Hemodialysis 200 800 mlmin of blood removal

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