P3 Therapeutics Test 1 Dialysis

Front 1

when should dialysis planning start

Back 1

CLcr < 30

this allows for adequate time for creation of vascular or perotineal access

Front 2

what are some indications for dialysis

Back 2

anorexia
Edema/CHF
N/V followed by weight loss
uncontrolled HTN
pruritis
neurological defecits (pt confused etc)

Front 3

what are some advantages of HD

Back 3

pulls off more solute therefore intermittent treatment
better monitoring
less technical failure

Front 4

what are some disadvantages of HD

Back 4

multiple visits
decrease in risidual renal function (b/c pulling off so much solute)\
disequilibrium, hypotention, muscle cramps (b/c may pull off too much fluid)
infections at catheter site
thrombosis at catheter site therefore mus use heparin

Front 5

what are some advantages of PD

Back 5

pt independence
less loss in residual renal function (not pulling as much solute)
less blood loss and iron deficiency (only exchanging fluids not removing blood)
no heparinization of blood needed
can admin drugs interpertonealy (insulin/pcn)
suitable for elderly and pediatric pt that can't tolerate HD (need good BP and vascular access for HD)

Front 6

what are some disadvantages of PD

Back 6

perotinitis
protein and AA loss
pt burnout
technique failure
decrease appetite b/c glucose load gives sense of fullness
mechanical problems (hernia, hemorrhoids, back pain, dialysate leakage)
inadequate ultrafiltration and solute dialysis in large pt unless large volumes and multiple exchanges are employed
EXTENSIVE ABDOMINAL SURGERY PRECLUDES PT FROM PD (a lot of scar tissue/adhesions decrease SA in peritenium)

Front 7

what type of vascular access do you have w/ HD

Back 7

temporary (intrajugular, subclavian, femoral)
permanent (AV fistula, grafts)

Front 8

what is an issue w/ femoral vascular access

Back 8

high chance of infection

Front 9

what are the properties of AV fistula vascular access

Back 9

2 months to muture
longest survival and least occurance of infection

Front 10

astinosis of what vein and artery makes AV fistula

Back 10

cephalic vein w/ radial artery
basilic vein w/ ulnar artery

Front 11

what are the properties of Grafts

Back 11

2-3 weeks to mature
made of polytetrafluorethylene (PTFE)

Front 12

what type of permanent access is initially used in most patients

Back 12

Grafts

Front 13

Grafts vs AV Fistula

Back 13

since Grafts are synthetic have higher chance of infection
grafts have shorter survival
grafts have increase risk of thrombosis

Front 14

what does the rate of diffusion depend on in HD

Back 14

molecular weight
membrane resistance
protein binding
blood and dialysate flow rates
concentration gradient

Front 15

how does concentration gradient and flow rates affect rate of diffusion

Back 15

concentration gradient - high [] in blood so have to set dialysate as not to pull too much off

flow rates - if pumping faster get more convection to pull drugs across

Front 16

what is the main use of ultrafiltration

Back 16

pull off excess body water

Front 17

what is the main mechanism by which PD is done and what are critical factors

Back 17

PD mainly done via diffusion therefore [] of dialysate and membrane hole size are critical

Front 18

what are the HD complications

Back 18

hypotension
cramps
head aches
nausea and vomiting
pruritus

Front 19

how does HD cause hypotension

Back 19

antihypertensive drug treatment prior to dialysis
excessive ultrafiltration
target weight too low
pt unable to compensatory increase CO
vasodilation b/c acetate dialysate

Front 20

how does HD cause cramps

Back 20

low Na [] in dialysate (pulls off a lot of Na from body)
dehydration
hypotension

Front 21

how does HD cause headaches

Back 21

vasodilation due to acetate dialysate
acute caffeine withdrawl (caffeine rapidly pulled off)

Front 22

how does HD cause pruritis

Back 22

dry skin (a lot of pt dehydrated)
increase CaPO4 products
allergy to heparin, dialysate, drugs etc
uremic toxins

Front 23

how does HD cause nausea and vomiting

Back 23

hypotension (decrease perfusion to stomach therefore food just sits there)
may be early sign of disequilibrium syndrome

Front 24

what kind of catheter is used in peritoneal dialysis

Back 24

indwelling catheter (2-6 weeks to mature)

Front 25

how should the dialysis solution be for PD

Back 25

warm and low pH to prevent carmelization of glucose

Front 26

what mechanisms does PD work with

Back 26

passive diffusion - waste removal
ultrafiltration (high [] dialysate and larger volume)
osmosis - concentration gradient

Front 27

what are some std dialysis regimines

Back 27

2 L @ 1.5% q 6hs
2 L @ 4.25% qd

typically pull 1-2 L of fluid

Front 28

if fluid overloaded or dry do you use a higher or lower dextrose []

Back 28

fluid OD - high dextrose []
dry - low dextrose []

Front 29

what are clearance modifiers fo PD

Back 29

molecular weight
charge
protein binding
lipid or water solubility
volume of distribution

Front 30

what are contraindication for PD

Back 30

multiple abdominal surgeries
hypertriglyceridemia (glucose drive TG up)
malnutrition (may discourage from eating)
mentally/physically challenged (unless have care provider)

Front 31

what are the gram + organism that cause PD

Back 31

S epidermidis
S aureus
Streptococci
Enterococci
diphtheroids

Front 32

what are the gram - organisms that cause PD

Back 32

E coli
P aeruginosa
Enterobacter
Acinetobacter
Klebsiella
Proteus

Front 33

what kind of access is used in ICU pts

Back 33

venous - venous

Front 34

what causes ICU pts to need dialysis and what method do you use

Back 34

AKI
use continuous hemofiltration 24hrs (ultrafiltration mechanism)

Front 35

how do you dose drugs in ICU pts

Back 35

very aggressively since a lot of drugs will be pulled off

Front 36

what are indication for dialysis in ICU pts

Back 36

electrolyte imbalances
refractory fluid overload
metabolic acidosis

Front 37

read up on drug dosing and dialysis

Back 37

read up on drug dosing and dialysis

Front 38

at what Clcr should dialysis planning start

Back 38

<30