Overview
This lecture covers the core differences between hemodialysis and peritoneal dialysis, essential nursing care, and high-yield NCLEX tips for renal failure management.
Hemodialysis: Concepts & Nursing Care
- Dialysis serves as an artificial kidney to clean blood by filtering waste and excess fluid/electrolytes.
- Hemodialysis uses a shunt in the arm; blood is filtered 3-4 times weekly.
- Missing sessions risks buildup of waste, especially potassium, which can lead to dangerous heart rhythms.
- Priority medications: Give calcium gluconate and IV regular insulin for high potassium to stabilize heart.
- Pre-dialysis assessment: Check fluid status (compare weights), take vital signs, assess edema, lung, and heart sounds.
- Fistula assessment: Must feel a thrill (vibration) and hear a bruit (whoosh); absence requires immediate provider contact.
- Hold meds that lower blood pressure before dialysis; remember ABCDs (ACE/ARB, Beta blockers, Calcium channel blockers, Diuretics, Dilators).
- Some meds are dialyzed out (antibiotics, digoxin, water-soluble vitamins); these should be held.
- Calcium supplements and insulin can be given before dialysis.
- IV heparin is used during dialysis to prevent clotting; no need for subcutaneous heparin.
Hemodialysis Complications & Patient Education
- Muscle cramps/tingling: Treat with calcium carbonate.
- Disequilibrium syndrome: Rapid solute removal can cause brain swelling (signs: restlessness, disorientation, headache, vomiting); priority is to stop/slow infusion and report, not trendelenburg or symptom meds.
- Fistula care: Created by connecting an artery to a vein; squeeze soft objects to aid healing; mild edema is normal for a week.
- Report pale skin or numbness immediately (early signs of poor perfusion).
- Prevent pressure on access site: Avoid tight clothing/jewelry, BP measurements, sleeping on arm, creams, or lifting over 5 lbs.
Peritoneal Dialysis: Concepts & Nursing Care
- Involves filling the peritoneal cavity with a hypertonic solution, allowing solutes to diffuse, then draining fluid.
- Start with weighing patient and warming solution before the procedure.
- Sterile technique is mandatory to prevent peritonitis (infection of peritoneal cavity).
- Signs of peritonitis: Fever, tachycardia, cloudy drainage—report immediately.
- Respiratory distress from overfilling: Raise head of bed first.
- Insufficient outflow: Assess patient (abdomen for distension/constipation), then assess device (kinks), and finally reposition to sideline if needed.
Nutrition After Dialysis
- Increase dietary protein post-dialysis due to protein loss during treatments.
Key Terms & Definitions
- Dialysis — Artificial blood purification for kidney failure.
- Hemodialysis — Blood filtered via machine using a vascular shunt.
- Peritoneal Dialysis — Fluid exchange across the peritoneal membrane to filter blood.
- Fistula — Surgically created artery-vein connection for hemodialysis access.
- Thrill/Bruit — Vibration/sound indicating blood flow in fistula.
- Disequilibrium Syndrome — Brain swelling due to rapid solute removal in dialysis.
- Peritonitis — Infection/inflammation of peritoneal cavity.
- Hyperkalemia — High potassium in the blood.
Action Items / Next Steps
- Review and memorize ABCD antihypertensives to hold before dialysis.
- Practice fistula assessment skills and patient education points.
- Study signs of dialysis complications and required nursing interventions.
- Read additional renal failure lecture content as recommended.