Dialysis and Renal Transplant

Nursing Care for HD (Types)

• AV Fistula

  • Permanent Access

  • Needs to mature for months

  • NO BP IV STICKS OR BLOOD DRAWS

  • Once Mature should be large, buldging, and tortuous looking

• AV Graft

  • 2-3 year Access

  • 2-3 week maturation (shorter)

  • Higher risk for infection, thrombus, stenosis (complications)

• On Assessment of AV Fistula/Graft

  • Hear a Bruit and Feel a Thrill

    • Bruit: whoosh sound on auscultation

    • Thrill: turbulent flow felt on papation

    • If absent notify HCP

• CV Catheter

  • Temporary Access

Nursing Care for HD (process)

• Risk of Infection

  • Note temp, color, and drainage

• Perfusion?

  • Note temp, Cap refill, Neuropathy

• Monitor Vital signs

  • Before, during (q 30 mins), and after

• Take weight before & after

  • Tell us how much to dialyze

• Blood Pressure

  • Risk of Hypotension due to rapid removal

• Electrolytes

  • May have muscle cramps, HA, Nausea, dizzy

• Monitor for FVE Before and FVD after

• Bleeding risk

  • Heparin is admitted to prevent clots in the machine

Nursing Care with PD

• Asses site for S/S of infection (peritonitis)

  • Redness, cloudy drainage, tenderness, Fever, Tachycardia, increase WBC

• Assess for Respiratory Distress

  • Diaphragm is pushed up

  • Raise HOB

  • Pneumonia, Atelectasis, crackles, tachypnea, SOB

• Warm the Diaysate to body temp

• Monitor Weight before/after

• Sterile Technique

• Monitor Color of waste

  • WNL = clear/straw colored

• Monitor for hyperglycemia

• Make sure tubing isn’t kinked

• Assess abdominal girth

• Monitor the outflow

What can a decreased outflow in PD indicate?

Kinked/malpositioned catheter.

Reposition the catheter, turn the patient to the side, gentle abdominal massage

Patient Education

• Increase Dietary Protein

• Limit Salt/Water

• Avoid submerging the shunt in water

• May or may not produce urine

• PD

  • Hand hygiene

  • examine the site

  • warm dialysate

  • increase the height of the dialysate

  • check for kinks

  • Reposition if necessary

Kidney Transplant Patient Education

• Lifelong treatment of DM, HTN, CAD

• Immunosuppressive therapy

  • risk for infection and cancer

• Avoid exposure to potentially infectious environments or persons

Rejection of Kidney Transplant

• Increase dose of immunosuppressives

• s/s

  • Fever, Decreased Urine, ^ Creatinine & BUN, protein, blood, casts in urine

  • Fatigue, SOB, Flank pain

  • HTN, n/v, confusion - Sodium

  • Increase in weight

Post Transplant Care

• VS/O2/Temp/Pain

  • Hypotension if bleeding

  • Decreased O2 if atelectasis, pneumonia

  • Temp increase = infection

• Incision

  • Assess for rejection

• Renal Functions

• Monitor INO

  • May have increased urine output

• Give Immunosuppressives and Pain meds

Action when rejection of transplant is suspected?

Increase immunosuppressive therapy