Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
30 Cards in this Set
- Front
- Back
What are indications for dialysis?
|
Significantly reduced GFR: <10
Weight loss Acidosis High BUN, creatinine |
|
What are the goals for dialysis therapy?
|
Replace filtration functions: get rid of the crap!
Maintain electrolyte balancing Replaceerythropoetin, Vitamin D analogs to control hyperparathyroidism |
|
What types of veins are used for urgent dialysis?
|
Can't use a peripheral vein!
Commonly used ones: Jugular Subclavian Femoral |
|
What vessels are typically used in chronic dialysis?
|
Fistulas between:
Radial and cephliac Brachial and cephalic |
|
What are risks for dialysis by a catheter?
|
Infection
Poor flow-->clotting |
|
What are the advantages of a fistula? Disadvantages?
|
Advantages:
Durable Good flow Low infection risk Disadvantage: Hard to create The fistula needs to mature before use |
|
What are the disadvantages of arterio-venous grafts?
|
High thrombosis risks
|
|
What is the effect of mass on diffusion rate? Concentration gradient?
|
Smaller the mass, greater the diffusion
Greater gradient, more diffusion |
|
What determines convection rates in dialysis? What happens with this?
|
Pressure differences
Molecules and solutes are pulled with the water due to the pressure differences |
|
What are the ways that the amount of dialysis completed is measured?
|
Urea reduction ratio: urea concentration after compared to before
KT/V: (Clearance*time)/(Volume of distribution of urea) |
|
If the patient is hyperkaelemic, what kind of diasylate should be given to them?
|
Diasylate with low potassium --> have a gradient for potassium out of the blood
|
|
What substance move out of the blood by convection? What carries them?
|
Sodium, larger molecules
Water |
|
What is the target weight for a person who is on dialysis?
|
Get them to their dry weight: the weight at which the px. is comfortable, doesn'thave edema, has normal BP,and isn't orthostatic
|
|
What are complications that can arise from dialysis pertaining to the therapy? Why?
|
Dialysis disequilibrium syndrome: vertigo caused by changes in Na concentrations
Hypotension Bleeding, hemolysis: px. is on anticoagulation infection |
|
What are complications of dialysis related to end stage renal disease?
|
Premature CV mortality
Renal osteodystrophy |
|
What is the typical schedule for a person on dialysis?
|
3x a week, 4 hrs/therapy
|
|
What is the membrane for the exchange of solutes in peritoneal dialysis?
|
The patients'own peritonealmembrane
|
|
Where does the diasylate sit inside a patient during peritonal dialysis?
|
Inside the peritoneal cavity - it just sits there.
|
|
What is the base equivalent given in peritoneal dialysate? Why not bicarb?
|
Lactate
Bicarb will precipitate out - bad news! |
|
Why is dextrose include in the peritoneal dialysis fluid?
|
Osmotic agent: it pulls water into the peritoneal fluid, bringing things in by convection
|
|
What is meant by a fast/slow transport time in peritoneal dialysis?
|
People who are slow transporters don't move the dextrose across their peritoneal membrane quickly --> maintain the gradient to draw things into the peritoneum longer
|
|
What is the main mechanism by which peritoneal dialysis occurs?
|
Diffusion
|
|
What substances are found in a high concentration in the blood of a person on dialysis?
|
Urea
Creatinine Potassium Unmeasured metabolic baddies We take creatinine as a proxy for these other guys - they're the ones that really cause the problems, not creatinine |
|
In peritoneal dialysis, is base a higher concentration in the blood or in the dialysate/
|
In the blood
|
|
How long should a person let peritoneal dialysis last?
|
4 hours
|
|
What is the effect of infection on peritoneal dialysis?
|
It causes someone to become a "faster" dialyze: in infection the vascularitoy of the peritoneum is increased.
|
|
What is added to the dialysate to facilitate water removal in peritoneal dialysis?
|
Dextrose
You can have different concentrations of it to facilitate removal from the body of more/less fluid |
|
What are disadvantages to using glucose as an osmotic agent?
|
1. Excess calories!
2. Doesn't maintain a concentration gradient for long |
|
What determines the amount of fluid removed by during peritoneal dialysis?
|
1. Concentration of the glucose in the dialysate
2. Length of time the dialysate is in the peritoneal cavity 3. Individual variation |
|
What are the complications that can occur with peritoneal dialysis?
|
1. Exit site infection - THINK OF THIS!
2. Loss of AAs, protein in the dialysate 3. Calories, poor appetite from the glucose 4. Hernia development 5. Peritoneal sclerosis 6. Burn out --> your peritoneal membrane gets worn out from having things exchange through it for so long. |