CKDESRD Management课件.ppt

* * * * Complications/considerations-hemodialysis (*important to understand these!) See also p. 1229 Tab. 47-13 *Prior to treatment- assessment of fluid status (weight before and after dialysis- *Best-limit wt gain-1-1.5 kg between dialysis (p.1222); condition of access, temperature, skin condition; during treatment- monitor changes in condition, perform vital signs every 30- 60 minutes Note-MOST medications- HOLD prior to dialysis/give after (except phosphate binders-give with meals!)- “dialyze out” ie many antibiotics, water soluble antibiotics; *meds as BP cause significant drop in BP...(unless informed otherwise)- check with staff/dialysis nurse; *caution with insulin- make sure patient will/can eat-dialysis may cause nausea- hypoglycemic response-careful monitoring! *Check Dialyziability of Drugs (PDF reference) During dialysis Hypotension, most common- related to changes in osmolality, rapid removal from vascular department, vasodilation -FYI-Osmolarity- measure of solute concentration, (number of osmoles of solute per liter of solution (osmol/L); Osmolality-measure of osmoles of solute per kilogram of solvent (osmol/kg). * Avoid- hold BP meds prior to dialysis, additional fluids given during dialysis Muscle cramps-due to altered fluid and electrolytes Cardiovascular; arrhythmias associated with fluid and electrolyte alterations; bleeding due to altered platelet function (uremia); *Cardiovascular disease –most common cause death-ESRD/dialysis Complications associated with extracorporeal circuit- (dialysis) Bleeding- heparin to prime circuit; “central line” access catheters contain 10,000 u Heparin; risk line separation, bleeding during access; accidental line separation-high pressure in line-arterial-venous connection=high flow! *exsanguination Neurologic: seizures (*know why this happens!) Disequilibrium syndrome especially with initial dialysis Urea, sodium and other solutes removed more rapidly from blood than from cerebrospin