Kidney Function
What is considered the "work horse" of the kidney?
The nephron
1 million per kidney.
# of functioning nephrons decreases with age.
10% for every 10 years of age after 40
Name 2 leading causes of CKD
Diabetes and Hypertension
Others include: Lupus, exposure to nephrotoxins, recovery from AKI, older age, family history, reduced renal mass, smoking
Name 3 advantages of PD
Slower, gentler
Minimal disruption of daily activities
Less restrictive diet
Done at home
Avoids systemic effects of heparin
Fewer adverse physiological consequences
What are the phases of PD?
Drain
Fill
Dwell
Name 3 basic nursing care interventions for the patient receiving PD
Hand hygiene
Warming the dialysate
Cover site with a dressing during hospitalization
Immobilize the catheter
Exit site care
Ensuring patient and/or family is performing exchanges properly for the hospital.
Name 3 functions of the kidney
Filtering
Fluid removal
Balance Body Chemistry
Control BP
Stimulate RBC Production
Promote Bone Strength & Prevent Blood Vessel Hardening
Name 3 Nephrotoxins
NSAIDs
Antibiotics
CT dye
What are the transport mechanisms utilized in PD?
Diffusion
Osmosis
Ultrafiltration
Why is dextrose content in the dialysate important?
The amount of dextrose in the solution will determine the amount of fluid that is removed.
Who would add medications to the dialysate
Pharmacy.
Most common meds added:
Antibiotics, heparin, insulin
Three things filtered through the kidney
Sodium, Potassium, Waste Products
Monitors phosphorus, calcium, and vitamin D
Name 2 things that can occur when the kidneys don't work well
Uremia
Fluid Overload
Hyperkalemia
Hyper/hypotension
Anemia
Decreased bone density
What are 2 contraindications to a patient opting for PD?
Abdominal surgeries
Hernias
Excessive obesity
Preexisting vertebral disease
Severe COPD
Rapid treatment is needed
Peritonitis
What should be included in the patient assessment prior to an exchange?
Vital signs
Dry weight
Labs
Nutritional status
Exit site assessment
Where would you document the PD catheter
LDA (Lines, Drains, and Airways)
Which is a better indicator of kidney filtration: Serum Creatinine or Glomerular Filtration Rate?
GFR-Glomerular Filtration Rate
These ethnic backgrounds have a higher incidence of CKD
Black Americans
Native Americans
Name 2 common complications of PD
Peritonitis
Weight gain
Weakening of the abdominal muscle
Hyperglycemia
Hyper/Hypotension
Damage to the catheter
Fibrin shreds = Clotting
Difficulty draining/filling
Is PD an Aseptic or Sterile Procedure?
Tricky One!
Strict aseptic technique while maintaining sterility of the peritoneal dialysis catheter tip
How often is routine exit site assessment and care completed?
At least daily.
An exit site score of = to or >4 can signify infection.
At what stage kidney disease will the patient be preparing for Dialysis Therapy?
Stage 4.
Stage 5 the patient will be on renal replacement therapy of some kind.
Not including HTN and DM, name a modifiable risk factor for chronic kidney disease
Autoimmune disease
Lupus
Exposure to Nephro-toxic drugs
Why are bowel habits and menses important items to discuss with your patient?
Constipation can cause poor filling and draining.
Female's effluent may have a bloody tinge due to menses.
What is SEAL?
Strength
Expiration
Amount
Leakage
What instances would you contact the LIP/Physician/Nephrologist?
Exit site score > or = to 4
Cloudy, bloody, or presence of fibrin the the effluent.
Slow draining/filling
Pain with draining/filling
Inability to instill the prescribed amount of dialysate