Dialysis (powerpoint)

Functions of Dialysis

  • Fluid and Electrolyte Regulation: Helps rid the body of excess fluid and electrolytes.
  • Acid-Base Balance: Achieves equilibrium of body's acid-base levels.
  • Waste Elimination: Removes waste products from the blood.
  • Homeostasis Restoration: Uses osmosis, diffusion, and ultrafiltration to restore internal balance.

Types of Dialysis

  • Hemodialysis: Involves the use of a dialyzer to filter blood.
  • Peritoneal Dialysis: Uses the peritoneum as a filtration membrane.
  • Continuous Renal Replacement Therapy (CRRT): Specialized for unstable patients.

Hemodialysis

Definitions
  • Shunt Blood: Blood is removed from the body, filtered through a dialyzer, and returned to circulation.
  • Vascular Access: Requires special access to the vascular system (e.g., AV fistula).
Indications for Hemodialysis
  • Renal insufficiency
  • Acute renal failure
  • Chronic renal failure
  • Drug overdose
  • Persistent hyperkalemia
  • Hypervolemia unresponsive to diuretics
Preprocedural Steps
  • Assess Access Site: Check for patency by listening for bruit, palpating for thrill, and checking distal pulses.
  • Essential Checks: Vital signs, laboratory values (BUN, creatinine, electrolytes, Hct), and weight.
  • Medication Review: Discuss any necessary medication adjustments with the provider.
  • Patient Education: Explain that sessions last 3-5 hours, typically three times a week.
Intraprocedural Care
  • Monitoring: Vital signs and laboratory values should be monitored throughout the procedure.
  • Anticoagulation Monitoring: Monitor coagulation; have protamine sulfate ready if needed.
  • Patient Comfort: Provide activities to occupy the client and emotional support.
Post-Procedure Monitoring
  • Expectations: Decrease in BP, weight, and lab values expected after dialysis.
  • Watch for Complications: Monitor for hypotension, bleeding, and indicators of infection.
Client Teaching
  • Care of Access Site: Instruct on checking the access site for bleeding, and avoiding heavy lifting or pressure on the arm.
Complications of Hemodialysis
  • Access Site Issues: Infection and clotting; monitor for signs.
  • Disequilibrium Syndrome: Early signs include nausea and agitation; slow the dialysis exchange rate.
  • Hypotension Management: Adjust fluid volumes gradually; notify nurse if experiencing symptoms during dialysis.
  • Anemia Management: Administer erythropoietin as prescribed and monitor blood levels.

Peritoneal Dialysis

Overview
  • Process: Instills dialysate into the peritoneal cavity, using the peritoneum for filtration.
  • Indications: Patients unable to tolerate hemodialysis or with vascular access difficulties.
Preprocedural Steps
  • Assessment: Assess dry weight, serum electrolytes, and ability to perform self-dialysis.
  • Patient Instruction: Explain sensations and discomfort during the procedure, if any.
Intraprocedural Monitoring
  • Vital Signs: Monitor frequently along with inflow/outflow discrepancies of dialysate.
  • Infection Signs: Look for fever, cloudy outflow, etc., indicating possible complications.
Post-Procedure Teaching
  • Home Care: Educate on self-care of access sites and conducting exchanges at home.
Complications of Peritoneal Dialysis
  • Peritonitis: Ensure aseptic technique and monitor for related symptoms (e.g., fever, redness).
  • Other Complications: Monitoring for protein loss, hyperglycemia, and mechanical issues.

Practice Questions (NCLEX Style)

Practice Question 1: Prior to Hemodialysis Actions
  • Assess AV fistula for bruit and check medications.
Practice Question 2: Post Hemodialysis Actions
  • Check laboratory values, assess headache/confusion, check access sites.
Practice Question 3: Continuous Ambulatory Peritoneal Dialysis Dwell Time
  • Understand typical dwell times for CAPD (e.g., 4-8 hours).