Recording,edsurg lecture-2025-03-13T18:07:13.447Z

Dialysis and Patient Care

• Dialysis Access

  • Critical importance of access as it is the patient's lifeline.

  • Patients should wear a bracelet indicating "do not use this extremity."

  • Without access, dialysis cannot be performed, risking the patient's life.

• Types of Dialysis Access

  • Fistula: A surgical connection between an artery and a vein.

  • Graft: A piece of synthetic tubing used to connect artery and vein.

• Nursing Assessments for Dialysis Access

  • Feel the Fluid: Assess the thrill and bruit to ensure access is functioning properly.

  • Post-Dialysis Assessment: Assess the patient's neurologic status and check for hypotension.

• Immediate Post-Dialysis Priorities

  • Check blood pressure and ensure it is within normal range to avoid hypotension.

  • Perform lung auscultation and ensure patient’s condition is stable from when they left for dialysis.

Peritoneal Dialysis

• Procedure Overview

  • Involves inserting a catheter into the abdominal cavity (peritoneum).

  • The peritoneum acts as a semipermeable membrane.

• Dialysate

  • Contains electrolytes (potassium, magnesium, calcium).

  • Used in the process to remove excess potassium from the patient’s system.

• Dwell Time

  • Time the dialysate remains in the abdomen before it is drained and replaced.

Kidney Transplants

• Surgical Procedure

  • The old kidney is not removed; the new kidney is placed in the lower abdomen.

  • Immediate urine production is typically observed after surgery, indicating function.

• Post-Transplant Care

  • Emphasis on adherence to immunosuppressant medications to prevent transplant rejection.

Eye Disorders: Cataracts

• Characteristics

  • Cloudiness affecting lens of the eye leads to decreased visual acuity, occurs gradually and usually painless.

• Treatment Options

  • Nonsurgical: Changes in eyewear, increased lighting, magnifiers.

  • Surgical: Lens removal and replacement with an implant.

  • Post-surgery care includes antibiotic drops, corticosteroid usage, and maintaining a head elevated position to prevent increased intraocular pressure.

Eye Disorders: Glaucoma

• Overview

  • Condition leading to increased intraocular pressure that can cause vision loss.

  • Common in those over 40, particularly with diabetic or hypertensive histories.

• Types

  • Open-angle glaucoma: Gradual loss of peripheral vision, often painless.

  • Closed-angle glaucoma: Sudden onset with severe pain, requires urgent intervention.

• Management

  • Eye drops to reduce intraocular pressure; surgical options available (trabeculoplasty).

Meniere's Disease

• Characteristics

  • Inner ear disorder characterized by episodic vertigo, dizziness, hearing loss, fullness in the ear, and tinnitus (ringing in the ear).

• Treatment

  • Managed with antihistamines, anticholinergics, antiemetics, and dietary sodium restrictions.

Increased Intracranial Pressure (ICP)

• Signs and Symptoms

  • Change in LOC, pupil size discrepancies, impaired eye movement, headaches, and Cushing's triad (increased systolic BP, decreased pulse, irregular respiratory patterns).

  • In infants, bulging fontanels and high-pitched crying due to discomfort.

• Management

  • Glasgow Coma Scale assessment is critical for monitoring.

  • Treatment may include diuretics, corticosteroids, and ensuring head elevation to manage ICP.

Head Injury and Hematomas

• Warning Signs

  • Change in LOC, potential seizures, visual disturbances.

• Types of Hematomas

  • Epidural: Rapid formation due to arterial tear; lucidity followed by deterioration.

  • Subdural: Venous bleed that can occur more slowly; requires monitoring over days.

  • Intracerebral: Bleed within the brain tissue, often linked to hypertension or trauma.

• Priority Actions

  • Immediate medical assistance is critical for all types of hematomas.

Study Tips and Important Concepts

• Prioritize understanding unique characteristics, symptoms, and management protocols for different conditions to excel in examinations, including NCLEX and other assessments.