CKD and Dialysis

what is uremia

accumulation of waste products in the blood with symptoms

what are the s/s of uremia

volume overload, dyspnea, anemia, uremic frost, confusion

what are the electrolyte levels for uremia

hyperphosphatemia and hypocalcemia

what does uremic frost indicate

pt needs dialysis

what are patients with uremia at risk for

infection

which is more indicative of kidney function: creatinine or BUN

creatinine

why is the urine dilute in CKD even if it is small amounts

kidneys cant concentrate urine

lab values for a patient in chronic renal failure

hyperkalemia (kidneys cant excrete), hyponatremia and hypocalcemia (fluid volume excess), decreased urine specific gravity

tx for hyperkalemia

kayexalate, insulin and D50, calcium gluconate

how can we slow the progression of CKD

tight control of BG, BP, and nutrition, kerendia

what are examples of antianemics given to pt with CKD

iron, epogen

why dont CKD pts typically recieve blood transfusions for low H&H

these patients have chronically low H&H and are used to it

diet for a patient with CKD

low protein, high carbs, low Na (no salt substitutes) phosphate and K+, fluid restriction

pt education for Na restriction in CKD patinets

avoid salt substitutes as they contain K+, follow DASH diet instead

what is often the first kind of dialysis a patient will receive

peritoneal

what is intermittent peritoneal dialysis

completed at night with a machine, pt is not very mobile

what is continuous ambulatory peritoneal dialysis

can be done 24/7 while the patient is mobile

what kind of access is used for peritoneal dialysis

catheter is inserted into the abdomen and uses the abdominal peritoneum as the semipermeable mebrane

what is dialysate

a hypertonic electrolyte fluid to pull fluids and waste out of the cells

what is the process for peritoneal dialysis

weight dialysate bag and hang it above the patient letting all the fluid go in, clamp the tubing and weight, lower bag below patient and let the fluid flow out, reweigh bag

how should the dialysate bag compare after peritoneal dialysis to before

bag should weigh more meaning it pulled off fluid and waste (negative fluid balance)

if the bag weighs less after peritoneal dialysis and there is positive fluid balance what interventions should take place

put the bag lower, check for kinks, have the pt turn side to side

what is the risk for peritoneal dialysis

infection

what are the advantages of peritoneal dialysis

can be used in emergent situations for unstable patients

what is the disadvantage of peritoneal dialysis

slow and time consuming

what kind of patients can receive hemodialysis

stable only

what is a risk associated with hemodialysis

infection and bleeding

what kind of access is used for hemodialysis

fistula and artifical kidney

how long to fistulas take to mature

up to 12 weeks

what is a fistula

arterialization of the vein

how does the nurse assess a fistula

feel a thrill, auscultate a bruit, feel distal pulses

nursing considerations for a patient with a fistula

no sticks, BP, or constrictive clothing on fistula side

what medication should be given prior to hemodialysis

heparin to prevent clotting of the artificial kidney

what are the advantages of hemodialysis

pulls of fluids and toxins of hemodialysis (risk for hypovolemia)