Hey everyone, it's nurse Mike here from simple nursing.com. Today we're breaking down hemmoialysis and periteneal diialysis. We're covering the key differences, nursing care and enclelex tips that you cannot miss. Now for all my simple nursing members, be sure to grab your study guides to help this renal info really stick for test day. All right, let's dive in. Dialysis is the machine version of the kidney used for our clients in renal failure. that kidney failure. So just like the kidney, dialysis helps to clean the blood like a washer machine by filtering out waste and flushing out excess fluid and electrolytes. So the memory trick we use anytime you see the word dial for dialysis just think dial like the soap. It helps to clean the blood. Now we have two types hemodialysis and peritineal dialysis. So for hemmoiolialysis a shunt is placed into the arm where blood is taken and washed in the dialysis machine around three to four times per week. So if a session is missed then we have a huge risk for excess electrolytes and waste in the blood. The one to know for exams and the enclelex write it down is potassium. So just think potassium is priority since it pumps the heart muscles. So in high potassium we have high pumps in the heart leading to ECG dysriythmias. Lots of exam questions come from here. So write this down. Priority is to give calcium gluconate to glue down those heart muscles. And then we also give IV regular insulin to push that potassium into the cell out of the bloodstream into the cell. Now, we go into way more detail about this in our renal failure lectures, but I wanted to give you the most tested content here to reinforce it. Okay. Now, as far as priority assessments before dialysis, it includes the double Fs here, fluid and fistula assessment. So, write this down. To assess fluid status, we always take weights and we compare the current and previous. So, we must check the medical record to compare the current weight with the last post dialysis weight. And we always take vital signs and assess for edema and also lung and heart sounds. Now in terms of assessing the fistula, the shunt. Huge enclelex tip. Write this down. You have to always feel a thrill or vibration on some question banks and hear a brute or a swoosh. So just remember fill a thrill, hear a brute. If these are not present, we have to report to the HCP immediately. This could mean that there's a clot formation in the fistula. basically decrease blood flow and the client can lose their arm. Now in terms of which medications to hold, we always hold meds that cause low blood pressure. Since fluid is removed during diialysis, which may cause hypotension, that low blood pressure. So to make this simple, for all the anti-hypertensives, simply remember A, B, C, and D. A is for aces and arbs ending in prill and sartin like leucinopril and low sartin. Just think prills are like a chill prill for the heart low blood pressure and sartins kind of sound like relax man with sartan decreased blood pressure. Now a little side note both retain potassium in the body causing hypercalemia. So for P in prills just think P for potassium and the S in sartin just think they spare potassium. Now B is for beta blockers ending in LOL like a tennol. So just think of the double L's for the double lows. Two L's for two low cardiac vitals low blood pressure and low heart rate. Now C is for calcium channel blockers ending in D-pine emil and z. So depine just think it declines the blood pressure and emil is calm and chill blood pressure. And then zam in deltayazm is like zen yoga for the heart decreased blood pressure. Now the last two D's D is for diuretics ending in eyid like feroseamide and hydrochloroioide. So just think they end in eyid so the body is dried and it lowers the blood pressure. And the last D is for dilators like nitroglycerin. So just think nitro vase O dilates the vessels to make that BP Lo. Now lastly in terms of washed out certain medications are dialized out of the body making them ineffective. So antibiotics like sillins and sephs penicellin and sephilosporins as well as digoxin that cardiac glycoside which gives a deeper contraction in heart failure and aphib patients. So just think dig joxen for digoxin. It digs for that deep contraction. And lastly, we hold water- soluble vitamins, vitamin B, C, and folic acid. Now, commonly chosen wrong answers was to hold calcium supplements. These ones are okay to give before diialysis to help bring down those phosphorus levels in the blood. And insulin is also okay to give because it's typically absorbed fast. So we can still give it with breakfast prior to dialysis. Now a little side note here during diialysis IV hepin is added to the blood to prevent clotting. So it's not necessary to give subcutaneous hepin or another blood thinner before or during diialysis. So don't get tricked. Now ATI had a question about a client who reports muscle cramps and tingling in the hands. You must prepare to give calcium carbonate. Just think calcium calms the cramps. And another question about priority assessment finding with hemodialysis clients. Key term here is restlessness. It could indicate deadly disequilibrium syndrome. Now, what the heck is that, right? Well, it's a deadly complication during or after hemmoiolysis. So, write this down. Dialysis disequilibrium syndrome. That DDS. It's a condition where solutes are removed too quickly from the blood which causes brain cells to swell with fluid. We're talking a big massive brain here resulting in deadly increased ICP that intercraanial pressure which eventually leads to coma and then death. So the key signs to write down restless and disoriented were the biggest ones there. You have to know those during diialysis or even after is a priority as well as vomiting and headache. Now the priority action is to stop or slow the infusion and key term here report to the provider. So don't let the enclelex trick you here. We do not place the client in trendelenburgg as it can increase pressure in the brain making that ICP worse. Many students get this wrong. And we do not give medications to stop the vomiting or even the headache. Again a general enclelex tip. any infusion causing a problem, we stop or slow the infusion immediately and contact the provider. Now, for patient education, in terms of care for a fistula, you must understand how it's created before you can properly care for it. So, creation involves a connection between an artery and a vein, typically near the wrist or the forearm. It permits high pressure arterial flow to go through a low pressure vein. Now, veins are typically not used to high pressures since veins vacuum blood back to the heart. So, it takes a few months to heal and settle in. Therefore, teaching the client is key. So, key terms here to write down. Squeeze or grip a rubber ball or a sponge or something soft a few times a day to help both blood flow and strengthen the new sight. And also, pitting edema is normal. Write that down. Big test tip here. Most students get this wrong. Edema, that fluid buildup in the arm, typically resolves on its own within a week or so as the body adjusts. Now, what's not normal? We must report this to the HCP, huge anlex tip. Remember the five Ps of Profusion, but really the earliest signs to know are the top two here. So, P for pale skin, that palar, and P for paristhesas, that numbness or tingling. Now, these two are the top to know since they're the earliest signs and the most tested. Now, we also have the other three below, but without immediate action, a patient can lose their arm from lack of oxygen. So, again, out of all these, the top two, pale skin and paristhesas, very common on exams since early intervention will always save life and limb. Now, another priority here is that clients must be careful with new shunts as they heal. So we have to avoid all pressure and monitor for key terms infection that warm red or drainage at the shunt site bleeding as well as big one here write this down feel a thrill feel that vibration this means blood flow is adequate so teach clients to check this every single day a few times a day that came up a lot on question banks we're monitoring for the stenosis basically that stiffening or even thrombosis is that blood clotting at the site. So just think you have to check for those good good good good good vibrations. Okay. Now for the no nos just think here we're trying to promote adequate blood flow and prevent that clotting. So we must avoid all pressure. So no restrictive clothing or jewelry especially watches or even bracelets. No blood pressure on the affected arm. No sleeping on that arm. No creams or lotions in terms of infection and no lifting over five pounds. So a key term here is no purse. These guys love to show up on exams as select all that apply questions. So be sure to think of the no- nos as no pressure. Get a full breakdown of what you need to pass the enclelex with our enclelex review lecture series and live creme sessions led by myself and industry experts. Now switching gears to peritinal dialysis. This is very different than hemodialysis in that there's no shunt in the arm. Instead, the peritineal cavity is filled up with hypertonic solution to pull out solutes. We allow the fluid to sit in the body for about 30 minutes. This is called the dwell phase. And then we empty the drain to gravity. So the key points here is before just like any diialysis, we take weight and we warm the solution. Typically, as a general rule, any fluid that's going inside the body, we want to make sure it's warm. Now, Kaplan mentions proper preparation for peritineal diialysis. The first action is to warm the dialysis. Now, the big key point out of this entire lecture is the deadly complication of infection. So, write this down. Infection risk. We must use sterile technique as priority when spiking and attaching the bag of dialysates. A small infection can lead to a very deadly infection in the peritineal cavity. This is known as peritonitis. So the key signs to report write this down is fever, tacocardia and cloudy drainage. We must report to the HCP immediately. So the memory trick we use is think no one likes cloudy days and no one likes cloudy drainage. Now don't get tricked. Priority findings are not oligura that low urine output or even puritis that itchiness of the skin. These are common and normal findings with almost all renal failure clients. So oligura just think no o or very low o urine output and oligura. This again is normal and expected because the kidneys have failed. They're basically broken. Now another deadly complication here is respiratory distress due to rapid infusion or overfilling the abdomen. So the key signs to know are crackles in the lung bases, rapid respirations and also dispnnea that difficulty breathing. So priority intervention is the first action we have to raise the head of the bed. Remember ABCs here breathing over circulation like blood pressure. Many students get this wrong on various quiz banks. So always intervene on breathing before that blood pressure. Now Kaplan gave a scenario about a patient on peritineal diialysis that begins to suddenly breathe more rapidly. The first action here was to raise that head of the bed. And lastly, a few select all that apply questions came from insufficient outflow. So big enlex tip here, we always assess the patient first and then assess devices after. And always assessment comes first before interventions which comes second. So when you get a question about insufficient outflow we always number one assess the patient assessing the abdomen for distension and constipation. Number two you assess the device for catheter kinks and obstructions. And then very lastly the biggest intervention here write this down. We reposition to sideline position. We don't flush the tubing initially. This can worsen an outflow problem and there's no need to contact the provider since repositioning will usually fix the problem. Now, after diialysis, we typically increase protein in the diet since the blood has been washed from waste and now we typically have low protein in the body. Thanks for watching. Did you know you can unlock beautifully handcrafted study guides packed with key points and memory tricks from all our videos? Plus, you'll get access to over 1,200 exclusive videos not on YouTube, all neatly organized by nursing school topic to make that complex nursing knowledge actually stick. You'll also gain thousands of practice questions written by current professors and actual ENCLEX writers. So, for access to all this and more, click right up here or visit simplening.com. And don't forget to subscribe to our YouTube channel. Happy studying and we'll see you in the next videos.