ATI Med-Surg: Chapter 57: Hemodialysis and Peritoneal Dialysis Questions and Answers with complete solution

Functions of dialysis - Answer-◯ Rids the body of excess fluid and electrolytes ◯ Achieves acid-base balance ◯ Eliminates waste products ◯ Restores internal homeostasis by osmosis, diffusion, and ultrafiltration ● Dialysis can sustain life for clients who have both acute and chronic renal failure. ● Dialysis does not replace the hormonal functions of the kidneys. ● Two types of dialysis are hemodialysis and peritoneal dialysis. Hemodialysis - Answer-Shunts the client's blood from the body through a dialyzer and back into circulation. Vascular access is needed for hemodialysis. Indications for Hemodialysis: Diagnoses - Answer-■ Renal insufficiency ■ Acute kidney injury ■ Chronic kidney disease ■ Drug overdose ■ Persistent hyperkalemia ■ Hypervolemia unresponsive to diuretics Indications for Hemodialysis: Client Manifestations - Answer-■ Related to fluid volume changes, electrolyte and pH imbalances, and nitrogenous wastes. ■ Hemodialysis is based on symptoms, not glomerular filtration rate (GRF). ■ Client symptoms include fluid overload, neurological changes, bleeding, or signs of uremia.Hemodialysis: Preprocedure - Answer-◯ Nursing Actions ■ Check for an informed consent. ■ Use the temporary hemodialysis dual- or triple-lumen catheter, or subcutaneous device until a longterm device is inserted and available for access. ■ Assess patency of a long-term device - arteriovenous (AV) fistula, or arteriovenous graft (presence of bruit, palpable thrill, distal pulses, and circulation). ■ Avoid taking blood pressure, administering injections, performing venipunctures or inserting IV lines on an arm with an access site. Elevate the extremity following surgical development of AV fistula to reduce swelling. ■ Assess vital signs, laboratory values (BUN, serum creatinine, electrolytes, Hct), and weight. ■ Discuss with the provider medications that need to be withheld until after dialysis. Dialyzable medications and medications that lower blood pressure are withheld. ◯ Client Education ■ Advise the client that hemodialysis is usually done three times per week, for 3- to 5-hr sessions. Two needles are inserted, one into an artery and the other into a vein. Hemodialysis: Intraprocedure - Answer-◯ Nursing Actions ■ Monitor for complications during dialysis. Dialysis circuit clotting, air bubbles in blood tubing, temperature of the dialysate (37.8° C [100° F]), regulation of the ultrafiltration. Hypotension, cramping, vomiting, bleeding at the access site, contamination of equipment. ■ Monitor vital signs and coagulation studies during dialysis. Monitor for bleeding, such as oozing from insertion site. Administer anticoagulants as prescribed. Heparin is used to prevent clotting of the blood with foreign surfaces. Monitor the aPTT for risk of hemorrhage. ■ Have protamine sulfate ready to reverse heparin if needed. ■ Provide emotional support. Offer activities, such as books, magazines, music, cards, or television, to occupy the client. ◯ Client Education■ Advise the client to notify the nurse of headache, nausea, or dizziness during dialysis. Advise the client not to eat during dialysis. Hemodialysis: Postprocedure - Answer-◯ Nursing Actions ■ Monitor vital signs and laboratory values (BUN, serum creatinine, electrolytes, Hct). Decreases in blood pressure and laboratory values are expected following dialysis. ■ Compare the client's preprocedure weight with the postprocedure weight as a way to estimate the amount of fluid removed (1 liter of fluid is equal to 1 kg or 2.2 lb). ■ Assess for the following: Complications (hypotension, clotting of vascular access, headache, muscle cramps, bleeding) Indications of bleeding, and/or infection at the access site Signs of disequilibrium syndrome Signs of hypovolemia (hypotension, dizziness, tachycardia) ■ Avoid invasive procedures for 4 to 6 hr after dialysis due to the risk of bleeding related to an anticoagulant. ◯ Client Education ■ Reinforce AV fistula or AV graft precautions. ■ Teach the client to perform the following: Alert the nurse of early signs of disequilibrium syndrome, such as nausea and headache. Check the access site at intervals following dialysis. Apply light pressure if bleeding. Check the graft for patency by checking for thrill or bruit. Monitor the access site for signs of an infection such as fever, redness, drainage or swelling. Contact the provider if bleeding from the insertion site lasts longer than 30 min following dialysis, for absence of thrill/bruit, or signs of infection. Take medications and supplements as prescribed to replace folate loss. Eat well-balanced meals to include foods high in folate (beans, green vegetables), and take supplements. Protein is lost with each exchange during dialysis and also requires the client to increase protein intake. Avoid lifting heavy objects with access-site arm.☐ Avoid carrying objects that compress or constrict the extremity. Avoid sleeping on top of the extremity with the access device.