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Hemodialysis, Peritoneal Dialysis, Kidney Transplant - Medical-Surgical (Med-Surg) - Renal System - YouTube
Channel: Level Up RN
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Hi, I'm Cathy with Level Up RN. In this聽
video, I am going to talk about hemodialysis,聽聽
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peritoneal dialysis, dialysis complications, as聽
well as a kidney transplant. At the end of the聽聽
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video, I'm going to give you guys a little聽
quiz to test your knowledge of some of the聽聽
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key facts I'll be covering in this video, so聽
definitely stay tuned for that. And as always,聽聽
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I will be following along with our Level聽
Up RN medical surgical nursing flashcards,聽聽
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so definitely pull those out if you have聽
them so you can follow along with me.
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First, let's talk about hemodialysis. So,聽
normally, the kidneys act as a filter to聽聽
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filter out excess fluid, electrolytes, and聽
waste products. But with chronic kidney disease,聽聽
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our kidneys are not doing that. So hemodialysis is聽
a procedure that will help to filter the patient's聽聽
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blood. So blood is brought outside the body, run聽
through a dialyzer, which removes excess fluid,聽聽
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electrolytes, and waste products, and then that聽
blood is brought back into the body. So this is聽聽
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a procedure that can be used with both acute and聽
chronic kidney disease. So prior to hemodialysis,聽聽
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we want to ensure we have patent vascular access.聽
So that may be an AV fistula, or it can be聽聽
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an intrajugular CBC. So if the patient has聽
an AV fistula, you want to auscultate for聽聽
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the bruit and palpate for a thrill. You want to聽
obtain your patient's vital signs and their weight聽聽
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and obtain labs prior to dialysis. And then聽
we may need to hold certain medications until聽聽
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after dialysis because certain medications may聽
just get filtered out when we filter that blood.聽聽
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Also, antihypertensive agents are often held聽
because, during dialysis, patients will often have聽聽
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a decrease in blood pressure. So if we give them聽
antihypertensive medications and we do dialysis,聽聽
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that blood pressure could possibly get too low.
During the procedure, you're going to want to聽聽
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monitor for hypotension and then monitor聽
for adverse effects, such as cramping,聽聽
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nausea and vomiting, and bleeding associated聽
with the heparin that we give patients during聽聽
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dialysis to prevent clots. So the reversal聽
agent for heparin is protamine sulfate.聽聽
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After the procedure, we want to take the patient's聽
weight again and their vital signs. A decrease in聽聽
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blood pressure and weight is expected. And then聽
we should compare the patients post-procedure聽聽
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weight with their pre-procedure weight to聽
estimate the amount of fluid that was removed.聽聽
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Another method we can use to filter the patient's聽
blood is peritoneal dialysis. This is where聽聽
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we instill a hypertonic dialysate solution聽
into the patient's peritoneal cavity, and we聽聽
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allow that to dwell. Because it's hypertonic,聽
it will draw in excess fluid from the body.聽聽
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And then, after the prescribed amount of time for聽
dwelling, we allow it to drain into a drainage聽聽
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bag, and that will remove excess fluid and waste聽
products. So, in terms of nursing care, prior to聽聽
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the procedure, we want to assess our patient's聽
weight. We want to warm the dialysate solution,聽聽
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and then we want to use sterile technique when聽
we are accessing the catheter insertion site.聽聽
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Once we have it all set up and we allow the聽
dialysate solution to dwell, and then when聽聽
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we're draining it, we want to make sure we are聽
keeping the outflow lower than the patient's聽聽
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abdomen. Also, we want to monitor the color of聽
the outflow from the catheter, so that should be聽聽
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clear or light yellow. If that outflow is bloody聽
or cloudy, that can mean possible infection.
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Now, let's talk about the complications associated聽
with dialysis. So for a patient receiving聽聽
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hemodialysis, you want to be on the lookout聽
for this disequilibrium syndrome. So this聽聽
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is where we have neurologic deterioration聽
that is associated with cerebral edema and聽聽
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an increase in intracranial pressure. Signs聽
and symptoms can include nausea and vomiting,聽聽
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confusion, a decrease in level of consciousness,聽
and if it progresses, it can cause seizures,聽聽
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coma, and death. So for mild symptoms,聽
we can slow the dialysis exchange rate.聽聽
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However, if symptoms become more severe,聽
we will need to discontinue hemodialysis.聽聽
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Another complication of hemodialysis is聽
hypotension, like I mentioned before.聽聽
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So for this, we would want to administer IV fluids聽
and colloids as prescribed by the provider. In聽聽
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addition, we would want to slow the exchange rate聽
and decrease the patient's head of the bed. So聽聽
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by bringing the head of the bed down, that helps聽
to bring the blood pressure up, and the opposite聽聽
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is true. So if we ever want to bring down a聽
patient's blood pressure, sitting them up straight聽聽
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is helpful. In terms of complications with聽
peritoneal dialysis, peritonitis is an important聽聽
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one to know. This is infection of the peritoneal,聽
which is the serous membrane that surrounds聽聽
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the abdominal organs. So signs and symptoms聽
of peritonitis include fever, a cloudy outflow聽聽
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from the peritoneal dialysis, as well as nausea聽
and vomiting, and abdominal pain and tenderness.
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The last topic I want to cover in this video聽
is a kidney transplant. So in terms of post-op聽聽
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nursing care, we're going to want to closely聽
monitor our patients urine output. A urine聽聽
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output that falls below 30 milliliters an hour聽
is cause for concern, and you would want to聽聽
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notify the provider about that. In addition, we聽
want to monitor bladder irrigation for clots,聽聽
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monitor for signs and symptoms of infection,聽
and then monitor for signs of organ rejection,聽聽
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which can occur directly after the surgery or聽
after a prolonged amount of time. So we have聽聽
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hyper-acute, acute, and chronic organ rejection.聽
Signs and symptoms may include fever, pain, weight聽聽
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gain, hypertension, and an increase in creatinine,聽
BUN, as well as white blood cells. In terms of聽聽
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patient teaching, you need to reinforce that the聽
patient should not engage in contact sports. In聽聽
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addition, you want to advise your patient to聽
monitor for signs and symptoms of infection聽聽
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and of rejection and monitor their blood pressure聽
daily. In addition, the patient will need to聽聽
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take immunosuppressive medications such as聽
cyclosporine for the rest of their lives.
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All right, it's time for a quiz. I have聽
three questions for you. First question.聽聽
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An outflow from peritoneal dialysis appears聽
cloudy. What complication would you suspect?聽聽
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The answer is peritonitis. Question number two.聽
What complication of hemodialysis is characterized聽聽
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by nausea and vomiting, a decrease in聽
level of consciousness, and seizures?聽聽
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The answer is disequilibrium syndrome. Question聽
number three. Following a kidney transplant,聽聽
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a urine output under blank milliliters per聽
hour should be reported to the provider.聽聽
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The answer is 30. Okay, that is it for this video,聽
and that is it for our medical surgical nursing聽聽
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renal system playlist. I hope it's been super聽
helpful. If so, be sure to like the video and聽聽
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leave me a comment. I love to hear from nursing聽
students and nurses who use our resources.聽聽
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Take care. First, let's talk about聽
hemodialysis. So, normally, the.
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