-
What are some causes of hypertension?
Fluid overload, non-adherence to medication schedule, renin response, Epogen side effect, anxiety, tension, DDS
-
What are some of s/s of hypertension?
Increased EP, headache, dizziness, edema, irritability, blurry vision, nervousness, or might even be asymptomatic
-
What are interventions for hypertension?
Evaluate source of HTN, promote fluid and medication compliance, identify source of stressors and promote resolution.
-
What are some preventions for hypertension?
Promote fluid and medication adherence
-
Systolic less than 90, diastolic less than 60, or systolic drop of 20 is indicative of ?
Hypotension
-
A pre-TX b/p of >140/90, post-tx. >130/90 are indicative of ?
Hypertension
-
What is the effect of hypotension organ stunning on the heart?
Acute stress on CV system, development of LV regional wall motion.
-
What is the effect of hypotension organ stunning on the gut?
Release of endotoxin in circulation, inflammation,
-
What is the effect of hypotension organ stunning on the kidneys?
Causes fibrosis, loss of RRF
-
What is the effect of hypotension organ stunning on the brain?
Causes multiple sites of white matter injury.
-
Vascular filling is slower than rapid fluid loss, Low blood volume, antihypertensive drugs, food ingestions, and cardiac disease are causes of ?
Hypotension
-
What are the s/s of hypotension?
SOB, N, V, cold, clammy skin, restlessness, rapid, shallow respirations, excessive yawning, diaphoretic
-
What are the interventions of hypotension?
- Set in flat supine position
- Min. UF active
- O2 administration per MD
- 100-200 NS IV
- Monitor B/P
- Oral Fluids(if less severe)
-
What are some prevention measures for hypotension?
Extended TX time, pure UF, frequent assessment of target weight, <13ml/kg/hr
-
Assisting with stretching, Min UF active, O2, 100-200ML NS IV, assess target weight are interventions of ?
Muscle cramps
-
Dietary control, UFR (<13ml/kg/hr), a decrease in sodium loading, increase time, UF profiling are preventative measures of ?
Muscle cramps
-
S/S of Muscle Cramps
Painful muscle contractions (extremites or ABD), (usually occurs late in dialysis)
-
What are some causes of muscle cramps?
Excessive or rapid fluid removal, tissue ischemia, electrolyte imbalance, increase in excercise, hyperthermia
-
___ degrees of temp from baseline is considered a fever?
2
-
What are s/s of fever?
Cold, shaking, fever, hypotension, headache, N,V.
-
What are s/s of pyrogenic effect?
Chills, shaking, fever, hypotension, vomiting, muscle pain
-
Do you continue tx with a pyrogenic reaction?
No
-
What is a seizure?
Involuntary muscle spasms and loss of consciousness
-
What are some causes of seizures?
Removal of anticonvulsives by dialysis(too closelt
-
Whata are s/s of seizures?
Changes in conciousness, twitching, jerking
-
What is jerking, change in consciousness, twitching s/s of ?
Seizures
-
How does changes in the dialysate temp. affect fever/chills?
If the dialysate temp is greater than the Pt's pre-temp
-
What should you do in the case of seizure?
- Protect the PT
- Treat hypotensions
- Assess for DDS
- Assess for hypoglycemia
- Admin. O2
- D/C TX(if there is no response from PT)
-
What is DDS
- Dialysis Disequilibrium Syndrome
- Condition in which rapid or changes in the PT's extracellular fluid affect the brain
-
What are some common causes of DDS?
- New PTs
- Skipping and/or shortening TXs
-
What are some S/S for DDS?
- Blurry Vision
- HTNHeadache
- Nausea
- Vomiting
- Arrythmias
-
What intervention are taken for DDS?
- Early recognition
- Decreased effectiveness of dialysis (Decrease BR, DFR, or TX time)
- D/C TX if severe
-
What are some signs of a clotted dialyser?
Low VP, unable to rinse back, dark blood, visible clots, frequent BFR alarms, high Hb
-
What is hemolysis?
Bursting of RBCs
-
What are some causes of Hemolysis?
High neg. pre-pump arterial pressure, chlorine/chlormines, exposure to disinfectant, hypotonic dyalsate
-
What are the s/s of hemolysis?
Cherry, blood, anxiety, restlessness, pain/burning in access, N/V, ABD cramps, chest tightness, dyspnea
-
What are some causes of First Use Syndrome?
- ETO reaction,
- Sensitivity to membrane material
- Immune response activations (complement)
-
What is First use Syndrome?
Group of symptoms occurring shortly after starting TX with a new dialyser
-
What are the s/s of first use syndrome?
Severe s/s occurs within 5-10 min. less severe w/in 20-40 min. chest pain, and or back pain, dyspnea, hypotension, nausea, general discomfort
-
What are interventions for First Use syndrome?
- Symptoms management
- D/C if severe
- O2 admin. for resp. complications
- Antihistamines
-
Do you return a PT with disinfectant infusion?
NO, please
-
S/S of First use syndrome?
- Pain at venous needle
- Itching
- Restlessness
- Resp. distress
- Flushing
- Chest pain
- Tingling around the lips
- Back pain
-
What are First Use syndrome Interventions?
- Stop the pump,
- Clamp lines, Do not return, assess VS, attach new NS bag
-
What are some causes of Air embolisms?
Empty bag, or seperation in lines
-
Air in venous, chest pain, difficulty breathing, convulsions, seizures are s/s of ?
Air embolisms
-
Preventions or air embolism
- Verify air detector is armed, verify, enough NS in bag for rinse back
- Fill drip chamber
-
SOB, wheezing or stridor, tachycardia, hives, itching, low back pain, periorbital edema, hypotension, anxiety, restlessness, chest pain, and eventually cardiac arrest are s/s of ?
Anaphylaxis
-
Beginner cannulator:
<__ mths. of HD experience, <___ cannulations
-
Intermidiate Cannulator:
=>__mths cannulation experience, at least __ successful cannulation
-
Expert cannulator:
Completed _____ skils competancies and trainings, expert assessment, and cannulation skills.
NFACT
-
A newly matured AVF is defined by
Post-op exam by surgeon or nephrologist, meets KNOQI rule of 6
-
Definition of mature AVF
Tolerated max needle gauge and BFR for > o equal to 3 TXs, > or equal to 6 till intermidiate cannulator can access
-
What defines an established AVF?
Cannuated for greater or equal than 2 months without s/s of dysfuntion
-
Needle gauge of AVF initial cannulation.
17G
-
What is HeRO acess?
Give when a vein is unable to connect to connect to arterial end. either because of lack of patent veins or distance.
-
Is the use of a tourniquet allowed for AVF?
Yes
-
What does BESTIPS stand for ?
- Bleeding
- Erosion
- Stenosis
- Thrombosis
- Infection
- Pseudoaneurysms
- Steal Syndrome
-
What is Steals Syndrome?
Condition in which hand (cannulation arm) isn't receiving enough blood due to poor flow. Usually end to end
-
Using clamps, check for flow every ____ min.
5-10
-
___ wks for good site rotations/healing time, avoiding aneurysms
2
-
Distance from the anastomosis and needle tips to avoid recirculation?
1.5 in.
-
__ episodes of hypotension per week increases mortality to 70%
2
-
A ____ covers a surface area of blood that equals 20ml of blood
fist
-
Catty is a 24 y/o, WD, males who routinely goes to the gym prior to dyalsis. Target weight: 88.5, Weight:92.5. You set the machine to remove 4kg in 3.5 hrs. B/P is 130/88. At one hr, Catty complaints of ABD pain
What condition is this?
Muscle cramps
-
On Saturday, the reuse technician was unable to reprocess dialyzers, refrigerate them accordingly, and perform reprocessing on Sunday evening after the BioMed had disinfected the water loop Sunday morning.
Monday morning, 2 PTs experience a drop in B/P, 4 PTs experienced fevers, and one was diaphoretic and SOB.
What condition is occurring?
Pyrogenic Reaction
- Intervention: Stop TX, obtain blood cultures, obtain LALs, sequester system (Red bag labeled PT name, date, NOT FOR PT USE)
- Store in the lab refrigerator
-
Today you have 8 PTs on the morning shift and 3 complained of a headache, one of nausea, and another of restlessness. Their intradialytic weight gain were 2.7 with 3 and 4-grade edema. All Pre-dialysis b/p greater than 140/90
What condition are they experiencing
Hypertension
Although 2.7 weight gain isn't alarming, edema must be taken into consideration due to the fluid shift
-
Nancy was just D/C'd from the hospital with a femoral cathetor
|
|
