Section 5: Renal Replacement Therapy

NUR 433: Adult Health II; MCUSON; Mrs. Cooper

when to start renal replacement therapy (RRT): AEIOU. what does A stand for

acidosis

acidosis is pH<_____ despite treatment

7.20

when to start renal replacement therapy (RRT): AEIOU. what does E stand for

electrolytes

_____ that won’t come down

hyperkalemia

when to start renal replacement therapy (RRT): AEIOU. what does I stand for

intoxication

intoxication with a _____ drug or poison

dialyzable

when to start renal replacement therapy (RRT): AEIOU. what does O stand for

overload

overload of fluid that _____ can’t fix

diuretics

when to start renal replacement therapy (RRT): AEIOU. what does U stand for

uremia

uremia: _____, pericarditis, and bleeding

encephalopathy

Clinical status matters more than any single lab value; _____ usually starts before uremic complications appear

dialysis

how dialysis works: _____ occurs when solutes move across a semipermeable membrane from high to low concentration (urea, creatinine, potassium out of the blood)

diffusion

how dialysis works: _____ occurs when water is pulled off by a pressure gradient

ultrafiltration

how dialysis works: _____ occurs when solutes are dragged along with the water being removed ("solvent drag")

convection

_____ _____ is best for stable patient needing rapid K+ or fluid removal

intermittent hemodialysis (HD) (3-4 h)

some key nursing concerns for intermittent HD (3-4 h) include Hypotension, cramps, dysrhythmias, blood loss, disequilibrium syndrome; hold _____ and dialyzable drugs before HD as ordered

antihypertensives

_____ _____ _____ is best for fluid overload only

slow continuous ultrafiltration (SCUF)

a key nursing concern for SCUF _____ removal

minimal

_____ _____ _____ is best for fluid and solute removal by convection

continuous venovenous hemofiltration (CVVH)

a key nursing concern for CVVH is replacement _____ pre- or post-filter

fluid

_____ _____-_____ ______ is best for fluid and solute removal by diffusion

Continuous Veno-Venous Hemodialysis (CVVHD)

a key nursing concern for CVVHD is when _____ runs countercurrent to blood

dialysate

_____ _____ _____ is best for maximal fluid and solute clearance

Continuous Venovenous Hemodiafiltration (CVVHDF)

a key nursing concern for CVVHDF is _____ plus replacement fluid

dialysate

_____ _____ _____ _____ _____ is best for patient stabilizing, coming off CRRT

Prolonged Intermittent Renal Replacement Therapy (PIRRT) (6-18 h)

a key nursing concern for PIRRT (6-18 h) combines convection and _____

diffusion

_____ _____ is rarely used for AKI

peritoneal dialysis

a nursing concern for peritoneal dialysis is _____ (cloudy effluent), hyperglycemia, and breathing compromise

peritonitis

Priority: a patient on vasopressors needs _____, not intermittent HD. CRRT removes fluid slowly and continuously, so it doesn’t drop the blood pressure

CRRT

_____ _____ _____: urea leaves the blood faster than it leaves the brain, so water shifts into brain cells. Signs: headache, nausea, vomiting, restlessness, confusion, seizures. Prevent it with shorter, slower first treatments

Dialysis disequilibrium syndrome

CRRT nursing care: every _____ intake and output, ultrafiltrate volume, vital signs, hemodynamics, temperature (the circuit cools the blood) need to be monitored

hour

CRRT nursing care: every _____-_____ hours, check the filter for clotting: dark fibers, falling ultrafiltrate, rising pressures. Change the filter every 24–48 h

24-48

CRRT nursing care: labs - CRRT removes phosphorus, calcium, potassium, and magnesium. With citrate anticoagulation, follow ionized calcium and watch for metabolic _____

alkalosis

CRRT nursing care: nutrition - Add ___-___ g/day of protein to replace amino acids lost in the circuit

10-15

Priority: pink or bloody ultrafiltrate means the filter membrane has _____. Stop the treatment and notify the provider.

ruptured