Podcast
Questions and Answers
Which of the following best describes the primary mechanism by which waste products are removed during hemodialysis?
Which of the following best describes the primary mechanism by which waste products are removed during hemodialysis?
- Osmosis
- Pinocytosis
- Active transport
- Diffusion (correct)
A patient undergoing hemodialysis suddenly develops tachypnea, chest pain, and anxiety. What is the MOST appropriate immediate nursing intervention?
A patient undergoing hemodialysis suddenly develops tachypnea, chest pain, and anxiety. What is the MOST appropriate immediate nursing intervention?
- Clamp the access tubing, reposition the patient in left-side Trendelenburg, and administer high-flow oxygen. (correct)
- Administer antihypertensive medication to stabilize blood pressure.
- Increase the ultrafiltration rate to remove excess fluid.
- Slow the rate of dialysis and notify the physician.
Why is heparin typically administered to a patient undergoing hemodialysis?
Why is heparin typically administered to a patient undergoing hemodialysis?
- To increase blood pressure during the procedure.
- To reduce clotting within the dialysis circuit. (correct)
- To prevent infection at the access site.
- To correct electrolyte imbalances.
Which of the following assessment findings would warrant withholding antihypertensive medication prior to a hemodialysis session?
Which of the following assessment findings would warrant withholding antihypertensive medication prior to a hemodialysis session?
What is the primary cause of disequilibrium syndrome in patients undergoing initial hemodialysis treatments?
What is the primary cause of disequilibrium syndrome in patients undergoing initial hemodialysis treatments?
Which vascular access site for hemodialysis is generally considered the MOST sustainable long-term option, assuming the patient's vasculature allows?
Which vascular access site for hemodialysis is generally considered the MOST sustainable long-term option, assuming the patient's vasculature allows?
A patient with a newly placed arteriovenous fistula (AVF) reports numbness and tingling in the hand on the same arm as the AVF. What complication should the nurse suspect?
A patient with a newly placed arteriovenous fistula (AVF) reports numbness and tingling in the hand on the same arm as the AVF. What complication should the nurse suspect?
During hemodialysis, ultrafiltration is used to remove excess fluid. Which physiological principle BEST describes this process?
During hemodialysis, ultrafiltration is used to remove excess fluid. Which physiological principle BEST describes this process?
Flashcards
Hemodialysis
Hemodialysis
Mimics kidney function by removing waste, excess water, and correcting electrolyte imbalances.
Central Venous Catheter
Central Venous Catheter
Temporary access to circulation, often used in acute situations.
Arteriovenous Fistula (AVF)
Arteriovenous Fistula (AVF)
Surgical connection of an artery and vein to create a large access point for dialysis.
Arteriovenous Graft (AVG)
Arteriovenous Graft (AVG)
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Heparin during Dialysis
Heparin during Dialysis
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Diffusion in Dialysis
Diffusion in Dialysis
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Ultrafiltration
Ultrafiltration
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Disequilibrium Syndrome
Disequilibrium Syndrome
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Study Notes
- Hemodialysis mimics kidney function using a closed system outside the body.
- Hemodialysis removes waste products and excess water.
- Hemodialysis corrects electrolyte abnormalities.
- Hemodialysis restores the acid-base buffer system.
- Hemodialysis requires access to client circulation.
- Hemodialysis requires a semi-permeable membrane (dialysis machine).
- Hemodialysis requires a dialysis solution (highly purified water, electrolytes, dextrose).
Access Site Options
- Central Venous double lumen catheter is a temporary solution, which is used for acute situations.
- Arteriovenous fistula is a peripheral vascular system where a surgeon has anastomosed the radial artery with the cephalic vein.
- Arteriovenous fistula creates a large access point underneath the skin.
- Arteriovenous graft implanted when the peripheral vascular system is not intact or fragile.
Dialysis Procedure
- Access the client's circulation.
- Administer heparin to prevent clotting at the access site.
- Heparinized blood flows through a semipermeable membrane in one direction.
- Dialysis solution flows in the opposite direction.
- Wastes are removed and electrolytes corrected via diffusion.
- Ultrafiltration removes excess water from the blood.
- Blood returns to the client via the access site after it has been cleansed.
- Typical dialysis procedure takes approximately 4 hours.
Nursing Interventions During Dialysis
- Administer anticoagulants.
- Monitor for bleeding.
- Assess vital signs frequently.
- Hypotension may occur due to excess fluid removal.
- Withhold antihypertensives prior to hemodialysis to prevent hypotension.
- Obtain blood pressure on the arm opposite the client's fistula or graft.
- Provide appropriate nutrition since the client can eat before or during dialysis (e.g. for diabetics).
Suspected Air Embolism - Assessment Findings
- Tachypnea (rapid breathing)
- Chest pain
- Anxiety
- Changes in sensorium (mental status)
- Hypotension (low blood pressure)
- Reduced O2 Saturation
Suspected Air Embolism - Interventions
- Immediately clamp the access tubing.
- Reposition the client in the left-side Trendelenburg position.
- Administer high-flow oxygen (O2).
- Notify Healthcare Provider (HCP) immediately as it is a medical emergency.
Suspected Disequilibrium Syndrome
- Results from sudden changes in the composition of the extracellular fluid.
- Solutes are removed from the blood faster than from the cerebrospinal fluid and the brain.
- Disequilibrium Syndrome creates an imbalance between extracellular and intracellular fluid.
- Disequilibrium Syndrome is more common in new clients during initial hemodialysis sessions.
Suspected Disequilibrium Syndrome - Clinical Manifestations
- Nausea and vomiting
- Headache
- Restlessness and agitation
- Confusion, seizure, and potential death
Suspected Disequilibrium Syndrome - Nursing Interventions
- Slow or stop dialysis if symptoms occur.
- Notify the Healthcare Provider (HCP) immediately.
- Reduce environmental stimuli.
- Prepare to administer high osmolar substitutes.
- Administer IV hypertonic saline.
- Administer IV mannitol.
- Prepare to dialyze for shorter periods at reduced flow rates to prevent recurrence.
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