321 - Exam 3 (Class Notes For Crf Diet And Dialysis)*

Front 1

CRF diet:
-what is restricted?

Back 1

restrict potassium, sodium, magnesium, and phosphorus

Front 2

CRF diet:
-what element do they need high amounts of?

Back 2

-they need foods high in calcium

Front 3

CRF diet:
-tell me about protein in their diet?

Back 3

-they will be on a protein restricted diet but make sure the protein they get is high biological protein (organ meats, chicken, beef, fish)

Front 4

what is the leading cause of renal failure?

Back 4

diabetes

Front 5

CRF diet:
-what do you teach them about vitamins

Back 5

-do not take a multivitamin. they need a specific vitamin, such as (renalvite)

Front 6

CRF
-Calcium regulation: will go on what 2 type of meds?

Back 6

phosphate binders or calcium carbonate

Front 7

CRF
-tell me about exercise?

Back 7

-Important that they have a daily exercise/walking regimen to help absorb calcium from the bone

Front 8

CRF
-tell me about their fluid intake?

Back 8

-fluid restriction (it is about 1200-1800) reserve fluid for when they take their pills
-IV fluids count

Front 9

Dialysis -Hold antihypertensives and sedatives, why?

Back 9

-hypotension and sedation occur as a result of the dialysis itself, don’t want to add to that

Front 10

Dialysis
--remove blood from (artery or vein) and return it through the (artery or vein)?

Back 10

--remove blood from artery and return it through the vein

Front 11

Dialysis
-AV fistula or grafts
Avoid trauma and occlusion (what do you do to avoid that?)

Back 11

no BP, IM, IV, no lab, no tight clothing, no jewelry

Front 12

Dialysis
--to see if the access site is working you check for a bruit and thrill. what are those?
-how often do you check for them?

Back 12

(bruit is the sound which is like a humming, thrill is what you feel) the thrill feels like vibration.
-they should be checked every 4 hours. if you don’t feel that, they can’t have dialysis

Front 13

Post-dialysis
-VS
-Weight
-Safety b/c of hypotension & sedation issue
-also, administer what drugs?

Back 13

Epogen, Aranesp, Epocrit (monitor BP because they can cause hypertension) but are given because you want to improve their erythropoiesis

Front 14

Dialysis
-tell me about hemostasis

Back 14

-hemostasis should have been accomplished during dialysis, you shouldn’t have to do anything. If your pt is bleeding from the site, that it not expected and it is not good.

Front 15

Peritoneal Dialysis
--holes at the end of catheter (called tenckhoff catheter)
-has 2 dacron cuffs which do what?

Back 15

(tissue adheres to that) which prevents bacteria from going from the surface of the skin into the peritoneal cavity

Front 16

Peritoneal Dialysis
-the end of the catheter is filled with what?

Back 16

-the end is filled with betadine to prevent something from growing in there and to keep it sterile in-between exchanges

Front 17

Peritoneal Dialysis
-when starting this, what do you do with the bag?

Back 17

-when starting this, take a bag of dialysate and warm it up b/c body temp is higher than room temp. weigh the bag before administering

Front 18

Peritoneal Dialysis
-hook up the special tubing to the bag of dialysate (the tubing has a section that you need to break to start the dialysis)
-what do you do with the clamp on the drainage bag?

Back 18

-the clamp on the drainage bag remains clamped because the dialysate has to dwell (4-6 hours) & when it is done dwelling, you drain it.

Front 19

Peritoneal Dialysis
-when it is draining, what do you need to do?

Back 19

you need to put it against a white background because the dialysate is clear or pale yellow. you do not want to see it cloudy (could mean infection)

Front 20

Peritoneal Dialysis
-how do you know when the bag is done draining?

Back 20

can take up to 30 min
- the bag will steam up and when the steaming area stops, it is done draining. if u r not sure, have them change positions so the catheter adjusts. when you think It is done draining, clamp it and weigh the bag and you will know how much you pulled off.

Front 21

Peritoneal Dialysis
--looking at how much fluid the pt gained/retained which will be represented as a:

what measurement are we weighing in?
-how long do you keep a running total for?

Back 21

+300 = fluid balance

-you are weighing it in mL, not pounds or kg.
-a high positive running balance is not good (+700)
-keep running total for 24 hrs

Front 22

Peritoneal Dialysis
-to prevent infection, what technique do you use?

Back 22

-Use aseptic technique – gloves, masks, and gowns. pt also wears mask

Front 23

Peritoneal Dialysis
-advantage to this diet?

Back 23

-pts don’t have to follow the diet as closing because you are taking waste products & electrolytes throughout the day, they don’t have an opportunity to accumulate that
-they will follow a renal diet