Question

Use Ati Active learning Template basic concept to demonstrate dialysis

Answer 1

Rids the body of excess fluid and electrolytes and achieves acid base balance, eliminates waste products
• Restores homeostasis by osmosis, diffusion and ultrafiltration

Dialysis Uses

renal insufficiency, both acute and chronic renal failure drug overdose if someone has persistent hyperkalemia or hypervolemia (too much fluid) that is unresponsive to diuretics

Subjectively - these patients present:

Fatigue, numbness and tingling of extremities, SOB, anorexia and dry itchy skin

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.
☐ Perform hand exercises that promote fistula maturation.

Objectively - these patients present:

lethargy, decreased attention span, seizures, tremors HTN, HF (so we will see signs of HF, edema, dyspnea, JVD) anemia, vomiting, pulmonary edema, dysrhythmias, pallor, bruising, halitosis (bad breath), diminished or dark colored urine

Goal of dialysis:

achieve and maintain the desired F&E balance, be free of infection and maintain a good lifestyle for individuals with failing kidneys

Hemodialysis

Shunts the client's blood from the body through a dialyzer and back into circulation. They have to have vascular access for hemodialysis.

Access for hemodialysis:

Could be a surgical shunt or we can do it with external vascular access through a port that has been placed that has external ... a catheter of types

Nursing interventions for an established access:

will listen for a bruit • look for a palpable thrill • we will also look for distant pulses and circulation • teach them to do both • Blood pressures are not taken on the arm that has the access site • No injections on the arm that venipunctures are done

post-op period

Make sure they elevate the extremity after they come back from surgery to decrease the swelling • it takes a length of time after surgery before it can be used. We need healing to occur and a fistula to develop

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.