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Complications of dialysis

  • Dialysis is a life-saving treatment for patients with end-stage renal disease, but it also carries some risks and potential complications.
  • Some of the common complications of dialysis are:
    • Hypotension: This is a drop in blood pressure that can occur during or after dialysis, especially if too much fluid is removed or the patient has a low blood volume. Symptoms include dizziness, nausea, vomiting, cramps, headache, chest pain, and shortness of breath.
      • To prevent or treat hypotension, the nurse should monitor the patient's vital signs, adjust the fluid removal rate, administer saline or hypertonic solutions, elevate the patient's legs, and stop or slow down the dialysis if needed.
    • Muscle cramps: These are painful spasms of the muscles that can occur during or after dialysis, usually in the legs or feet. The exact cause is not clear, but it may be related to fluid shifts, electrolyte imbalances, or nerve irritation.
      • To prevent or treat muscle cramps, the nurse should ensure adequate hydration, avoid excessive fluid removal, correct electrolyte abnormalities, massage the affected muscles, apply heat or cold packs, and administer antispasmodic medications if prescribed.
    • Infection: This is a serious complication that can affect the access site (fistula, graft, or catheter), the bloodstream, or other organs. Infection can be caused by bacteria, fungi, or viruses that enter through the access site or during dialysis. Symptoms include fever, chills, redness, swelling, pain, pus, drainage, or foul odor at the access site, and signs of sepsis or organ dysfunction.
      • To prevent or treat infection, the nurse should follow strict aseptic technique when handling the access site and dialysis equipment, inspect and clean the access site regularly, change dressings as needed, administer antibiotics or antifungal medications if prescribed, and monitor for signs of infection and report them promptly.
    • Anaemia: This is a low level of red blood cells (RBCs) or haemoglobin in the blood that can result from chronic kidney disease or dialysis. Anaemia can cause fatigue, weakness, pallor, shortness of breath, chest pain, and increased risk of cardiovascular complications.
      • To prevent or treat anaemia, the nurse should monitor the patient's haematocrit and haemoglobin levels regularly
      • administer erythropoietin-stimulating agents (ESAs) or iron supplements if prescribed
      • educate the patient on dietary sources of iron and folate.
    • Bone and mineral disorders: These are abnormalities in calcium, phosphorus, parathyroid hormone (PTH), and vitamin D metabolism that can occur in patients with chronic kidney disease or dialysis. These disorders can cause bone loss, fractures, joint pain, itching, calcification of soft tissues and blood vessels (vascular calcification), and increased risk of cardiovascular complications.
      • To prevent or treat bone and mineral disorders, the nurse should monitor the patient's serum calcium, phosphorus, PTH, and vitamin D levels regularly. They should also administer phosphate binders, calcium supplements, vitamin D analogues, or calcimimetics if prescribed.
      • They should educate the patient on dietary restrictions of phosphorus and calcium.

Questions on Complications of dialysis

Correct Answer is C

Explanation

Incorrect. The catheter should not be immersed in water during bathing or showering, as this can introduce pathogens and increase the risk of infection.

Correct Answer is A

Explanation

Incorrect. While checking the client's platelet count is important, it is not the first action to address active bleeding. Applying pressure to the bleeding site takes priority to control the bleeding.QUESTIONS

Correct Answer is C

Explanation

Incorrect. Encouraging the client to perform another exchange without further assessment can potentially exacerbate any underlying issue causing the cloudy effluent.

Correct Answer is C

Explanation

This statement is incorrect. Increasing the dialysate solution flow rate may not be appropriate without further assessment of the client's fluid status. It could worsen the fluid overload and further increase blood pressure.

Correct Answer is C

Explanation

This statement is incorrect. Serum potassium levels may be monitored for a client on peritoneal dialysis due to the potential for electrolyte imbalances, but they are not the primary concern during ESA therapy for anemia management.

Correct Answer is C

Explanation

Incorrect. Applying a heating pad to the affected muscles is not recommended during dialysis, as it may cause burns or worsen the cramps.

Correct Answer is D

Explanation

Hypervolemia (severe fluid overload) is a critical indication for initiating dialysis in clients with end-stage renal disease. Dialysis helps remove excess fluid from the body and can relieve symptoms such as pulmonary edema and hypertension.

Correct Answer is A

Explanation

Incorrect. Administering prescribed intravenous medications may be necessary during dialysis, but it is not the priority action stated in this question.

Correct Answer is D

Explanation

Uremia, which is the accumulation of urea and other waste products in the blood, can lead to various complications, including pruritus. Dialysis helps remove these waste products from the bloodstream and may alleviate the itching associated with uremia.

Correct Answer is C

Explanation

This statement is incorrect. Hyponatremia (low sodium levels) is not the primary indication for initiating dialysis in this scenario. Uremia and the accumulation of waste products are the primary concerns that require dialysis to address.QUESTIONS

Correct Answer is C

Explanation

This statement is incorrect. Elevating the client's legs may promote blood flow, but it does not address the immediate issue of lightheadedness and dizziness. Assessing the client's blood pressure and pulse rate is the priority to determine the appropriate intervention.

Correct Answer is B

Explanation

This statement is incorrect. Monitoring blood urea nitrogen (BUN) levels is crucial for clients with ESRD, but it is not directly related to the administration of heparin during hemodialysis.QUESTIONS

Correct Answer is C

Explanation

This statement is incorrect. Peritoneal dialysis uses the peritoneal membrane as a filter. It involves the instillation and drainage of dialysate fluid into the abdominal cavity through a catheter.

Correct Answer is D

Explanation

A significantly decreased glomerular filtration rate (GFR) indicates that the kidneys' ability to filter waste products and excess fluids from the blood is severely impaired. Dialysis can help support kidney function and remove waste products when the GFR is critically low.

Correct Answer is A

Explanation

This statement is incorrect. Hypertonic dialysate would not cause hypotension. In fact, it may lead to a decrease in blood pressure due to fluid removal, but it would not be considered a primary cause of hypotension.

Correct Answer is B

Explanation

No explanation

Correct Answer is A

Explanation

This statement is incorrect. Iron intake may need to be managed for clients with anemia, which is common in end-stage renal disease (ESRD) and dialysis. However, protein restriction remains a more significant dietary consideration for clients on hemodialysis.

Correct Answer is B

Explanation

This statement is incorrect. Administering an anticoagulant medication is not indicated for muscle cramps during hemodialysis. Anticoagulants are used to prevent blood clots during the procedure but would not alleviate muscle cramps.

Correct Answer is D

Explanation

This statement is accurate. Dialysis is the process of removing waste products, excess fluids, and toxins from the blood when the kidneys are no longer able to perform these functions adequately.

Correct Answer is D

Explanation

Severe metabolic acidosis, which results from the kidneys' inability to adequately excrete acids and regulate pH balance, is a critical indication for initiating dialysis in clients with CKD.

Correct Answer is B

Explanation

Incorrect. Administering intravenous hypertonic saline during dialysis is not a routine intervention to prevent hypotension. It may be used in specific cases, but fluid management is the primary approach.

Correct Answer is C

Explanation

This statement is incorrect. Peritoneal dialysis does not require a catheter to be inserted into the bladder. Instead, it uses a catheter to infuse and drain dialysate into and out of the peritoneal cavity.

Correct Answer is A

Explanation

This statement is incorrect. Elevating the client's legs may help improve blood flow, but it does not address the underlying cause of the reported symptoms. The nurse should first check the client's blood pressure and pulse rate to assess for hypotension before implementing further interventions.

This statement is accurate. Infection is a significant risk for clients on peritoneal dialysis due to the direct access to the peritoneal cavity through the catheter. Strict aseptic technique is crucial to prevent infections.

This statement is incorrect. Assessing for swelling and tenderness in the neck is not related to the AV fistula assessment. Swelling and tenderness may be related to other issues but are not specific to AV fistula functioning.

This statement is correct. Cloudy dialysate drainage may indicate infection or peritonitis. The nurse should check the client's vital signs and assess for signs of abdominal pain or tenderness, as this requires immediate evaluation.

Incorrect. While daily dressing changes are important, using sterile technique for catheter dressing changes may not be necessary, as the dressing does not directly contact the peritoneal cavity during CAPD exchanges.

Incorrect. Checking the client's pre-dialysis weight is not the priority when the client is experiencing severe neurological symptoms. Immediate assessment and intervention are needed.

Incorrect. Placing the client in a semi-Fowler's position may be appropriate for respiratory distress, but the nurse should first assess the client's vital signs and overall condition before implementing positioning changes.

No explanation

This statement is incorrect. Notifying the healthcare provider about the symptoms is important, but the nurse should first assess the catheter for possible issues to determine if immediate intervention is needed.

Uremia, which is characterized by elevated levels of urea and other waste products in the blood, is a critical indication for initiating dialysis in clients with acute kidney injury. Dialysis helps remove these toxic substances from the bloodstream.

Incorrect. Administering an antiemetic medication is not indicated for a metallic taste in the mouth, as it is not associated with nausea or vomiting.

Incorrect. Limiting fluid intake only on the day of dialysis treatment is not sufficient to maintain overall hydration and may lead to imbalances and complications between dialysis sessions.

This statement is incorrect. Encouraging the client to consume dairy products is not directly related to managing constipation. While calcium intake may be important for bone health in clients with ESRD, it is not a primary intervention for constipation.QUESTIONS

Correct. Notifying the healthcare provider about any redness or drainage at the catheter site is essential, as these can be signs of infection or other complications that require prompt evaluation and treatment.

This statement is incorrect. Cleaning the catheter site with hydrogen peroxide is not recommended, as it can be too harsh and irritating to the skin. Instead, the site should be cleaned with mild soap and water or as instructed by the healthcare provider.

Incorrect. If an AV fistula starts bleeding, the client should not apply pressure to the site. Instead, they should immediately elevate the arm and apply pressure to the bleeding site with a clean cloth or bandage while seeking medical attention.QUESTIONS

Incorrect. Clients on dialysis typically need to restrict their phosphorus intake to prevent complications related to high phosphorus levels, such as bone disease and cardiovascular issues.

This statement is incorrect. Hypokalemia (low potassium levels) is not an indication for initiating dialysis. In fact, dialysis may lead to a reduction in potassium levels, and clients on dialysis are more likely to experience hyperkalemia.

Correct. Abdominal pain and fever in a client on peritoneal dialysis may indicate peritonitis, an infection of the peritoneal cavity. Obtaining a peritoneal fluid sample for testing is essential to confirm the diagnosis and initiate appropriate treatment promptly.

This statement is accurate. Cloudy drainage from the catheter site may indicate peritonitis, which is an infection of the peritoneal cavity. Obtaining a sample of the drainage for culture and sensitivity testing can help identify the presence of infection and guide appropriate treatment.

No explanation

This statement is incorrect. Hemodialysis does not use a pump to circulate dialysate through the intestines; that description is characteristic of peritoneal dialysis.

This statement is incorrect. Serum potassium levels may be monitored for a client on hemodialysis due to the potential for electrolyte imbalances, but they are not the primary concern during ESA therapy for anemia management.
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