Hemodialysis 200-800 mL/min of blood removal. Arteriovenous (AV) fistula : joiing artery to vein in forearm. Accommodate 2 of 14-16 G needles Arteriovenous (AV) graft: used with CRF External AV shunt : peripheral artery with peripheral vein: want to feel the thrill in vein, listen and hear bruit Maintenance of access Complications of access : infection, clotting, depression, self esteem issues Candidates: susceptible to rapid fluid and electrolyte and metabolic changes associated with dialysis. DM, HF, elderly pt. not as efficient but still gets the job done Principles: peritoneum serves semipermeable membrane in peritoneal cavity, diffusion and osmosis 500-3000 mL of dialysate used. Takes a lot more time. Complications Peritonitis: most common infection. S/S: cloudy drainage, abd pain, rebound tenderness, hypotension Leakage: resolves spontaneously, avoid abd muscle strain during healing process, start with low amount then increase. Bleeding: might pull blood from menstruating women into peritoneal cavity long term effects: hernia, atherosclerosis, back pain, anorexia, sweet taste in mouth d/t glucose absorbed Procedure, Follow up and teaching Pt. preparation: VS, Wt., abd girth, check labs Equipment preparation: dialysate warmed and primed tubing. Strict sterile technique, 2-3 L over 10 min dwell time. Exchange: should not be cloudy only clear and straw Post procedure: labs, VS Follow up: monthly checkups with physician, high protein diet and fiber Teaching: pt and caregiver if doing it at home
Chronic Renal Failure (CRF) CRF Nursing Processes Nursing Processes Kidney Transplant Progressive irreversible gradual deterioration of renal failure 90% of nephrons destroyed when you reach this point Body is unable to maintain F&E and metabolic History DM is #1 cause HTN Glomerulonephritis Obstruction of urinary tract Polycystic kidney disease Pyelonephritis Pathophysiology Nephron destruction waste accumulates in blood uremia/azotemia affects all body systems Capillary flow pressure increases and sclerosing veins Stages of CRF Decreased renal reserve: GFR 50% of normal, asymptomatic lab normal (Norma GRF 120 mL/min) Renal insufficiency: GFR 20- 50% of normal: azotemia, anemia d/t inability to make RBCs, HTN Renal Failure: GFR < 20% oliguric, edema, metabolic acidosis End stage renal disease (ESRD): GFR < 5% renal replacement therapy needed to sustain life. Assessment Severity of S/s vary on degree of impairment: comorbidities and clients age Uremia: urine in blood Early S/S: nausea, apathetic, fatigue, vomiting, confusion Cardiovascular : edema, HTN d/t Na and water retention, peripheral vascular resistance, HF, pericarditis, angina, hyperkalemia: peaked T waves, predominant cause of death Respiratory : pulmonary edema, crackles, SOB, tachypnea, kussmal respirations, fluid overload Hematologic : anemia d/t decreased ertythopotein, impaired platelet function Gastrointestinal : smell ammonia on
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- Fall '16
- Karen Price