Studied by 8 people
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)
Note 
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