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