Dialysis 101
Dialysis replaces the function of which organs in the body?
What are the kidneys?
Main functions of the kidneys
What are removal of fluid and waste
Balance blood pressure
Balance electrolytes
Assist in red blood cell production
Fluid restrictions are VERY important for patients making little to no urine. True/False?
True.
(Excess fluid causes high BP, edema, CHF, breathing difficulties and a host of other problems)
To clean and filter the blood, we have to get it out of the patient first. What are the 2 main routes of accomplishing this?
Catheter or Fistula. (Bonus points for graft, which is similar to a fistula, but made of synthetic material)
CMS regulations REQUIRE coordination of care between SNF and Dialysis Staff. Name 2 ways in which this is accomplished. (Communication channels)
What are EMR documentation, IDT meetings, verbal report, written communication, emails.
Two main pieces of equipment/systems used for dialysis.
What are the hemodialysis machine (NxStage System One) and the water treatment system (Pureflow)?
The most common causes of kidney failure
What are diabetes and high blood pressure?
A fluid is defined as anything that is liquid at room temperature such as ice and jello. Ture/False
True.
Also consider things like soups, shakes. It all counts toward total fluid intake.
Catheters (CVC's) need to be clean, dry and monitored for signs of infection. True/False
True.
Remember to coordinate care between SNF and dialysis staff if signs of infection are noted!
Who will document vitals signs in PCC?
Who is the dialysis RN
The tube shaped piece of equipment that is the business end of the dialysis process. Where the filtering/cleaning actually takes place.
What is the dialyzer?
True/False: A person can live with just one kidney
True
This electrolyte is of critical importance for dialysis patients. (Hint: affects electrical activity of heart)
Potassium
Bleeding from a fistula of graft can happen at any time, but is most likely to happen when? In the first few hours after dialysis or randomly?
Within the first few hours after dialysis.
*Possible to occur when changing dressings. To control bleeding, hold direct pressure with sterile gauze for at least ten minutes. Dress and monitor for further signs of bleeding.
Significant changes in appetite are important to communicate for this reason
Because weight changes are monitored closely to assess fluid overload.
The correct answer:
A: The blood is filtered by a semipermeable membrane, surrounded by a solution called dialysate.
B: The blood is cleaned by mixing it with dialysate.
What is A?
A person can get a ********** (new kidney) from someone else through a complicated and time consuming process for both parties, but the benefits and longer lifespan are significant.
Transplant
These foods are avoided by dialysis patients due to very high potassium levels.
Bananas, potatoes in any form (fries, mashed), spinach, tomatoes.
We don't take blood pressures on arms with fistulas or discharge patients with pressure bandaging in place for this reason
What can cause immediate and long term damage to a fistula?
The dialysis center welcomes all the feedback the SNF staff can give! Positive and "constructive!" True/False
What is True! We need communication to smooth out the kinks.
You can email or text the Director of Operations any time of day or night!
Patients are weighed before AND after treatment for this reason
What is to assess fluid balance in patient
Name 2 symptoms of kidney failure
Decreased urine output, fluid overload, fatigue, poor appetite, itching, mental fogginess, abnormal lab values, uremic smell
What food group do patients need MORE of?
What are proteins?
If any staff member observes that a CVC clamp is in the open position, or if the cap is not in place, this is potentially life threatening and must be addressed immediately. True or False?
What is TRUE!
If a clamp is open and the cap becomes dislodged or removed, an air embolism will occur. Clamp it immediately.
An uncapped, unprotected catheter opening is a direct line of infection. Disinfect immediately and apply sterile cap. Notify dialysis staff.
Critical issues to communicate include at least 3 of these:
Changes in medication, cognitive status, diet. New diagnosis, appointments/procedures/surgeries. Upcoming discharge from facility. Injuries, acute illness, infections, etc. Complaints. Abnormal labs. (Any other valid answers will count!)