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What are some causes of hypertension?
Fluid overload, non-adherence to medication schedule, renin response, Epogen side effect, anxiety, tension, DDS
What are some of s/s of hypertension?
Increased EP, headache, dizziness, edema, irritability, blurry vision, nervousness, or might even be asymptomatic
What are interventions for hypertension?
Evaluate source of HTN, promote fluid and medication compliance, identify source of stressors and promote resolution.
What are some preventions for hypertension?
Promote fluid and medication adherence
Systolic less than 90, diastolic less than 60, or systolic drop of 20 is indicative of ?
A pre-TX b/p of >140/90, post-tx. >130/90 are indicative of ?
What is the effect of hypotension organ stunning on the heart?
Acute stress on CV system, development of LV regional wall motion.
What is the effect of hypotension organ stunning on the gut?
Release of endotoxin in circulation, inflammation,
What is the effect of hypotension organ stunning on the kidneys?
Causes fibrosis, loss of RRF
What is the effect of hypotension organ stunning on the brain?
Causes multiple sites of white matter injury.
Vascular filling is slower than rapid fluid loss, Low blood volume, antihypertensive drugs, food ingestions, and cardiac disease are causes of ?
What are the s/s of hypotension?
SOB, N, V, cold, clammy skin, restlessness, rapid, shallow respirations, excessive yawning, diaphoretic
What are the interventions of hypotension?
- Set in flat supine position
- Min. UF active
- O2 administration per MD
- 100-200 NS IV
- Monitor B/P
- Oral Fluids(if less severe)
What are some prevention measures for hypotension?
Extended TX time, pure UF, frequent assessment of target weight, <13ml/kg/hr
Assisting with stretching, Min UF active, O2, 100-200ML NS IV, assess target weight are interventions of ?
Dietary control, UFR (<13ml/kg/hr), a decrease in sodium loading, increase time, UF profiling are preventative measures of ?
S/S of Muscle Cramps
Painful muscle contractions (extremites or ABD), (usually occurs late in dialysis)
What are some causes of muscle cramps?
Excessive or rapid fluid removal, tissue ischemia, electrolyte imbalance, increase in excercise, hyperthermia
___ degrees of temp from baseline is considered a fever?
What are s/s of fever?
Cold, shaking, fever, hypotension, headache, N,V.
What are s/s of pyrogenic effect?
Chills, shaking, fever, hypotension, vomiting, muscle pain
Do you continue tx with a pyrogenic reaction?
What is a seizure?
Involuntary muscle spasms and loss of consciousness
What are some causes of seizures?
Removal of anticonvulsives by dialysis(too closelt
Whata are s/s of seizures?
Changes in conciousness, twitching, jerking
What is jerking, change in consciousness, twitching s/s of ?
How does changes in the dialysate temp. affect fever/chills?
If the dialysate temp is greater than the Pt's pre-temp
What should you do in the case of seizure?
- Protect the PT
- Treat hypotensions
- Assess for DDS
- Assess for hypoglycemia
- Admin. O2
- D/C TX(if there is no response from PT)
What is DDS
- Dialysis Disequilibrium Syndrome
- Condition in which rapid or changes in the PT's extracellular fluid affect the brain
What are some common causes of DDS?
- New PTs
- Skipping and/or shortening TXs
What are some S/S for DDS?
- Blurry Vision
What intervention are taken for DDS?
- Early recognition
- Decreased effectiveness of dialysis (Decrease BR, DFR, or TX time)
- D/C TX if severe
What are some signs of a clotted dialyser?
Low VP, unable to rinse back, dark blood, visible clots, frequent BFR alarms, high Hb
What is hemolysis?
Bursting of RBCs
What are some causes of Hemolysis?
High neg. pre-pump arterial pressure, chlorine/chlormines, exposure to disinfectant, hypotonic dyalsate
What are the s/s of hemolysis?
Cherry, blood, anxiety, restlessness, pain/burning in access, N/V, ABD cramps, chest tightness, dyspnea
What are some causes of First Use Syndrome?
- ETO reaction,
- Sensitivity to membrane material
- Immune response activations (complement)
What is First use Syndrome?
Group of symptoms occurring shortly after starting TX with a new dialyser
What are the s/s of first use syndrome?
Severe s/s occurs within 5-10 min. less severe w/in 20-40 min. chest pain, and or back pain, dyspnea, hypotension, nausea, general discomfort
What are interventions for First Use syndrome?
- Symptoms management
- D/C if severe
- O2 admin. for resp. complications
Do you return a PT with disinfectant infusion?
S/S of First use syndrome?
- Pain at venous needle
- Resp. distress
- Chest pain
- Tingling around the lips
- Back pain
What are First Use syndrome Interventions?
- Stop the pump,
- Clamp lines, Do not return, assess VS, attach new NS bag
What are some causes of Air embolisms?
Empty bag, or seperation in lines
Air in venous, chest pain, difficulty breathing, convulsions, seizures are s/s of ?
Preventions or air embolism
- Verify air detector is armed, verify, enough NS in bag for rinse back
- Fill drip chamber
SOB, wheezing or stridor, tachycardia, hives, itching, low back pain, periorbital edema, hypotension, anxiety, restlessness, chest pain, and eventually cardiac arrest are s/s of ?
<__ mths. of HD experience, <___ cannulations
=>__mths cannulation experience, at least __ successful cannulation
Completed _____ skils competancies and trainings, expert assessment, and cannulation skills.
A newly matured AVF is defined by
Post-op exam by surgeon or nephrologist, meets KNOQI rule of 6
Definition of mature AVF
Tolerated max needle gauge and BFR for > o equal to 3 TXs, > or equal to 6 till intermidiate cannulator can access
What defines an established AVF?
Cannuated for greater or equal than 2 months without s/s of dysfuntion
Needle gauge of AVF initial cannulation.
What is HeRO acess?
Give when a vein is unable to connect to connect to arterial end. either because of lack of patent veins or distance.
Is the use of a tourniquet allowed for AVF?
What does BESTIPS stand for ?
- Steal Syndrome
What is Steals Syndrome?
Condition in which hand (cannulation arm) isn't receiving enough blood due to poor flow. Usually end to end
Using clamps, check for flow every ____ min.
___ wks for good site rotations/healing time, avoiding aneurysms
Distance from the anastomosis and needle tips to avoid recirculation?
__ episodes of hypotension per week increases mortality to 70%
A ____ covers a surface area of blood that equals 20ml of blood
Catty is a 24 y/o, WD, males who routinely goes to the gym prior to dyalsis. Target weight: 88.5, Weight:92.5. You set the machine to remove 4kg in 3.5 hrs. B/P is 130/88. At one hr, Catty complaints of ABD pain
What condition is this?
On Saturday, the reuse technician was unable to reprocess dialyzers, refrigerate them accordingly, and perform reprocessing on Sunday evening after the BioMed had disinfected the water loop Sunday morning.
Monday morning, 2 PTs experience a drop in B/P, 4 PTs experienced fevers, and one was diaphoretic and SOB.
What condition is occurring?
- Intervention: Stop TX, obtain blood cultures, obtain LALs, sequester system (Red bag labeled PT name, date, NOT FOR PT USE)
- Store in the lab refrigerator
Today you have 8 PTs on the morning shift and 3 complained of a headache, one of nausea, and another of restlessness. Their intradialytic weight gain were 2.7 with 3 and 4-grade edema. All Pre-dialysis b/p greater than 140/90
What condition are they experiencing
Although 2.7 weight gain isn't alarming, edema must be taken into consideration due to the fluid shift
Nancy was just D/C'd from the hospital with a femoral cathetor