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What is Dialysis?
Movement of fluid and molecules across a semipermeable membrane from one compartment to another.
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What are the two methods of dialysis?
Peritoneal Dialysis(PD) and Hemodialysis(HD)
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Expain Hemodialysis:
Requires permanent access to the bloodstream through a fistula.
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What is a fistula:
An unusual opening between two organs. They are ofter created near the wrist and connected to an artery and a vein.
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Explain Peritoneal Dialysis:
uses the peritoneal cavity a semipermeable membrane and is less efficient than hemodialysis.
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When does dialysis normally begin?
When the GFR (or creatinine clearance) is less than 15ml/min.
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Diffusion is:
Movement of solutes from an area of greater to an area of lesser concentration.
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Osmosis:
Movement of fluid from an area of lesser to an area of great concentration of solutes.
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Untrafiltration:
(Water and Fluid removal) results when there is an osmotic gradient or pressure gradient across the membrane.
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What are the three phases of the PD cycle?
- Inflow (fill)
- Dwell (equilibration)
- & Drain
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Inflow:
a certain amount of solution is infused through an established catheter over 10 minutes.
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Dwell:
Diffusion and osmosis occur between the patients blood and the peritoneal cavity. Takes 20-30 minutes or as much as 8 hours.
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What are the 2 types of Peritoneal Dialysis?
- Automated Peritoneal Dialysis (APD)
- Continuous Ambulatory Peritoneal Dialysis (CAPD)
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Automated Peritoneal Dialysis
A cycler is used to deliver the dialysate. It is times and controls the fill, dwell, and drain. This is safe to use at night.
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What are the 2 most common infections of the peritoneal cath exit site?
- Staph. Aureus
- & Staph. Epidermidis (from skin flora)
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For heomdialysis what are the types of vascular access?
- Arteriovenous fistulas (AVF)
- Arteriovenous grafts (AVG)
- Temp. and semipermanent caths
- Subcutaneous ports
- Shunts
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Disequilibrium Syndrome:
A reslut of very rapid change in the composition of the extracellular fluid. Symptoms: nausea, vomiting, confusion, restlessness, headaches, twitching, jerking, and seizures.
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What is the main nursing goal to help the patient on dialysis?
Help the patient regain or maintain positive self-esteem and control of his or her life to continue to be productive in society.
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Complications of Hemodialysis:
- Hypotension
- Muscle Cramps
- Blood Loss
- Hepatitis
- Sepsis
- Disequilibrium Symdrome
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What kind of diet does a patient on hemodialysis need?
- High Quality protein
- Low potassium
- Low sodium
- Low phosphate
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Difference between AV fistula and a graft:
AV fistula much less likely to clot than grafts but takes longer to be used for dialysis. Neither of them impact needle size or patient moblilty.
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Why do you need thrill and bruit in the fistula site?
Indicates adequate blood flow through the fistula.
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If you have had a chronic kidney disease and are on dialysis now what food changes will be made?
more protein will be allowed in the patients' diet.
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What is a plus to using CAPD verses HD?
Diabetic patients will have fewer dialysis related complications with CAPD
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What things should be monitored after kidney transplant?
Urine output hourly, BUN, Creatinine, Electrolytes, incision, VS, and fluid volume status.
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