Dialysis o o This involves the movement of fluid and particles across a semipermeable membrane.

It is a treatment that can help restore fluid and electrolyte balance. Control acid-base balance, and remove toxic and waste product from the body.

Hemodialysis o It is a method for removing waste products such as potassium and urea, as well as free water from the blood when the kidneys are incapable of doing this. o It involves shunting the patients blood from the body through a dialyzer in which diffusion and ultrafiltration occur and back into the patient circulation. o Movement of small solutes by diffusion through the addition of dialysate to the fluid side of the filter. Advantages of Hemodialysis Effective method to remove waste products Performed by trained professional Provides socialization for patient Disadvantages of Hemodialysis Physical ups and downs Use of needles (invasives) Dietary restriction Vascular access Travel to center Physiologic Principles of Dialysis 1. Diffusion-Movement of particles from an area of greater to an area of lesser concentration. 2. Osmosis-Movement of water across a semi-permeable membrane from an area of lesser to an area of greater concentration of particles. 3. Ultrafiltration- movements of fluid a semi-permeable membrane as a result of an artificially created pressure gradient. Types of Access Points 1. Arteriovenous AV Fistula (6 wks) AV Graft (2-3wks) 2. External arteriovenous shunt

3. Pemoral/ Subclavian vein catheterization (temporary access/permeath)

Nursing Management of Patient undergoing Hemodialysis Before Dialysis: Check the Doctors order Weigh the patient Take the initial Vital Signs Get sample of blood Access patients physical status Examination of the venous access During Dialysis: Monitoring of physical status for evidence of physiologic imbalance and change Providing comfort and safety Helping the patient to understand and adjust to the care and change in lifestyle Nursing Responsibilities: Check Blood Pressure and Pulse rate 30-60minutes Antihypertensive medications are withheld in the morning of dialysis until after the treatment After food to eat Check the patency of the tubes and access Disequilibrium Phenomenon It results when excess of solutes are cleared from the blood more rapidly that they can diffuse from the bodys cell into the vascular compartment. ***headache, hypertension, restlessness mental confusion, nausea and vomiting Technical Complications: Blood leaks Tubings separation Dialysate concentration errors Patients Complication Fever-infection Blood reaction Chest pain

Difficulty of breathing Restlessness Depression Cardiac arrhythmias/arrest

Facilitate the Fluid Balance o We should facilitate the fluid balance-hypovolemea-prevent (0.9 PNSS) NSS,-safe Plain Saline NormaL Saline o Diaphoresis o Prevent blood loss o Check heparin o Check signs for bleeding Post: o Pressure dressing o Maintaining the activity 3 Types of Continuous Renal Replacement Therapy (CRRT) 1. Continuous Veno Venous Hemofiltration (CVVH) 2. Continuous Veno Venous Hemodialysis (CVVHD) 3. Continuous Veno Venous HemoDiaFiltration (CVVHDF) Peritoneal Dialysis o It is instilling dialyzing fluid into the peritoneal cavity, and the peritoneum becomes the dialyzing membrane. o Maintained continuously until 36hrs. The Procedure Preliminary: 1. Secure a consent 2. Abdomen is shaved and draped as for surgical procedure 3. Dialyzing fluid is warmed to body temperature. 4. Bladder should be emptied before the procedure 5. Weigh the patient prior to the procedure Performance: 1. An incision is made just below the umbilical area 2. A trocar is inserted through the incision into the peritoneal cavity. 3. The obturator is rfemoved and the tip of the catheter is paced on the lowest part of the abdominal cavity to ensure good flow of fluid 3 Periods: 1. Instillation Period -catheter is connected to administration tubing and dialysis cycle is begun -the inflow clamps are open and dialysate infuses rapidly into the peritoneal cavity and then is closed. -inflow periods is 5-10 minutes

2. Equilibration Period -osmosis, diffusion, filtration takes place. -equilibration period is 20minutes 3. Drainage Period -outflow clamp is opened and dialysate drains from peritoneal cavity.

Types of Peritoneal Dialysis 1. Continuous Ambulatory Peritoneal Dialysis (CAPD) -One method leading to self-dialysis that is pratical and promotes independence. -Approximately 2L of dialysate is maintained in the peritoneal cavity and exchanged by the patient through a PERMANENT catheter. -4 to 5 times each day -No special equipment 2. Continuous Cyclic Peritoneal Dialysis (CCPD) -Cyclic machine is used to instill and drain dialysate from the patient. -machine has a series of clamps that are controlled by timers. -6 to 8 hours -can connect up to the cyclic at bedtime, set the machine, and be dialyzed while sleeping. Care during Peritoneal Dialysis 1. Regulating fluid volume and drainage -check VS -observe patients behavior -record fluid balance -small amount of heparin may be added to dialysate -turn the patient from side to side 2. Promoting comfort -mild analgesic/ procaine HCl -turn patient from side to side -oral care and bathing as needed -divertionary activities 3. Preventing complications -check patients respiratory rate and quality -head of patients bed can be elevated -frequent small meals -aseptic technique -observe patient for signs of peritonitis Advantages of Peritoneal Dialysis patient can readily be taught the process patient can dialyze alone in any location without need for machinery

 patient has few dietary restrictions more freedom less needle tricks Disadvantages of Peritoneal Dialysis Peritonitis Membrane Failure Nursing Responsibilities 1. Observing the color of outflow 2. Accurate according of each dialysis cycle on a flow sheet. 3. Frequently monitoring of VS, weight, and general condition 4. Prevention of complication of immobility 5. Check tubing for patency of drainage 6. Inform the Doctor about the fluid balance least every 8 hours and notified for any changes 7. Called samples of drained dialysate in sterile containers 8. Observe for any signs of complications Physiologic Conditions 1. Peritonitis 2. Protein loss 3. Hyperglycemia 4. Pulmonary edema 5. Perforation of intestines 6. Hypotension 7. Hypostatic pneumonia 8. Respiratory distress 9. Abdominal comfort Technical Complication Incomplete Drainage Leakage or bleeding Nursing Management of Patient undergoing Kidney Transplant -transplanting of kidney from a living donor or decreased donor to a recipient who has ESRP. Medical Management Physical examination Tissue typing, blood typing and antibody screening Lower urinary tract is studied Patient must be free from infection Psychosocial evaluation Advantages of Transplantation Most like your own kidney No dialysis needed

 No access needed normal diet(-sodium) more norm-1life style Disadvantages risk of major surgery risk of body rejecting kidney possible side effects of drugs lower resistance to illness body image changes Monitoring and Managing Potential Complications teach breathing exercises early ambulation care of surgical incision monitor for possible bleeding monitor for the effects of corticosteroid and antibiotic therapy Nursing Management for kidney transplant patient 1. Assessing the patient for transplant rejection Oliguria Edema Fever Increasing BP Weight gain Swelling/tenderness over the transplant kidney or graft 2. Preventing infection Monitor blood chemistry tests, leukocyte and platelet counts Shaking chills Fever Tachycardia Tachypnea Leukocytosis/ leokocytopenia Monitor urine culture, wound drainage, catheter and draintips Perform handwashing 3. Monitoring Urinary Function Monitor urine output hourly Regulate IVF Hemodialysis may be necessary 4. Addressing psychological concerns Assess patients coping and stress May refer patient for counseling