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60 Cards in this Set
- Front
- Back
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life maintaining therapy
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renal replacement therapy
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the movement of fluid and molecules across a semipermeable membrane from one compartment to another
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renal replacement therapy
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three common types of renal replacement therapy
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* hemodialysis
* continuous renal replacement therapy * peritoneal dialysis |
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this therapy is referred to as "outside the body"
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hemodialysis and peritoneal dialysis
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4 functions of renal replacement therapy
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* remove excess water
* remove waste * correct electroltye distrubances * correct acid-base balance |
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renal replacement therapy is begun when ths can no longer be managed conservatively
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uremia
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indications for use of renal replacement therapy in ARF
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* life threatening hyperkalemia
* severe volume overload * impending pulmonary edema * increased acidosis unrefractive to other therapy * pericarditis * severe confusion due to uremia * drug overdose |
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indications for use of renal replacement therapy in CRF
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* uremia affecting other body systems
* hyperkalemia * unresponsive fluid overload * failure of diuretic/fluid restriction therapy * pericardial friction rub |
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criteria for hemodialysis
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* pt must be hemodynamically stable
* pt must have suitable vascular access * pt must be able to tolerate heparin |
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most common dialysis catheter
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uldall
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temporary intravenous access caths for hemodialysis may be placed in
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jugular, subclavian, or femoral veins
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permanent dialysis access
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AV fistula
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created most commonly in the forearm with an anastamosis between an artery and a vein
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AV fistula
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how long does it take for an AV fistula to mature
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6-12 weeks
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surgical anastamosis between an artery and a vein of synthetic material
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AV graft
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this will be used when the pts vessels are not suitable for a fistula
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AV graft
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self healing but can become infected and are thrombogenic
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AV graft
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how long does it take for an AV graft to mature
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2-4 weeks
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pts with AV grafts are at risk for
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* steal syndrome
* aneurysm formation * stenosis |
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assessment of an AVF or AVG should reveal
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a thrill and a bruit
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this should be avoided in the extremity with an AVF or AVG
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BP, IV or venipuncture
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AVF or AVG, which is less likely to clot or to become infected
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the AVF
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nursing considerations pre hemodialysis
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* baseline VS, weight, hemodynamics
* know HD goals for pt * report to HD nurse * meds that are not dialyzed off |
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complications of HD include
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* hypotension
* muscle cramps * hemorrhage * hepatitis * sepsis * disequilibrium syndrome * air embolism * chest pain/dysrrhythmia * hypertension |
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nursing considerations post hemodialysis
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* report from HD nurse
* meds that need caught up * how much fluid was removed * was goal removal achieved * acid base/electrolyte imbalances corrected * documentation of issues * intake and output assured with session |
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continuous treatment where blood is removed from the body through an artery or vein and circulated for an extended period of time
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continuous renal replacement therapy
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water, electrolytes and small to medium-sized molecules are removed by
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ultrafiltration
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indications for CRRT include
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* pt cant tolerate hemodynamic instability and fluctuation fluid and electrolyte levels often associated with HD
* pts who arent candidates for PD * pts who need more than the 3-4 hrs HD provides * pts who require large amounts of IV fluids and/or TPN |
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advantages of CRRT include
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* doesnt use rapid fluid shifts
* doesnt require a dialysis RN to run * can be initiated emergently |
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SCUF =
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slow continuous ultrafiltration
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CVVH =
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continuous veno-venous hemofiltration
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CVVH-D =
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continuous veno-venous hemofiltration with dialysis
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blood circulates thru a small volume, low resistance filter, using the pts BP rather than a blood pump to circulate
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continuous arteriovenous therapies
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common forms of CRRT include
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* SCUF
* CVVH * CVVH-D |
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requires arterial access
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continuous arteriovenous therapies
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forms of continuous arteriovenous therapies
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* SCUF
* CAVH * CAVH-D |
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rarely used due to risk of arterial events
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continuous arteriovenous therapies
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continuous arteriovenous therapy access typically
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femoral artery and vein
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most common form of CRRT
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continuous venovenous therapies
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uses venous double lumen catheters for access and blood pump to cycle
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continuous venovenous therapy
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blood removed via arterial limb, jugular, femoral, or subclavian site cycled thru hemofilter and returned via the venous limb of the cath
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continuous venovenous therapy
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continuous venovenous therapy includes
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* CVVU
* CVVH * CVVH-D |
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CRRT technical problems include
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* access
* clotting * air * blood leak * hypotension * hypothermia |
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nursing considerations pre and intra CRRT include
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* baseline weight, lytes/BUN/creat
* baseline assessment w/VS every half hour * baseline fluid balance and hourly balance * anticoagulation therapy, PT/PTT * NS fluid boluses and/or 5% albumin and slow ultrafiltration for hypotension * baseline perfusion status and q2h perfusion status |
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nursing considerations post CRRT include
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* calculation of fluid balances
* manage hypotension/perfusion * monitor for signs of hemorrhage * monitor for hypothermia * assess for infection * monitor lytes/BUN/creat/CBC/PT/PTT * monitor anticoagulation status * monitor for air or blood alarms |
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in this form of dialysis the peritoneum acts as the semipermeable membrane
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peritoneal dialysis
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sterile dialysate is introduced and waste products are cleared by osmosis and diffusion
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peritoneal dialysis
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in peritoneal dialysis the peritoneum allows
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waste products and extra fluid to pass from the blood to the dialysis solution
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glucose solution that pulls waste and extra fluid into the abdominal cavity
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dialysis solution used in peritoneal dialysis
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indications for peritoneal dialysis include
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* pt unable or unwilling to undergo transplant
* pt who is not a candidate for HD * initially while pt is being evaluated for HD * when access to the blood stream is not available |
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advantages of PD over HD
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* technical equipment and supplies are less complicated
* less need for highly skilled personnel * adverse effects are few, especially in pts with cardiac disease |
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disadvantages of PD
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* requires time to remove waste products adequately and restore fluid and electrolyte balance
* may lead to peritonitis * may result in complications: pulmonary congestion and venous stasis |
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contraindications to PD
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* existing peritonitis
* recent abdominal surgery * abdominal adhesions * recurrent abd wall or inguinal hernias * excess obesity * COPD |
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complications associated with insertion of Tenckhoff Catheter include
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* perforation of bladder, bowel, or blood vessels
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typically for outpts with ESRD but not as good as HD for clearance
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intermittent PD
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used by ESRD pts, can be performed at home by pt or family member
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continuous ambulatory PD
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in this typoe of dialysis the dialysate is in the peritoneum 24/7
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continuous ambulatory PD
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this type of peritonal dialysis is typically done overnight with a prolonged daylight dwell
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continuous cyclic PD
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physiological complications of PD include
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* peritonitis
* catheter infection * hypotension * hypertension and volume overload * protein loss, high BUN and creat * carb and lipid abnormalities * encapsulating sclerosis peritonitis * hypokalemia * hperglycemia * pain |
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technical complications of PD include
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* incomplete recovery of fluid
* leakage around the catheter * blood tinged fluids * malposition of the catheter |
