Hemodialysis Study Guide PDF

STUDY GUIDE – MEDICAL SURGICAL HEMODIALYSIS The process of Hemodialysis mimics the function of the kidneys by using a closed system outside the client's body by: removing waste products removing excess water corrects electrolytes abnormalities...

STUDY GUIDE – MEDICAL SURGICAL HEMODIALYSIS The process of Hemodialysis mimics the function of the kidneys by using a closed system outside the client's body by: removing waste products removing excess water corrects electrolytes abnormalities It restores acid-based buffer system with the following requirements 1. access to the client circulation 2. Semi permeable membrane (dialysis machine) 3. Dialysis solution (highly purified water, electrolytes, dextrous) Access Site 1. Central Venous double lumen catheter (temporary acute situation) 2. Arteriovenous fistula - peripheral vascular system - surgeon has anastomosed the radial artery with the cephalic vein to create a large an access point underneath the skin 3. Arteriovenous graft - if peripheral vascular system is not intact or fragile; a synthetic graft is implanted Dialysis Procedure (approximately 4 hours) 1. Access on the client's circulation 2. Administer heparin to the client - necessary to prevent or reduce clotting on the access site. 3. Heparinized blood flows through a semipermeable membrane in one direction. 4. Dialysis solution flows in the opposite direction. 5. Wastes are removed and electrolytes are corrected via diffusion 6. Ultrafiltration remove excess water from the blood. 7. Blood returns to the client via the access life after it has been cleansed. Nursing Interventions 1. Administer anticoagulants. 2. Monitor for bleeding. 3. Assess vital signs frequently. Hypotension may occur due to excess fluid removal. 4. Withhold antihypertensives prior to hemodialysis as this may trigger hypotension. 5. Obtain blood pressure on the arm opposite of the client's fistula or graft. 6. Provide appropriate nutrition since the client can eat before or during dialysis. (e.g. diabetic) Suspected Air Embolism Assessment Findings Tachypnea Chest pain Anxiety Changes in sensorium Hypotension REduced O2Sat Interventions Immediately clamp the access tubing Reposition the Client left-side Trendelenburg Administer high - flow O2. Notify HCP (medical emergency) Suspected Disequilibrium Syndrome Results from sudden in the composition of the extracellular fluid Solutes are removed from the blood faster than the cerebrospinal fluid and brain. This creates a gross imbalance between extracellular and intracellular fluid. More common in a new client during initial hemodialysis sessions. Clinical manifestations Nausea, vomiting Headache Restlessness and agitation Confusion - seizure -- death Nursing Interventions Slow or stop dialysis Notify HCP immediately Reduce environmental stimuli Prepare to administer high osmolar substitutes IV hypertonic saline IV mannitol Prepare to dialyze for shorter periods at reduced flow rates to prevent recurrence