💧 Dialysis Drama
Which electrolyte would you expect the dialysis process to remove efficiently from the blood?
Potassium
During peritoneal dialysis, what should normal dialysate effluent generally look like?
Clear/colorless or light straw-colored.
When assessing an AV fistula or graft, the nurse is looking and listening for two important signs of blood flow. Name them.
Thrill and bruit.
Which electrolyte abnormality can rapidly become life-threatening because of its effect on cardiac conduction?
Hyperkalemia.
A client with progressive CKD has a laboratory value that tells you how effectively the kidneys are filtering blood.
What is it called?
GFR — glomerular filtration rate.
A client develops headache, nausea, and restlessness shortly after an initial hemodialysis treatment. What complication should the nurse suspect?
Dialysis disequilibrium syndrome.
A client notices that their dialysate is suddenly cloudy. What complication should immediately come to mind?
Peritonitis.
Should the nurse take a blood pressure on the arm containing an AV fistula or graft?
No, avoid blood pressure measurements on the access arm.
A client with kidney failure has a potassium level of 7.0 mEq/L. Why should the nurse prioritize this finding?
Severe hyperkalemia can cause life-threatening cardiac dysrhythmias and cardiac arrest.
As kidney function worsens, what trend would you see when monitoring creatinine?
Increase or Rise.
Why can a client experience neurological symptoms during dialysis disequilibrium syndrome?
Rapid changes in BUN/solute concentration can cause fluid shifts into brain tissue, contributing to cerebral edema and increased intracranial pressure.
Give three assessment findings that could support a diagnosis of peritonitis.
1. Abdominal pain/tenderness
2. Fever
3. Nausea/vomiting
4. Cloudy effluent,
5. Elevated WBC count
6. Malaise
7. Decreased bowel sounds.
A client with an AV fistula reports that the hand below the fistula has become cold and numb.
What does this suggest?
Possible vascular insufficiency/steal syndrome.
A dialysis client has crackles throughout both lungs, significant edema, and a rapid weight increase. What problem should the nurse suspect?
Fluid overload.
A kidney transplant client develops decreased urine output, increasing creatinine, edema, weight gain, and hypertension.
What complication should the nurse suspect?
Renal transplant rejection.
Name two nursing priorities for a client suspected of experiencing dialysis disequilibrium syndrome.
1. Seizure precautions
2.Frequent neurological assessment.
3.Monitoring laboratory values
A client says, “My abdomen hurts a little when the dialysate first goes in.” Why might this occur, particularly early in treatment?
Mild discomfort during initial dialysate inflow can occur as the client adjusts to peritoneal dialysis. Warming the dialysate can decrease discomfort.
You palpate an AV fistula and can no longer feel the usual vibration. What should you be concerned about?
Possible loss of blood flow/access occlusion or thrombosis;
A client with a kidney stone develops severe flank/abdominal pain, abdominal distention, and no urine output. What complication should the nurse recognize?
Urinary obstruction causing anuria;
A client with acute tubular necrosis asks why their GFR is decreasing.
What structure has been directly injured?
Renal tubular cells.
A client misses dialysis and subsequently develops crackles, significant edema, and rapid weight gain.
What major complication should the nurse suspect, and what assessment finding would make the situation even more urgent?
Fluid overload.
Respiratory compromise, such as worsening hypoxemia or pulmonary edema, would make the situation especially urgent.
A client receiving peritoneal dialysis has fever, abdominal tenderness, nausea, vomiting, and opaque effluent.
What complication is most likely, and what should the nurse anticipate doing with the effluent?
Peritonitis;
Effluent should be collected/sent for culture and sensitivity
A client has foul-smelling drainage and redness around an AV access.
What would this indicate?
Infection.
Which finding should generally receive the greatest priority:
Hemoglobin 10 g/dL
Creatinine 3.0 mg/dL
Potassium 7.0 mEq/L
Glucose 250 mg/dL
Potassium 7.0 mEq/L
Match the kidney problem to its cause:
Prerenal
Intrarenal
Postrenal
Possible causes:
A. Urinary obstruction
B. Damage within the kidney
C. Decreased blood flow to the kidney
Prerenal → C. Decreased blood flow
Intrarenal → B. Damage within the kidney
Postrenal → A. Urinary obstruction