Dialysis Study Guide latest updated
Explain the four transport mechanisms that play a role in dialysis - correct Answer-
Ultrafiltration
Convection
Diffusion
Osmosis
Ultrafiltration (UF) - correct Answer-Fluid pushed through the semipermeable
membrane; filtration of fluid with pressure
Convection - correct Answer-"Solute Drag"
Solutes dragged across semipermeable membrane (SPM) along with fluid moving
across the SPM
Ex. like a water current pulling sand with it
Diffusion - correct Answer-PARTICLES move from an area of HIGH concentration to
LOW concentration
Particles move from HIGH --> LOW concentration
Osmosis - correct Answer-FLUID moves from area of LOW to HIGH concentration
What are the kidneys excretory functions? - correct Answer-To normalize electrolytes
Remove wastes
Provide fluid and nutrient balance
What are the kidneys endocrine functions? - correct Answer-Renin secretion
Erythropoietin secretion
Vit D activation (active vit D = calcitriol)
What is the function of the acid concentrate in dialysate? - correct Answer-Provides the
concentration gradient for diffusion
What is the function of bicarbonate in dialysate? - correct Answer-In the dialysis
solution- buffers the acid concentrate
When diffused into the pts body- normalizes body pH
How do we replace normal kidney functions? - correct Answer-Excretory- normalize
electrolytes, provide fluid balance through UF
,Endocrine- provide medications (ex epo, iron, vit D, calcium)
Outline the treatment goals for a pt with CKD - correct Answer-Slow progression of CKD
Manage comorbidities and complications
Control symptoms
Minimize the effects of CKD on pts lifestyles
Kidney replacement therapy modality education
Encouraging pts to actively participate in their healthcare
What are the most common causes for CKD in the USA? - correct Answer-Diabetes
HTN
Polycystic Kidney Disease (PKD)
Why is it important to know what caused your pt's CKD? - correct Answer-So the nurse
and PCT can inquire about possible problems during data collection and assessment
S/S of fluid imbalance - correct Answer-HTN
Edema
SOB
What does HTN lead to? - correct Answer-Left Ventricular Hypertrophy (LVH)
Why is sodium balance important? - correct Answer-Leads to volume expansion -->
increased cardiac output (CO) --> increased peripheral vascular resistance -->
increased BP
It attracts water --> increased BP if too high
S/S Hyperkalemia (>5.5 mEq/L per Davita) - correct Answer-> 6.5 mEq/L S/S:
Extreme muscle weakness
Abnormal heart rhythm
Possible cardiac arrest
S/S Hypokalemia (<3.5 mEq/L) - correct Answer-Fatigue
Muscle weakness
Paralysis
Respiratory failure
Cardiac instability
Arrhythmias
Cardiac arrest
Average lifespan of RBCs vs dialysis pt RBCs - correct Answer-Average lifespan is
about 120 days
Dialysis pt RBC lifespan is about 60 days (1/2 the amount of time)
,Why are dialysis pts anemic? - correct Answer-PRIMARY cause: lack of the hormone
erythropoietin (EPO)
SECONDARY cause: inadequate iron stores, inadequate dialysis, malnutrition, blood
loss during tx
How can you prevent contributing to lower hgb levels and blood loss in dialysis pts? -
correct Answer-Ensure epo dose is correct and administered
Rinseback blood completely
Avoid repeat lab draws
What is pericarditis? - correct Answer-Inflammation of the membrane (pericardial sac)
around the heart
What is included in the tx of pericarditis on the dialysis side? - correct Answer-Decrease
or stop heparin
Give more frequent dialysis
Systemic effects of CKD and advice for pts - correct Answer-DRY ITCHY SKIN- use
hyper-fatty soaps and lotions, caution regarding safety at home, provide emotional
support, control diabetes and phos
PERIPHERAL NEUROPATHY- monitor for changes in motor function or decreased
strength, restless legs, burning feet - advise pt NOT to walk barefoot, have good foot
care practices
GI PROBLEMS- ex N/V, monitor for bleeding problems, constipation, diarrhea, ER
visits, take meds as ordered
PSYCHOLOGICAL PROBLEMS- verbalize struggles to IDT, especially the SOCIAL
WORKER
What are the four key elements affected in CKD- Mineral Bone Disorder (MBD)? -
correct Answer-1. Calcium (Ca)
2. Phos
3. Parathyroid hormone (PTH)
4. Vit D (calcitriol)
All of these lead to MBD when they are abnormal
What are symptoms of CKD-MBD in addition to bone disease? - correct Answer-Soft
tissue calcification
Itching
Muscle weakness
Pathological fractures
Tendon ruptures
, Compression of vertebrae
Atherosclerosis
Heart disease
What is your role in MBD management? - correct Answer-Report symptoms
Urge pts to take meds (at home and at tx)
Report noncompliance issues r/t nonadherence
How much of normal kidney function does ICHD dialysis replace? - correct Answer-15%
Define AKI - correct Answer-Acute kidney injury
Term incorporates a wide spectrum of kidney issues
Includes acute kidney failure as well as less catastrophic kidney function changes
May dialyze in an outpt facility until kidney function recovers
What are the 3 categories of possible causes of AKI? - correct Answer-Pre-renal: before
the kidneys
Intra-renal: in the kidneys
Post-renal: after the kidneys (ex. ureters or bladder)
Give examples of pre-renal causes of AKI - correct Answer-Obstruction
Volume Depletion
Impaired Cardiac Function
Examples of intra-renal causes of AKI - correct Answer-Ischemic acute tubular necrosis
(ATN)
Sepsis, SIRS, Septic shock
Anaphylaxis
Drugs
Goodpasture syndrome (autoimmune illness where body attacks lungs and kidneys)
Acute glomerulonephritis
Trauma
Open heart surgery
Examples of post-renal causes of AKI - correct Answer-Obstruction
Oliguric
Bladder rupture
Pregnancy
Outline the treatment goals for a pt with AKI dialyzing in the outpt facility - correct
Answer-Find the cause of AKI and tx
Explain the four transport mechanisms that play a role in dialysis - correct Answer-
Ultrafiltration
Convection
Diffusion
Osmosis
Ultrafiltration (UF) - correct Answer-Fluid pushed through the semipermeable
membrane; filtration of fluid with pressure
Convection - correct Answer-"Solute Drag"
Solutes dragged across semipermeable membrane (SPM) along with fluid moving
across the SPM
Ex. like a water current pulling sand with it
Diffusion - correct Answer-PARTICLES move from an area of HIGH concentration to
LOW concentration
Particles move from HIGH --> LOW concentration
Osmosis - correct Answer-FLUID moves from area of LOW to HIGH concentration
What are the kidneys excretory functions? - correct Answer-To normalize electrolytes
Remove wastes
Provide fluid and nutrient balance
What are the kidneys endocrine functions? - correct Answer-Renin secretion
Erythropoietin secretion
Vit D activation (active vit D = calcitriol)
What is the function of the acid concentrate in dialysate? - correct Answer-Provides the
concentration gradient for diffusion
What is the function of bicarbonate in dialysate? - correct Answer-In the dialysis
solution- buffers the acid concentrate
When diffused into the pts body- normalizes body pH
How do we replace normal kidney functions? - correct Answer-Excretory- normalize
electrolytes, provide fluid balance through UF
,Endocrine- provide medications (ex epo, iron, vit D, calcium)
Outline the treatment goals for a pt with CKD - correct Answer-Slow progression of CKD
Manage comorbidities and complications
Control symptoms
Minimize the effects of CKD on pts lifestyles
Kidney replacement therapy modality education
Encouraging pts to actively participate in their healthcare
What are the most common causes for CKD in the USA? - correct Answer-Diabetes
HTN
Polycystic Kidney Disease (PKD)
Why is it important to know what caused your pt's CKD? - correct Answer-So the nurse
and PCT can inquire about possible problems during data collection and assessment
S/S of fluid imbalance - correct Answer-HTN
Edema
SOB
What does HTN lead to? - correct Answer-Left Ventricular Hypertrophy (LVH)
Why is sodium balance important? - correct Answer-Leads to volume expansion -->
increased cardiac output (CO) --> increased peripheral vascular resistance -->
increased BP
It attracts water --> increased BP if too high
S/S Hyperkalemia (>5.5 mEq/L per Davita) - correct Answer-> 6.5 mEq/L S/S:
Extreme muscle weakness
Abnormal heart rhythm
Possible cardiac arrest
S/S Hypokalemia (<3.5 mEq/L) - correct Answer-Fatigue
Muscle weakness
Paralysis
Respiratory failure
Cardiac instability
Arrhythmias
Cardiac arrest
Average lifespan of RBCs vs dialysis pt RBCs - correct Answer-Average lifespan is
about 120 days
Dialysis pt RBC lifespan is about 60 days (1/2 the amount of time)
,Why are dialysis pts anemic? - correct Answer-PRIMARY cause: lack of the hormone
erythropoietin (EPO)
SECONDARY cause: inadequate iron stores, inadequate dialysis, malnutrition, blood
loss during tx
How can you prevent contributing to lower hgb levels and blood loss in dialysis pts? -
correct Answer-Ensure epo dose is correct and administered
Rinseback blood completely
Avoid repeat lab draws
What is pericarditis? - correct Answer-Inflammation of the membrane (pericardial sac)
around the heart
What is included in the tx of pericarditis on the dialysis side? - correct Answer-Decrease
or stop heparin
Give more frequent dialysis
Systemic effects of CKD and advice for pts - correct Answer-DRY ITCHY SKIN- use
hyper-fatty soaps and lotions, caution regarding safety at home, provide emotional
support, control diabetes and phos
PERIPHERAL NEUROPATHY- monitor for changes in motor function or decreased
strength, restless legs, burning feet - advise pt NOT to walk barefoot, have good foot
care practices
GI PROBLEMS- ex N/V, monitor for bleeding problems, constipation, diarrhea, ER
visits, take meds as ordered
PSYCHOLOGICAL PROBLEMS- verbalize struggles to IDT, especially the SOCIAL
WORKER
What are the four key elements affected in CKD- Mineral Bone Disorder (MBD)? -
correct Answer-1. Calcium (Ca)
2. Phos
3. Parathyroid hormone (PTH)
4. Vit D (calcitriol)
All of these lead to MBD when they are abnormal
What are symptoms of CKD-MBD in addition to bone disease? - correct Answer-Soft
tissue calcification
Itching
Muscle weakness
Pathological fractures
Tendon ruptures
, Compression of vertebrae
Atherosclerosis
Heart disease
What is your role in MBD management? - correct Answer-Report symptoms
Urge pts to take meds (at home and at tx)
Report noncompliance issues r/t nonadherence
How much of normal kidney function does ICHD dialysis replace? - correct Answer-15%
Define AKI - correct Answer-Acute kidney injury
Term incorporates a wide spectrum of kidney issues
Includes acute kidney failure as well as less catastrophic kidney function changes
May dialyze in an outpt facility until kidney function recovers
What are the 3 categories of possible causes of AKI? - correct Answer-Pre-renal: before
the kidneys
Intra-renal: in the kidneys
Post-renal: after the kidneys (ex. ureters or bladder)
Give examples of pre-renal causes of AKI - correct Answer-Obstruction
Volume Depletion
Impaired Cardiac Function
Examples of intra-renal causes of AKI - correct Answer-Ischemic acute tubular necrosis
(ATN)
Sepsis, SIRS, Septic shock
Anaphylaxis
Drugs
Goodpasture syndrome (autoimmune illness where body attacks lungs and kidneys)
Acute glomerulonephritis
Trauma
Open heart surgery
Examples of post-renal causes of AKI - correct Answer-Obstruction
Oliguric
Bladder rupture
Pregnancy
Outline the treatment goals for a pt with AKI dialyzing in the outpt facility - correct
Answer-Find the cause of AKI and tx
