Med-Surg - Renal System, part 8: Hemodialysis, Peritoneal Dialysis, Kidney Transplant
Hi, I'm Cathy with Level Up RN. In this video, I am going to talk about hemodialysis, peritoneal dialysis, dialysis complications, as well as a kidney transplant. At the end of the video, I'm going to give you guys a little quiz to test your knowledge of some of the key facts I'll be covering in this video, so definitely stay tuned for that. And as always, I will be following along with our Level Up RN medical surgical nursing flashcards, so definitely pull those out if you have them so you can follow along with me.
First, let's talk about hemodialysis. So, normally, the kidneys act as a filter to filter out excess fluid, electrolytes, and waste products. But with chronic kidney disease, our kidneys are not doing that. So hemodialysis is a procedure that will help to filter the patient's blood. So blood is brought outside the body, run through a dialyzer, which removes excess fluid, electrolytes, and waste products, and then that blood is brought back into the body. So this is a procedure that can be used with both acute and chronic kidney disease. So prior to hemodialysis, we want to ensure we have patent vascular access. So that may be an AV fistula, or it can be an intrajugular CBC. So if the patient has an AV fistula, you want to auscultate for the bruit and palpate for a thrill. You want to obtain your patient's vital signs and their weight and obtain labs prior to dialysis. And then we may need to hold certain medications until after dialysis because certain medications may just get filtered out when we filter that blood. Also, antihypertensive agents are often held because, during dialysis, patients will often have a decrease in blood pressure. So if we give them antihypertensive medications and we do dialysis, that blood pressure could possibly get too low.
During the procedure, you're going to want to monitor for hypotension and then monitor for adverse effects, such as cramping, nausea and vomiting, and bleeding associated with the heparin that we give patients during dialysis to prevent clots. So the reversal agent for heparin is protamine sulfate. After the procedure, we want to take the patient's weight again and their vital signs. A decrease in blood pressure and weight is expected. And then we should compare the patients post-procedure weight with their pre-procedure weight to estimate the amount of fluid that was removed. Another method we can use to filter the patient's blood is peritoneal dialysis. This is where we instill a hypertonic dialysate solution into the patient's peritoneal cavity, and we allow that to dwell. Because it's hypertonic, it will draw in excess fluid from the body. And then, after the prescribed amount of time for dwelling, we allow it to drain into a drainage bag, and that will remove excess fluid and waste products. So, in terms of nursing care, prior to the procedure, we want to assess our patient's weight. We want to warm the dialysate solution, and then we want to use sterile technique when we are accessing the catheter insertion site. Once we have it all set up and we allow the dialysate solution to dwell, and then when we're draining it, we want to make sure we are keeping the outflow lower than the patient's abdomen. Also, we want to monitor the color of the outflow from the catheter, so that should be clear or light yellow. If that outflow is bloody or cloudy, that can mean possible infection.
Now, let's talk about the complications associated with dialysis. So for a patient receiving hemodialysis, you want to be on the lookout for this disequilibrium syndrome. So this is where we have neurologic deterioration that is associated with cerebral edema and an increase in intracranial pressure. Signs and symptoms can include nausea and vomiting, confusion, a decrease in level of consciousness, and if it progresses, it can cause seizures, coma, and death. So for mild symptoms, we can slow the dialysis exchange rate. However, if symptoms become more severe, we will need to discontinue hemodialysis. Another complication of hemodialysis is hypotension, like I mentioned before. So for this, we would want to administer IV fluids and colloids as prescribed by the provider. In addition, we would want to slow the exchange rate and decrease the patient's head of the bed. So by bringing the head of the bed down, that helps to bring the blood pressure up, and the opposite is true. So if we ever want to bring down a patient's blood pressure, sitting them up straight is helpful. In terms of complications with peritoneal dialysis, peritonitis is an important one to know. This is infection of the peritoneal, which is the serous membrane that surrounds the abdominal organs. So signs and symptoms of peritonitis include fever, a cloudy outflow from the peritoneal dialysis, as well as nausea and vomiting, and abdominal pain and tenderness.
The last topic I want to cover in this video is a kidney transplant. So in terms of post-op nursing care, we're going to want to closely monitor our patients urine output. A urine output that falls below 30 milliliters an hour is cause for concern, and you would want to notify the provider about that. In addition, we want to monitor bladder irrigation for clots, monitor for signs and symptoms of infection, and then monitor for signs of organ rejection, which can occur directly after the surgery or after a prolonged amount of time. So we have hyper-acute, acute, and chronic organ rejection. Signs and symptoms may include fever, pain, weight gain, hypertension, and an increase in creatinine, BUN, as well as white blood cells. In terms of patient teaching, you need to reinforce that the patient should not engage in contact sports. In addition, you want to advise your patient to monitor for signs and symptoms of infection and of rejection and monitor their blood pressure daily. In addition, the patient will need to take immunosuppressive medications such as cyclosporine for the rest of their lives.
All right, it's time for a quiz. I have three questions for you. First question. An outflow from peritoneal dialysis appears cloudy. What complication would you suspect? The answer is peritonitis. Question number two. What complication of hemodialysis is characterized by nausea and vomiting, a decrease in level of consciousness, and seizures? The answer is disequilibrium syndrome. Question number three. Following a kidney transplant, a urine output under blank milliliters per hour should be reported to the provider. The answer is 30. Okay, that is it for this video, and that is it for our medical surgical nursing renal system playlist. I hope it's been super helpful. If so, be sure to like the video and leave me a comment. I love to hear from nursing students and nurses who use our resources. Take care. First, let's talk about hemodialysis. So, normally, the.
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