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Renal 2 Exam

What is the general care of AV fistula or graft? No BP, blood draws, IV sticks in arm with either. Feel for thrill, auscultate for bruit (fistula), no constrictive clothing or watch, no heavy lifting.
After hemodialysis, keep dressing on for ____ hours and watch for Redness, swelling, temp, clotting of access port
Post op care for fistulas and grafts Arm elevated on pillow, dressing dry and intact, observe for s/s infection, assess distal circ, assess for steal syndrome
distal ischemia is known as ________. It is the diversion of arterial blood, inadequate collateral circ. Steel syndrome
Steel syndrome can happen after fistula or grafts, dialysis, or later in years
Once sutures are out, may clean graft/ AV site with soap and water
Once pain subsides, post op AV/graft should exercise daily, 6xs/day for 5 min
Complications of AV, graft include steel syndrome, stenosis, infection, thrombosis
Nursing responsibilities prior to hemodialysis procedure include Wt, edema, BP, heart and lung sounds. Condition of vascular access, temp, general skin condition
Difference between last post-dialysis weight and the present pre-dialysis weight should be no more than 1-1.5 kg or 2-3.5 lb
I kg of fluid is equal to 1 L fluid
Rate of hemodialysis is 300-900 mL/min
During hemodialysis, VS should be taken q 30 min
What nursing responsibilities during and post hemodialysis Monitor heart and lung sounds, VS q 30 min, evaluate fluid status, BP and wt
Don't give ______ meds prior to dialysis BP
What are some advantages of hemodialysis? Rapid fluid removal, rapid urea/creat removal, effective K removal, less protein loss
What are some disadvantages of hemodialysis Having a fistula, Complications, lack of freedom, time constraints, generally do not feel good, hypotension during dialysis
What is used to treat muscle cramps during hemodialysis? Decrease filtration rate or 0.9 infusion to increase Na level
What are some complications/SE of hemodialysis? Hypotension, Muscle cramps, loss of blood d/t heparin, hepatitis, sepsis, disequilibrium syndrome
Occurs from hemodialysis d/t rapid changes of cellular fluid (removing solutes). Disequilibrium syndrome
What are s/s Disequilibrium syndrome H/A, confusion, CP, syncope, seizures, N/V, twitching
What is the diet for those on hemodialysis? Restrict K, Phos, Na, fluids, proteins
For this, access is gained by inserting cath through anterior abd wall and rests in peritoneal cavity. Scar tissue forms to hold cath in place Periotoneal dialysis
Contraindications of peritoneal dialysis Multiple dialysate solution going into abd, recurrent abd or inguinal hernias, obesity, chronic back problems, COPD, CHF, Pancreatitis, Diverticulitis
Dialysis solution for PD is available in ___ or ___ L volumes 1 or 2
Dianeal, Inpersol w glocuse concentration of 1.5, 2.4, and 4.25%
Electrolyte composition of dialysate for PD simiar to ___________. Amount of products determined by pt______ Plasma, weight
Solution for PD should be warmed to room temp to increase _______, _________, and ______ peritoneal clearance, prevent hypothermia, and enhance comfort
What are the three phases of PD? Inflow, Dwell, and Drain time
Prescribed amount of solution infused over _____ min; then ________. What stage is this done? 10, clamp cath; Inflow
Allows for equilibrium: diffusion and osmosis occur between pt's blood and peritoneal cavity. This is the _______ phase and lasts _____ hours. Dwell, 4-10
Phase takes 15-30 min Drain time
DM pts may have specific ________ due to hyperglycemia could occur dwell time
What position for PD? Semi-fowler's; side-to-side
Pt will complete an average of how many PD cycles per day? 4
What are some advantages of PD? Immediate initiation, less complicated than HD, portable, fewer diet restrictions, short training time, preferable for DM,
What is the diet for PD? No added salt, extra protein, no K restrictions, Phos restric
What is the fluid restriction for PD? About 750 mL/day
What are some complications of PD? Infection, peritonitis, abd pain, pulmonary complications, protein loss
What are some signs of peritonitis? Cloudy fibrin strings or turbulent solution when drained
Created by: mreedy