rate, administer anticonvulsants/barbiturates if needed

    Peritoneal Dialysis Indications

    • Older adults requiring dialysis
    • Unable to tolerate anticoagulation
    • Difficulty with vascular access
    • Chronic infections or unstable condition
    • Chronic diseases (diabetes mellitus, heart failure, severe hypertension)

    Peritoneal Dialysis Complications

    • Peritonitis: infection of the peritoneum, requiring prompt treatment with antibiotics and possibly hospitalization
    • Infection: can occur at the catheter insertion site or in the peritoneal cavity, requiring prompt treatment with antibiotics
    • Protein loss: can occur through the peritoneum, requiring nutritional adjustments
    • Hyperglycemia: can occur in patients with diabetes, requiring careful monitoring and management of blood glucose levels
    • Hyperlipodemia: elevated blood lipid levels, requiring careful monitoring and management

    Peritoneal Dialysis Dialysate Flow Observations

    • Poor inflow or outflow:
      • Causes: obstruction or twisting of the tubing, constipation, client positioning, fibrin clot formation, catheter displacement
    • Nursing actions:
      • Reposition client
      • Milk the tubing to break up clots
      • Check tubing for kinks or closed clamps
    • Outflow color:
      • Should be pale yellow or amber
      • Cloudy outflow: possible infection
      • Brownish outflow: possible peritonitis (emergency)
    • Outflow amount:
      • Should equal or exceed inflow amount
    • Other observations:
      • Fever
      • Bloody, cloudy, or frothy outflow
      • Drainage at access site
      • Respiratory distress
      • Abdominal pain
      • Insufficient outflow
      • Wetness at access site dressing (dialysate leakage)
      • Exit-site infections

    AV Shunt vs. AV Graft

    • AV fistula: uses patient's own arteries and veins, considered the best choice for vascular access
      • Provides good blood flow
      • Lower risk of clotting/infection
    • AV graft: uses artificial material (e.g., Gore-Tex)
      • Provides a solution for small or weak veins
      • Can be used 2-4 weeks after placement
      • Outpatient surgery under local anesthetic
      • Used when permanent access sites are exhausted

    Medications to Avoid in ESRD

    • Statins: doses adjusted due to liver and diabetes conditions
    • NSAIDs: kidney clearance problems, can build up in the blood
    • Pain medications: kidney clearance problems, can build up in the blood
    • Antibiotics: kidney function should be evaluated before administration
    • Antivirals: kidney function should be evaluated before administration
    • Certain diabetes medications: kidney clearance problems
    • Antacids: can affect electrolyte and acid-base balance

    Continuous Ambulatory Peritoneal Dialysis (CAPD) Advantages

    • Performed by the patient
    • 4-2 liters of dialysate exchanged into the peritoneal cavity
    • Dwells for 4-8 hours, 7 days a week
    • Continuous connect system or disconnect for later exchange
    • No machine or partner required

    Common Problems After Dialysis

    • Peritonitis: infection of the peritoneum, requiring prompt treatment
    • Pain: can occur at the access site or in the muscles
    • Infections: can occur at the access site or in the body
    • Hypotension: can be caused by fluid removal during dialysis
    • Muscle cramps: can occur during or after dialysis
    • Blood loss: can occur during procedures, requiring prompt intervention

    Studying That Suits You

    Use AI to generate personalized quizzes and flashcards to suit your learning preferences.

    Quiz Team

    Related Documents

    Chapter 57 Hemodialysis and Peritoneal Dialysis PDF

    Description

    This quiz covers essential topics related to kidney failure prevention and management. It includes monitoring lab values, understanding nephrotoxic medications, managing MAP pressure, and nutrition for patients with end-stage renal disease (ESRD). Test your knowledge and enhance your understanding of kidney health and treatments.

    More Like This

    Use Quizgecko on...
    Browser
    Open
    Browser
    Browser