a nurse is caring for a client who is receiving peritoneal dialysis. the nurse should monitor This is a topic that many people are looking for. savegooglewave.com is a channel providing useful information about learning, life, digital marketing and online courses …. it will help you have an overview and solid multi-faceted knowledge . Today, savegooglewave.com would like to introduce to you Medical Surgical Nursing – Hemodialysis, Peritoneal Dialysis and Kidney Transplant. Following along are instructions in the video below:
In this video. We are going to talk about some procedures related to the renal renal system. So your kidneys their main function is to filter your blood.
So they designed to get rid of excess waste products excess electrolytes and excess fluid from the body when the kidneys are not working properly then those things can back up into the system. And cause a lot of problems. So if a patients kidneys are not working properly they may require hemodialysis so hemodialysis will help to eliminate excess fluid electrolytes and waste products from the body.
Its typically done three times a week before the procedure. Were gonna want to check for vascular access. So were going to want to check for patency of the av shunt.
So we can use our stethoscope to listen for a bruit. We can also you know feel the thrill. And we want to check for distal pulses as well in that arm in addition prior to dialysis.
We want to assess the patients vital signs their lab values and their weight so during the procedure. There are a number of complications that can occur so were definitely going to want to monitor the patients blood pressure. Carefully we do expect that their blood pressure will decrease throughout the procedure.
But we definitely need to monitor for hypotension. This is a key side effect with dialysis in addition. We want to monitor the patient for cramping.
Nausea and vomiting and bleeding bleeding. Because we are in all likelihood. Giving them heparin to prevent clotting during the dialysis procedure.
However if we end up with too much heparin and more bleeding than we want then we definitely need to remember the antidote for heparin. Which is protamine sulfate. So after the procedure like i said before were expecting decreased blood pressure.
So were gonna take the blood pressure. We would expect that to be decreased. We would also expect several lab values to be decreased.
So if we had electro levels that were super high before dialysis. We would expect those to come down and then we want to compare the patients weight from before the procedure to after the procedure to help estimate the amount of fluid that was removed during dialysis. So one liter of fluid approximately equals one kilogram.
All right lets talk about some patient teaching related to hemodialysis so first of all we want the patient to increase their protein intake after dialysis as protein is lost with each exchange also we want to advise the patient to avoid carrying things on the arm with their access site. We also dont want them to sleep on that side with the access site and then after when they first get their fistula done. We would want to encourage hand exercises to help mature that fistula and then in terms of complications.
That can occur with hemodialysis. A big one to be familiar with is disequilibrium syndrome.
So signs and symptoms include nausea vomiting decreased level of consciousness as well as possible seizures. This is due to an increase in intracranial pressure that can occur during dialysis. So its going to be really important for us to slow the exchange rate to help to prevent this equilibrium syndrome.
Also hypotension is another complication with dialysis so we would need to administer iv fluids or colloids as ordered by the provider and then we can also slow the exchange rate as well to help prevent hypotension and then we may may also need to lower the head of the bed. So again if we want to decrease a patients blood pressure. We want to sit them up if we want to increase their blood pressure in the case of hypotension here.
We want to lay them down flat. So we want to lower the head of the bed. All right lets move on now to peritoneal dialysis.
So if patients oh like older patients have issues with anticoagulants such as heparin or if they have vascular access difficulties. If we have like difficulties maintaining a peyton av shut. Then peritoneal dialysis may be a good option for those patients.
So this peritoneal dialysis is where we instill and dwell. A hypertonic solution in the peritoneal cavity to remove waste products. So before the procedure.
Were going to want to get the patients weight just like we did with hemodialysis. Were gonna want to warm the dialysate solution and were gonna want to use sterile technique. When accessing the catheter insertion site.
So thats going to be really important and then during the procedure. Were going to want to closely monitor the inflow and the outflow of the dialysate. Okay and we want to keep the outflow lower than the patients abdomen.
So its the same type of thing as we have with like a urinary catheter. We dont want the catheter bag like up here. Because thats not gonna work out gravity.
Wise. We want that lower and just like with our catheter with our peritoneal dialysis. We want the outflow to be lower than the patients abdomen.
So were gonna want to closely monitor the color of the outflow. Because it should be clear and yellow. So if we see that the outflow is bloody or cloudy that is indicative of a possible infection okay so you want to closely monitor that outflow complications that can happen from peritoneal dialysis include peritonitis.
Which is an infection of the peritoneum. Which is the membrane that lines like the abdominal wall. So signs and symptoms of pear to need peritonitis include fever.
Yulin drainage. Erythema.
Swelling and discolored dialysate. So again if its cloudy or bloody. Then that definitely me the patient has possible infection going on also after peritoneal dialysis protein loss is a possible complication so were definitely going to want to encourage the patient to increase their intake of protein and then hyperglycemia may also occur so we would administer insulin as needed for that patient.
And then lastly pore inflow or outflow is an issue or a complication that can happen so if were having issues with in floor outflow. We want to make sure. Theres no kinks in the tubing.
So just like with a urinary catheter. If theres a kink that urines gonna back up into the bladder same deal with peritoneal dialysis. If we have a kink in the tubing.
Then that dialysate is not going to flow out properly so were gonna check for kinks. Were gonna also address any kind of constipation that the patient has because if they have constipation that could also impair flow and then we can try repositioning the patient to help improve the outflow and then we can also melt tubing to help break up any clots that may be there okay. So thats it with peritoneal dialysis lastly.
Were going to talk about a kidney transplant. So i wouldnt necessarily get into the weeds and the details about kidney transplants. But i would know a few basic things so first of all before the procedure.
The patient will likely be put on some kind of the kind of immunosuppressant therapy and then after the procedure. Were really gonna want to closely monitor. The patients urine output.
Urine output should always be over 30 milliliters per hour. Okay anytime. A patient has a urine output that drops below 30 million milliliters.
An hour youre definitely going to want to notify the provider. That is a big issue were gonna monitor the patient for signs and symptoms of infection following their transplant. So this includes fever erythema and incisional drainage and then were going to monitor for organ rejection.
So signs and center of organ rejection. Can include fever. Hypertension and pain at the site.
So rejection can be hyper acute. Which happens very quickly very quickly within like 48 hours of the surgery or it can take longer in an acute or a chronic rejection scenario and then lastly. We want to provide some important patient teaching for a patient who is just undergone a kidney transplant.
So this includes consuming a low fat high fiber and high protein. And low sodium diet. So again low fat high fiber high protein.
And low sodium and then we want to teach them to avoid contact sports. So im gonna stop here we will pick it up with more renal information in my next video thanks. .
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