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Questions and Answers
What clinical manifestation is likely associated with an infection?
What clinical manifestation is likely associated with an infection?
What is the primary goal of the new approach to kidney transplantation described?
What is the primary goal of the new approach to kidney transplantation described?
What does the process of injecting blood stem cells from the donor achieve?
What does the process of injecting blood stem cells from the donor achieve?
Which of the following actions is essential for hospital staff and visitors in infection control?
Which of the following actions is essential for hospital staff and visitors in infection control?
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What should be monitored to determine if the new hybrid immune system is effective?
What should be monitored to determine if the new hybrid immune system is effective?
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What is a key component of preoperative teaching for patients undergoing elective abdominal surgery?
What is a key component of preoperative teaching for patients undergoing elective abdominal surgery?
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Which immunosuppressive agent is known as Prograf?
Which immunosuppressive agent is known as Prograf?
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What is the purpose of early ambulation in the preoperative phase?
What is the purpose of early ambulation in the preoperative phase?
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What characteristic distinguishes hyperacute rejection from other types of rejection?
What characteristic distinguishes hyperacute rejection from other types of rejection?
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What is a primary complication associated with hemodialysis?
What is a primary complication associated with hemodialysis?
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Which symptom is specifically associated with both acute rejection and infection?
Which symptom is specifically associated with both acute rejection and infection?
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What is the main goal of postoperative management for a transplanted kidney?
What is the main goal of postoperative management for a transplanted kidney?
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Which access method is NOT used for hemodialysis?
Which access method is NOT used for hemodialysis?
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What dietary consideration is important for patients post-kidney transplant?
What dietary consideration is important for patients post-kidney transplant?
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What nursing intervention is essential to monitor during hemodialysis?
What nursing intervention is essential to monitor during hemodialysis?
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What is the most reliable test for evaluating kidney transplant rejection?
What is the most reliable test for evaluating kidney transplant rejection?
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Continuous Renal Replacement Therapy is most appropriate for which condition?
Continuous Renal Replacement Therapy is most appropriate for which condition?
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Which of the following is a characteristic of peritoneal dialysis?
Which of the following is a characteristic of peritoneal dialysis?
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What is one reason high-flux dialysis would be preferred?
What is one reason high-flux dialysis would be preferred?
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What should be monitored in the dialysate during peritoneal dialysis?
What should be monitored in the dialysate during peritoneal dialysis?
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Which of the following symptoms indicates the necessity for hemodialysis in chronic conditions?
Which of the following symptoms indicates the necessity for hemodialysis in chronic conditions?
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Which symptom may indicate an infection during clinical assessments?
Which symptom may indicate an infection during clinical assessments?
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What is the primary novel technique being utilized in the prevention of rejection after kidney transplantation?
What is the primary novel technique being utilized in the prevention of rejection after kidney transplantation?
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What effect does the injection of blood stem cells from the donor have on the recipient?
What effect does the injection of blood stem cells from the donor have on the recipient?
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Which of the following practices is essential in infection control measures for hospital staff and visitors?
Which of the following practices is essential in infection control measures for hospital staff and visitors?
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How did the Stanford team determine that the new hybrid immune system would not attack the transplanted organ?
How did the Stanford team determine that the new hybrid immune system would not attack the transplanted organ?
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What is an appropriate indication for using Continuous Venovenous Hemofiltration (CVVH)?
What is an appropriate indication for using Continuous Venovenous Hemofiltration (CVVH)?
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Which statement about kidney transplantation is correct?
Which statement about kidney transplantation is correct?
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What preoperative evaluation is necessary for a patient undergoing kidney transplantation?
What preoperative evaluation is necessary for a patient undergoing kidney transplantation?
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What should be monitored to ensure safety during the insertion of a catheter for dialysis?
What should be monitored to ensure safety during the insertion of a catheter for dialysis?
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Which statement is true regarding the management of a patient in advanced dialysis procedures?
Which statement is true regarding the management of a patient in advanced dialysis procedures?
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Which symptom is associated with hyperacute rejection?
Which symptom is associated with hyperacute rejection?
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What is the primary reason for early ambulation in the preoperative phase?
What is the primary reason for early ambulation in the preoperative phase?
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Which immunosuppressive agent is commonly used to prevent transplant rejection?
Which immunosuppressive agent is commonly used to prevent transplant rejection?
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What is a key sign of acute rejection in kidney transplant recipients?
What is a key sign of acute rejection in kidney transplant recipients?
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What diagnostic tool is most reliable for evaluating rejection in kidney transplantation?
What diagnostic tool is most reliable for evaluating rejection in kidney transplantation?
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Which condition is managed with a tapering dosage of immunosuppressive agents?
Which condition is managed with a tapering dosage of immunosuppressive agents?
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Which of the following indicates a need for monitoring blood pressure after kidney transplantation?
Which of the following indicates a need for monitoring blood pressure after kidney transplantation?
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What is not a common preoperative teaching focus for patients undergoing elective abdominal surgery?
What is not a common preoperative teaching focus for patients undergoing elective abdominal surgery?
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Which condition is NOT a primary indication for initiating hemodialysis?
Which condition is NOT a primary indication for initiating hemodialysis?
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What is the primary purpose of using a high-flux dialysis membrane?
What is the primary purpose of using a high-flux dialysis membrane?
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Which of the following complications is associated with peritoneal dialysis?
Which of the following complications is associated with peritoneal dialysis?
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During hemodialysis, how frequently should blood pressure and pulse rate be checked?
During hemodialysis, how frequently should blood pressure and pulse rate be checked?
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What is a key nursing intervention before initiating peritoneal dialysis?
What is a key nursing intervention before initiating peritoneal dialysis?
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Which type of dialysis access is primarily used in hemodialysis?
Which type of dialysis access is primarily used in hemodialysis?
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Which statement about fluid management in hemodialysis is accurate?
Which statement about fluid management in hemodialysis is accurate?
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What is the typical duration of a hemodialysis session?
What is the typical duration of a hemodialysis session?
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Study Notes
Renal Replacement Therapies
- Renal replacement therapies include hemodialysis, peritoneal dialysis, and continuous renal replacement therapy (acute/urgent and chronic/maintenance)
- Hemodialysis: high and increasing potassium levels, fluid overload, impending pulmonary edema, increasing acidosis, pericarditis (uremic), advanced uremia
- Chronic/Maintenance Hemodialysis: advanced CKD & ESKD, uremic signs & symptoms, hyperkalemia, fluid overload, general lack of well-being
- Dialyzers: hollow-fiber devices with tiny capillary tubes, porous tubes acting as semipermeable membranes, constant flow of solution maintains concentration gradient facilitating waste exchange across membrane, removing and discarding waste in the dialysate solution, High-flux dialysis uses highly permeable membranes to increase clearance of low- and mid-molecular-weight molecules
- Peritoneal Dialysis: uses the peritoneum, a 36-hour procedure
- Hemodialysis Access: arteriovenous fistula, internal jugular/subclavian/femoral vein catheterization, arteriovenous graft
- Hemodialysis Duration: 3 to 4 hours
- Peritoneal Dialysis Duration: 36 hours
- Complications for Hemodialysis: disequilibrium syndrome, hypotension, bleeding, exit-site infection, peritonitis, hernia, pulmonary complications
- Complications for Peritoneal Dialysis: exit-site infection, peritonitis, hernia, pulmonary complications
- Nursing Interventions for Hemodialysis: checking blood pressure and pulse every 30-60 minutes; weighing patient before and after dialysis, monitor intake and output, monitor for signs of disequilibrium syndrome, headache, hypertension, restlessness, mental confusion, and nausea; watch for signs of bleeding, avoiding taking blood pressure on AV fistula site, avoid blood extraction on AV fistula site, provide diversion activities throughout the dialysis process
- Nursing Interventions for Peritoneal Dialysis: monitor vital signs and observe for changes in behavior, ensuring catheter patency; adding procaine HCI to dialysate to minimize discomfort, observing for signs of peritonitis, maintain aseptic technique during catheter insertion and throughout the procedure.
- Continuous Renal Replacement Therapies: hemofilter, indications (acute or chronic kidney failure, fluid overload with oliguric kidney disease, high metabolic/nutritional needs), Continuous Venovenous Hemofiltration (CVVH), Continuous Venovenous Hemodialysis (CVVHD)
- Kidney Transplantation: from living donor or cadaver, transplanted kidney placed in iliac fossa anterior to iliac crest, ureters anastomosed to the ureter of the recipient
- Preoperative Management: bringing patient's metabolic state to a normal level, complete physical examination, tissue typing, blood typing, antibody screening, assessing lower urinary tract for bladder neck function and ureteral reflux, ensuring patient is free from infection, psychological evaluation, corticosteroid evaluation, and hemodialysis before transplant
- Preoperative Nursing Interventions: management like elective abdominal surgery, preoperative teaching (postoperative pulmonary hygiene, pain management options, dietary restrictions, intravenous and arterial lines, tubes, early ambulation)
- Postoperative Management: maintaining homeostasis until transplanted kidney functioning well, immunosuppressive therapy (azathioprine, corticosteroids, cyclosporine, OKT3, Prograf, Mycophenolate), tapering immunosuppressive drugs over several weeks, patient must take anti-rejection medication
- Rejection & Failure: Hyperacute rejection (within 24 hours, immediate antibody-mediated reaction, generalized glomerular capillary thrombosis, necrosis, immediate removal of organ), Acute rejection (within 3 to 14 days, tenderness at transplant site, decrease in serum creatinine, malaise, fever, oliguria, early recognition and immunosuppressant therapy), Chronic rejection (after, fatigue, generalized edema, anuria or decreased urine output, tenderness at transplant site, immunosuppressive therapy), diagnostic tools (ultrasound, percutaneous renal biopsy, X-ray)
- Drugs: azathioprine, belatacept, cyclosporine, everolimus, mycophenolate mofetil, prednisone, sirolimus, tacrolimus
- Postoperative Nursing Interventions: assessing for signs and symptoms of rejection, oliguria, edema, fever, increasing blood pressure, weight gain, swelling or tenderness over the transplanted kidney or graft, assessment of serum creatinine, BUN, leukocytes and platelets, distinction between infection and rejection
- Monitoring for Infection: protecting client from hospital staff, visitors, and others with active infections, careful hand washing is imperative, face mask may be worn, clinical manifestations (shaking chills, fever, tachycardia, tachypnea, either an increase or a decrease in WBCs, or leukopenia), practice strict aseptic technique
- Update: new research from Stanford University, new approach to prevent rejection without immunosuppressive drugs, transplantation with the usual process and addition steps, blood stem cells from the donor, immune cells recognize donor organ as friend, monitoring recipient's hybrid immune system, slowly weaning patient away from immunosuppressive drugs
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Description
This quiz provides a comprehensive overview of renal replacement therapies, including hemodialysis, peritoneal dialysis, and continuous renal replacement therapy. Explore critical concepts such as the mechanisms of dialysis, indications for treatment, and access methods for hemodialysis. Perfect for nursing students and healthcare professionals looking to deepen their understanding of kidney replacement options.
