Dialysis Module 2

Front 1

What are the working units of the kidneys?

Back 1

Nephron

Front 2

What makes up a nephron?

Back 2

Glomerulus and a tubule

Front 3

What is a glomerulus?

Back 3

Tangled ball of capillaries held together by a membrane called a Bowman's capsule.

Front 4

What is the function of the glomerulus?

Back 4

Filter OUT water and wastes.

Front 5

What is the function of kidney tubules?

Back 5

Reabsorb chemicals and water the body needs.

Front 6

What are the functions of the kidney?

Back 6

Remove waste
Fluid/electrolyte balance
Acid-base balance
Make hormones

Front 7

What are the endocrine functions of the kidney?

Back 7

Make erythropoietin and calcitriol

Front 8

What does calcitriol do?

Back 8

It is active vit D. It controls the balance of Ca and Ph that is key to bone metabolism.

Front 9

What are the 3 types of acute kidney failure?

Back 9

Prerenal - not enough blood flow to the kidneys

Intrarenal - injury to the kidneys

Postrenal - urinary blockage

Front 10

What are the S/S of stage 3 kidney failure?

Back 10

Fatigue, anemia, Ca/Ph disorder, edema, HTN

Front 11

What causes chronic kidney disease?

Back 11

Diabetes, HTN, glomerular diseases, polycystic kidney disease...

Other - birth defects, kidney stones, SLE, street drugs, cancer, kidney infections, AIDS, sickle cell anemia

Front 12

What are the S/S of uremia?

Back 12

Fatigue/weakness/dizziness
Feeling cold
Confusion
Pale skin/gums/fingernail beds (due to anemia)
Edema
More/less urine. Bubbly/foamy urine. Nocturia.
Itching
Flu-like symptoms
Ammonia breath/metallic taste in mouth
Back/flank pain
Dyspnea
Yellow skin
Insomnia
Sexual problems
Joint swelling/bone pain

Front 13

What is uremia?

Back 13

Build up of wastes in the blood.

Front 14

What is anemia in CKD associated with?

Back 14

Left ventricular hypertrophy - leading cause of death in people with kidney disease.

Front 15

What are some interventions for managing anemia in CKD pts?

Back 15

Rinse back as much blood as possible.

Report unusual bleeding.

Use pediatric blood tubes for blood tests.

Urge pts to stay for full time of tx.

Assess s/s of unusual bleeding, infecction, SOB, chest pain, etc.

Front 16

What causes secondary hyperparathyroidism in CKD pts?

Back 16

Not enough vitamin D. Less Ca absorbed from food. Kidneys not removing Ph.

Less Ca + More Ph = PTH release.

PTH takes Ca out of bones.

Causes bone/joint pain, musle pain, and weakness. (Renal osteodystrophy)

Front 17

What is renal osteodystrophy?

Back 17

Brittle bones due to secondary hyperparathyroidism.

Causes bone/joint pain, muscle pain, weakness.

Front 18

How can I help manage secondary hyperparathyroidism?

Back 18

Report S/S.

Reinforce teaching.

Urge pts to take meds/follow diets.

Front 19

What are some interventions for pruritus management?

Back 19

Aveeno baths
Phosphate binders
Complete dialysis tx

Front 20

What causes pruritis in the dialysis pt?

Back 20

Uremic toxins
Increased Ph levels

Hives may be from the pork/beef heparin, chemical used to sterilize equipment.

Front 21

What causes pericarditis in the CKD pt?

Back 21

Infection, sx, acute illness, poor dialysis

Front 22

What are the S/S of pericarditis?

Back 22

Constant chest pain, FEVER, low blood pressure, irregular heartbeat, PERICARDIAL FRICTION RUB

IF A PT HAS PERICARDITIS, DO NOT START THE TX UNTIL THEY HAVE BEEN ASSESSED.

Front 23

What causes amyloidosis in the CKD pt?

Back 23

Kidneys usually remove its excess.

Front 24

What are the S/S of amyloidosis?

Back 24

Carpal tunnel, joint pain, bone cysts, compression fractures.

Front 25

What are some interventions for bleeding management?

Back 25

Question pts about bleeding b/w tx

Change heparin dose?

Report excessive dialyzer clotting

Front 26

What are S/S of hypernatremia?

Back 26

Thirst, flushed skin, fever, seizures, death

Front 27

What are S/S of hyponatremia?

Back 27

If dialysate does not have enough sodium.

Low BP, muscle cramps, restlessness/anxiety, pain at access site, headache, nausea.

Front 28

What are the S/S of hyperkalemia?

Back 28

Muscle weakness, dysrhythmias, abdominal cramps.

Cardiac arrest

Front 29

What are the S/S of hypokalemia?

Back 29

Vomiting/diarrhea

Front 30

What are the S/S of hypercalcemia?

Back 30

Vomiting, weakness, confusion, coma

Front 31

What are the S/S of hypocalcemia?

Back 31

Tchvotnik/Trousseau's signs, numbness, seizures, tetany

Front 32

What are the S/S of hyperphosphatemia?

Back 32

Pruritis, bone disease

Front 33

What do you do if you mix your own dialysate?

Back 33

DOUBLE CHECK WITH SECOND STAFF MEMBER

Front 34

What side effects do immunosuppressants have?

Back 34

Weight gain, HTN,increased risk of infection/diabetes/cancer

Front 35

What is the biggest risk with peritoneal dialysis?

Back 35

Peritonitis

Front 36

Continuous ambulatory PD interventions

Back 36

4 exchanges at 30min each/day

Wash hands
Control airflow to the room
Wear a mask
Use aseptic technique

Front 37

What are the different dialysis options?

Back 37

Nocturnal
Short daily
In center
Conventional (home)
Ambulatory PD
Automated PD (use a cycler at night)
Continuous PD (combination of ambulatory and automated PD)

Front 38

Who all is on the HD care team?

Back 38

Pt
Nurse
Nephrologist
Social worker
Tech (biomed, reuse, patient care)
Dietician

Reuse techs reprocess dialyzers.
Biomed techs maintain/repair equipment.

Front 39

What causes a high BUN and what are the symptoms?

Back 39

Not enough dialysis/increase tissue breakdown/high protein intake/GI bleeding

N/V and confusion

Front 40

What causes a low BUN and what are the symptoms?

Back 40

N/V, diarrhea, poor protein intake

Weakness and weight loss

Front 41

What are signs that a dialysis pt has lost body weight, even if postdialysis weight is unchanged?

Back 41

Fluid build-up in ankles/fingers

SOB

Pt says he can't lie flat in bed

Front 42

What are some interventions for thirst?

Back 42

Avoid salt/sugary foods
Ask MD to change Rx's that cause dry mouth
Know your fluids
Use sm cups
Hard candy
Brush teeth/rinse with mouthwash
Suck frozen grapes or ice cubes
Use lemon wedges to stimulate saliva
Ask wait staff not to refill your glass when you eat out
Take pills with applesauce or pudding
Measure your fluids

Front 43

What do you do if a pt starts cramping during dialysis?

Back 43

Give a NS bolus and tell them to decrease their salt intake.

They are cramping because there is not enough fluid in the vascular space.

Front 44

What are some high potassium foods?

Back 44

Espresso/cappuccino, avocados, mangos, bananas, orange juice, dried fruit, cantaloupe, dried peas/beans, tomato sauce, potatoes

Salt substitutes

Front 45

What are some high phosphorus foods?

Back 45

Dairy, meat, nuts, peanuts, dried bean/peas, whole grains, chocolate, colas

Front 46

What is an important aspect of teaching?

Back 46

Repeat the information many times.

Pts may not be able to learn because of fear or pain.

Front 47

What phrase do we avoid with the tx plan?

Back 47

We do not say "comply" or "adhere".

We say "follow the tx plan".

Front 48

What can pts do to be involved in their tx?

Back 48

Track blood test results in a notebook.
Follow diet.
Learn to put in their own needles.
Weigh themselves and record the number
Calculate how much fluid to remove at each tx
Check dialyzer with a staff member
Check machine settings and dialysate
Report symptoms
Know what their pills is for and how to take them correctly

Front 49

What do we encourage in dialysis pts?

Back 49

HOPE

They need to stay active by exercising and working/hobbies.