Noncuffed is for ____ term use. How many mos?
Cuffed is for ____ term use. How many mos?
- 1. short. < 1mos
- 2. long. more than 1 mos
True or False
We should start patient on hemodialysis if pt. has a low GFR
False. Hemodialysis is based on pt.'s symptoms, not GFR
Why is femoral not a common site for hemodialysis?
Because of hematoma, mobility restrictions, and infxn
The most common complication of post-dialysis is hypotension. Intervention?
Hold vasoactive drugs before HD
What are the most common access complications in HD?
Thrombosis (clotting)- thrombolytic drug, stricture - tx baloon angiolasty
What r the differences between AV fistula & AV graft? (HD)
What are AV fistula/graft precautions?
AV fistula is formed by connecting artery to vein. The increased pressure of the arterial blood flow into the vein causes the vessel walls to thicken (increases strength)
AV graft - synthetic material used to connect artery & vein
Precautions - assess for access circulation - thrill/bruit & assess distal pulse.
What is the anticoagulation used in Hemodialysis?
Heparin remains active in the body for 4-6 weeks. What is the pt. at risk for during or immediately after HD?
Heparin - prevents blood clots from forming within the dialyzer or blood tubing
Peritoneal Dialysis is convenient because it's mobile and you can move a lot more. But what is its disadvantage?
How much exchanges & how often should you give exchanges to patient?
Can insulin, abx be placed in diasylate?
Everytime you connect or disconnect it is an increase chance to peritonitis: cloudy urine, board-like pain, fever, malaise N/V
Depends on the patient's manifestations & lab data.
Who is ideal for peritoneal dialysis?
If hemodynamically unstable, cannot tolerate anticoagulation, vascular access problems, or PD until AV fistula matures, also older adults
What are the exclusion criteria for renal transplant?
What test is usually ordered after renal transplant? Why?
Advanced cardiac dz, cancer in the last 2-5 yrs, all metastatic cancer, chronic infxn, alcohol or other substance abuse
Renal scan. To assess renal function
When is nephrectomy usually done for?
What should we do first prior to nephrectomy?
When pt. has renal cell carcinoma, renal trauma
Arterial embolization because renal cell tmours are highly vascular
What is the tx for kidney dz d.o that shows signs of htn, edema & fluid overload? (i.e: Glomerulonephritis, PKD)
diuretic, sodium & water restriction (UOP + 500cc)
What usually precedes in acute GN? What is the recovery rate?
What are the diagnostic tools for acute GN?
Infection. Recovery rate is quickly & completely
- U/A to check proteinuria, hematuria.
- Diagnosed by renal biopsy
What are the tx for acute GN?
- Uremia - meds, dialysis, plasmapheresis PRN
- Fluid overload, HTN, edema - diuretics, Na & water restriction (UOP + 500)
- Infxn - abx
Tx for overflow incontinence?
Surgery to remove the obstruction or repair of genital prolapse
- Intermitten cath
- Bladder compression
Tx for urge incontinence
Drug to relax smooth muscle & increase bladder's capacity
Nutrition - avoid foods that have direct bladdedr stimulating or diuretic effect
- Behavioral interventions: bladder training (increase interveral by 15-30 min til bladder can tolerate more volume)
- habit training (for cognitively impaired) - void q2h. Goal is to pee before incontinence occur
What does CKD tx primarily focuses on?
Control the CAUSES OF CKD
Adhere to drugs, regular physical activity, water, avoid OTC & NSAIDs
Nursing int/tx for dysmenorrhea
- Prostaglandin synthetase inhibitors: NSAID
- Oral contraceptives
- Low fat & vegetarian diet,
- Thiamine, Ca, Mg, V1 & fish oil supplements
tx for endometriosis
- Oral contraceptives
- Ca & Mg supplements
Surgical - remove the endometrial implants
Nursing intv for fistula (reproductive system)
- Assist in perineal hygiene sitz bath
- Bladder, bowel training
- Wear disposable undergarment
What is the most common gynecological cancer? (major cause of pelvic pain & infertility)
What is the assessment finding for this?
Dx test for this?
Postmenopausal bleeding, palpable uterine mass or polyp
Transvaginal ultra sound & endometrial biopsy. Pap smear
If it's a benign & asymptomatic ovarian cyst, what is the tx
What is considered large?
Oral contraceptives to depress ovulation
Large is 6-8 cm. Evaluate for cancer. CT, MRI, laparoscopy
What are the early predictable metastasis of prostate cancer?
What is the late metastasis?
Nearby lymph nodes, bones of sacrum, pelvis, lumbar spine
Late - lungs, liver, adrenals, & kidneys
What diet risk factors predispose a patient to prostate cancer?
- Diet high in animal fat
- Vit D & E deficiency
Tx for prostate cancer
Prevent by having screening for men >50
Surgery: Prostate removal