What are the 4 transport mechanisms in hemodialysis?
- ultrafiltration
- Convection
- diffusion
- osmosis
What is ultrafiltration?
Fluid pushed through the semipermeable membrane
What is convection?
When solutes are dragged across the semi-permeable membrane along with fluid
What is diffusion?
When particles move from an area of high concentration to low concentration
What is osmosis?
When fluid moves from an area of low concentration to high concentration
What is the function of acid concentrate?
Provides the concentration gradient for diffusion to take place and helps normalize electrolytes
What are some of the kidneys’ excretory functions? (3)
- normalizing electrolytes
- removing wastes
- providing fluid and acid base balance
What is the function of bicarbonate in the dialysate solution?
to buffer the acid concentrate
What is the function of the bicarbonate when it diffuses into the patient’s blood?
normalizes body pH
What is hyperkalemia? What are the symptoms? (3)
High potassium in the blood; more than 5.5 mEq
- extreme muscle weakness
- abnormal heart rhythm
- possible cardiac arrest
What is hypokalemia? What are the symptoms?
Low potassium in the blood; less than 3.5 mEq
- muscle weakness
- fatigue
- paralysis
- respiratory failure
- cardiac instability
- arrhythmias
- cardiac arrest
What are the kidneys’ endocrine functions?
- renin secretion
- erythropoietin secretion
- Vitamin D activation
How do we replace normal endocrine kidney functions?
- By providing medications
How much of the normal kidney function is replaced by hemodialysis?
- Around 15%
What is uremia and how does it affect the body?
Uremia: buildup of wastes in the blood due to kidney failure
- Affects all body systems
What are the most common causes of chronic kidney disease (CKD) in the USA? (3)
- diabetes
- hypertension
- polycystic kidney disease
Outline the treatment goals for a patient with CKD (6)
- slowing the progression of CKD
- managing comorbidities and complications
- controlling symptoms
- minimizing the effects of CKD on patients’ lifestyle
- Kidney replacement therapy modality education
- Encouraging patients to actively participate in their healthcare
Why is it important to know what causes your patient’s CKD?
So the nurses and PCTs can inquire about possible problems during data collection and assessment
What are some signs and symptoms of fluid imbalance (3)
- hypertension
- edema
- shortness of breath
Why is sodium balance important? (4)
- leads to volume expansion
- increased cardiac output
- increased peripheral vascular resistance
- increased blood pressure
What would you advise a patient with CKD to do with dry, itchy skin?
use hyper-fatted soaps and lotions
What would you advise a patient with CKD to do with peripheral neuropathy (nerve pain in the extremities)? (5)
Monitor patient for changes in motor functions, decreases strength in legs, complaints of restless legs, burning.
- advise them to not walk barefoot and have good footcare
What would you advise a patient with CKD to do with GI problems? (2)
- inform RN and physician of any bleeding problems/constipation/diarrhea/ER visits, take medications as ordered such as stool softeners
What would you advise a patient with CKD to do with any psychological problems?
- Verbalize struggles to IDT (core team), particularly the social worker
