NSG 411 EXAM 2 QUESTIONS WITH DETAILED ANSWERS
What is CRRT?
Continuous renal replacement therapies
If an acute or chronic kidney disease pt is too clinically unstable for traditional
hemodialysis (too ill)
Requires access to the circulation & blood to pass through hemofilter 24h for
several days
What are 3 benefits to CRRT?
No abrupt variations in fluid removal or osmolality
Good solute clearance
Better hemodynamic tolerance
What is the goal of peritoneal dialysis?
Remove toxic substances & metabolic wastes
Reestablish normal fluid & establish balance
What are indications for peritoneal dialysis?
If unable/unwilling to undergo HD
Older pts
Pts w/ DM or CVD
Risk for adverse effects of systemic heparin
Susceptible to rapid fluid, electrolyte, & metabolic changes w/ HD
Severe HTN, HF, Pulm edema not responsive to usual txs
What types of patients is PD contraindicated in?
Hx of major ab surgery
Altered LOC, dexterity, & other physical limitations (arthritis)
Non-conducive environment
Describe a PD catheter:
soft, flexible, silicone w/ radiopaque strip (for x-ray visualization)
,*non-dominant side allows easy access to catheter connection site when
exchanges done
Explain the aspects of peritoneal dialysis:
Peritoneal membrane (semipermeable): sterile dextrose dialysate fluid
(hypertonic) introduced thru PD catheters
Clearance via diffusion & osmosis
Ultrafiltration (water removal): increased w/ high glucose concentration
Explain exchanges, dialysate, and draining with PD:
Exchange: entire cycle - infusion (fill), dwell, drain
Dialysate (2-3L): infused by gravity into peritoneal cavity for 5-10 mins
*Prescribed dwell time for diffusion/osmosis
Drain: PD catheter unclamped -> solution drains by gravity thru closed system
(10-20 mins)
What is CAPD vs CCPD?
CAPD: continuous ambulatory peritoneal dialysis (manual)
CCPD: continuous cycling peritoneal dialysis - cycler machine automatically
performs exchanges at night
*# of exchanges & freq prescribed based on lab values/uremic symptoms
Explain different types of possible drainage with PD?
Effluent: colorless or straw colored; not cloudy - good
Bloody: first exchanges after new catheter insertion
Explain peritonitis as a complication with PD:
*most common & serious complication
Cloudy dialysate drainage fluid = first sign
Ab pain & rebound tenderness
Hypotension & s/s shock
Need effluent for cell count, Gram stain, & culture
,Antibiotic agents added to exchanges - intraperitoneal antibiotic agents
Antibiotic therapy ~10-14 days
What are other complications with PD?
Abdominal hernias from increased pressure (incisional, inguinal, diaphragmatic,
umbilical)
Hiatal hernia & hemorrhoids
Low back pain & anorexia
Mechanical problems (fibrin clots in catheter, constipation)
Explain some actions with peritoneal dialysis troubleshooting:
Turn pt side to side or raise HOB to decrease drainage
Check catheter latency: kinks, closed clamps
Secure, intact, dry dressing
Skin care
Edu: fluid/weight loss, lab values
What are advantages vs disadvantages with PD?
Advantages: no hemodialysis machine or venipuncture; control over daily
activities; more liberal diet
Disadvantages: continuous dialysis 24/7
What are normal BUN, creatinine, and GFR values?
BUN: 6-20 (over 65yrs 8-23; children 5-18)
Creatinine: Men 0.9-1.3; Women 0.6-1.1
GFR: 90-125 (how kidneys are filtering/functioning)
What is an AKI?
Rapid loss of renal function d/t kidney damage
What is the treatment and goal with AKI?
, Tx: replace renal function, minimize lethal complications, reduce causes of
increased kidney injury
Goal: minimize long-term loss of renal function (common in hospitals & outpatient)
*high mortality rate
What lab values are seen for AKI?
>50% increase in serum creatinine
Non-oliguria: >800mL/day (normal)
Oliguria: <0.5 mL/kg/hr (low)
Anuria: <50mL/day (absence)
Explain the RIFLE classification for AKI:
R(risk): creatinine 1.5x baseline, GFR decrease >25%, output 0.5mL/kg/h for 6 hrs
I(injury): creatinine 2x baseline, GFR decrease >50%, 0.5mL/kg/h for 12 hrs
F(failure): creatinine 3x baseline, GFR decrease >75%, <0.3mL/kg/h for 24h OR
anuria 12h
L(loss): Persistent AKI -> loss of kidney function >4wks
E(ESKD): >3mo
What are some reversible causes of AKI?
Hypovolemia
Hypotension
Reduced cardiac output/HF
Obstruction of kidney/lower urinary tract (tumor, clot, stone)
Bilateral obstruction of renal arteries/veins
What are a few risk factors for AKI/ARF?
What is CRRT?
Continuous renal replacement therapies
If an acute or chronic kidney disease pt is too clinically unstable for traditional
hemodialysis (too ill)
Requires access to the circulation & blood to pass through hemofilter 24h for
several days
What are 3 benefits to CRRT?
No abrupt variations in fluid removal or osmolality
Good solute clearance
Better hemodynamic tolerance
What is the goal of peritoneal dialysis?
Remove toxic substances & metabolic wastes
Reestablish normal fluid & establish balance
What are indications for peritoneal dialysis?
If unable/unwilling to undergo HD
Older pts
Pts w/ DM or CVD
Risk for adverse effects of systemic heparin
Susceptible to rapid fluid, electrolyte, & metabolic changes w/ HD
Severe HTN, HF, Pulm edema not responsive to usual txs
What types of patients is PD contraindicated in?
Hx of major ab surgery
Altered LOC, dexterity, & other physical limitations (arthritis)
Non-conducive environment
Describe a PD catheter:
soft, flexible, silicone w/ radiopaque strip (for x-ray visualization)
,*non-dominant side allows easy access to catheter connection site when
exchanges done
Explain the aspects of peritoneal dialysis:
Peritoneal membrane (semipermeable): sterile dextrose dialysate fluid
(hypertonic) introduced thru PD catheters
Clearance via diffusion & osmosis
Ultrafiltration (water removal): increased w/ high glucose concentration
Explain exchanges, dialysate, and draining with PD:
Exchange: entire cycle - infusion (fill), dwell, drain
Dialysate (2-3L): infused by gravity into peritoneal cavity for 5-10 mins
*Prescribed dwell time for diffusion/osmosis
Drain: PD catheter unclamped -> solution drains by gravity thru closed system
(10-20 mins)
What is CAPD vs CCPD?
CAPD: continuous ambulatory peritoneal dialysis (manual)
CCPD: continuous cycling peritoneal dialysis - cycler machine automatically
performs exchanges at night
*# of exchanges & freq prescribed based on lab values/uremic symptoms
Explain different types of possible drainage with PD?
Effluent: colorless or straw colored; not cloudy - good
Bloody: first exchanges after new catheter insertion
Explain peritonitis as a complication with PD:
*most common & serious complication
Cloudy dialysate drainage fluid = first sign
Ab pain & rebound tenderness
Hypotension & s/s shock
Need effluent for cell count, Gram stain, & culture
,Antibiotic agents added to exchanges - intraperitoneal antibiotic agents
Antibiotic therapy ~10-14 days
What are other complications with PD?
Abdominal hernias from increased pressure (incisional, inguinal, diaphragmatic,
umbilical)
Hiatal hernia & hemorrhoids
Low back pain & anorexia
Mechanical problems (fibrin clots in catheter, constipation)
Explain some actions with peritoneal dialysis troubleshooting:
Turn pt side to side or raise HOB to decrease drainage
Check catheter latency: kinks, closed clamps
Secure, intact, dry dressing
Skin care
Edu: fluid/weight loss, lab values
What are advantages vs disadvantages with PD?
Advantages: no hemodialysis machine or venipuncture; control over daily
activities; more liberal diet
Disadvantages: continuous dialysis 24/7
What are normal BUN, creatinine, and GFR values?
BUN: 6-20 (over 65yrs 8-23; children 5-18)
Creatinine: Men 0.9-1.3; Women 0.6-1.1
GFR: 90-125 (how kidneys are filtering/functioning)
What is an AKI?
Rapid loss of renal function d/t kidney damage
What is the treatment and goal with AKI?
, Tx: replace renal function, minimize lethal complications, reduce causes of
increased kidney injury
Goal: minimize long-term loss of renal function (common in hospitals & outpatient)
*high mortality rate
What lab values are seen for AKI?
>50% increase in serum creatinine
Non-oliguria: >800mL/day (normal)
Oliguria: <0.5 mL/kg/hr (low)
Anuria: <50mL/day (absence)
Explain the RIFLE classification for AKI:
R(risk): creatinine 1.5x baseline, GFR decrease >25%, output 0.5mL/kg/h for 6 hrs
I(injury): creatinine 2x baseline, GFR decrease >50%, 0.5mL/kg/h for 12 hrs
F(failure): creatinine 3x baseline, GFR decrease >75%, <0.3mL/kg/h for 24h OR
anuria 12h
L(loss): Persistent AKI -> loss of kidney function >4wks
E(ESKD): >3mo
What are some reversible causes of AKI?
Hypovolemia
Hypotension
Reduced cardiac output/HF
Obstruction of kidney/lower urinary tract (tumor, clot, stone)
Bilateral obstruction of renal arteries/veins
What are a few risk factors for AKI/ARF?
