Urinary System
Urinary Tract Calculi Dialysis Movement of fluid/molecules
across a semipermeable membrane from one compartment to another
Used to correct fluid/electrolyte imbalances and to remove waste
products in renal failure Treat drug overdoses Begun when patients
uremia can no longer be adequately managed conservatively Initiated
when GFR (or creatinine clearance) is less than 15 mL/min Dialysis
Two methods of dialysis available Peritoneal dialysis (PD)
Hemodialysis (HD) ESKD treated with dialysis because There is a
lack of donated organs Some patients are physically or mentally
unsuitable for transplantation Some patients do not want
transplants Osmosis and Diffusion across Semipermeable Membrane
Peritoneal Dialysis Peritoneal access is obtained by inserting a
catheter through the anterior abdominal wall Technique for catheter
placement varies Usually done via surgery Tenckhoff Catheter
Waiting period of 7 to 14 days preferable Two to 4 weeks after
implantation, exit site should be clean, dry, and free of
redness/tenderness Once site healed, patient may shower and pat dry
Dialysis Solutions and Cycles Available in 1- or 2-L plastic bags
with glucose concentrations of 1.5%, 2.5%, and 4.25% Electrolyte
composition similar to that of plasma Solution warmed to body
temperature Three phases of PD cycle Inflow (fill) Dwell
(equilibration) Drain Called an exchange Inflow Prescribed amount
of solution infused through established catheter over about 10
minutes After solution infused, inflow clamp closed to prevent air
from entering tubing Dwell Also known as equilibration Diffusion
and osmosis occur between patients blood and peritoneal cavity
Duration of time varies, depending on method Drain Lasts 15 to 30
minutes May be facilitated by gently massaging abdomen or changing
position Complications Exit site infection Peritonitis Hernias
Lower back problems Bleeding Pulmonary complications Protein loss
Effectiveness and Adaptation Short training program Independence
Ease of traveling Fewer dietary restrictions Greater mobility than
with HD Hemodialysis Obtaining vascular access is one of most
difficult problems Types of access Arteriovenous fistulas and
grafts Temporary vascular access Vascular Access for Hemodialysis
Dialyzers Long plastic cartridges that contain thousands of
parallel hollow tubes or fibers Fibers are semipermeable membranes
Hemodialysis Procedure Two needles placed in fistula or graft One
needle is placed to pull blood from the circulation to the HD
machine The other needle is used to return the dialyzed blood to
the patient Components of Hemodialysis Continual Renal Replacement
Therapy (CRRT) Alternative or adjunctive method for treating AKI
Means by which uremic toxins and fluids are removed Acid-base
status/electrolyte balance adjusted slowly and continuously Often
used in hemodynamically unstable patients Hemofilter change every
24 to 48 hours Ultrafiltrate should be clear yellow Specimens may
be obtained for evaluation Most common approaches: venovenous
Continuous venovenous hemofiltration (CVVH) Continuous venovenous
hemodialysis (CVVHD) Q&A: A patient undergoes peritoneal
dialysis exchanges several times each day. What should the nurse
plan to increase in the patients diet?a) Fatb) Proteinc) Caloriesd)
Carbohydrates
Kidney Transplantation Very successful One-year graft survival
rate Cadaver transplants: 90% Live donor transplants: 95%
Advantages of kidney transplantation over dialysis Reverses many of
the pathophysiologic changes associated with renal failure
Eliminates dependence on dialysis Less expensive than dialysis
after the first year Kidney Transplantation Immunosuppressive
Therapy Goals Adequately suppress the immune response Maintain
sufficient immunity to prevent overwhelming infection Complications
Rejection Acute rejection Occurs days to months after
transplantation Chronic rejection Process that occurs over months
or years and is irreversible Infection CV Disease Malignancies
Recurrance of Renal Disease Steriod-Related Complications Q&A:
Six days after kidney transplantation from a deceased donor, a
patient develops a temperature of 101.2 F (38.5 C), tenderness at
the transplant site, and oliguria. The nurse recognizes that these
findings indicatea) Acute rejection, which is not uncommon and is
usually reversible.b) Hyperacute rejection, which will necessitate
removal of the transplanted kidney.c) An infection of the kidney,
which can be treated with IV antibiotics.d) The onset of chronic
rejection of the kidney with eventual failure of the kidney.
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