Renal Concepts in Critical Care


nursebob 02/06/01

I. Diffusion - movement of particles from greater to lesser concentration.
II. Osmosis - movement of water across a semipermeable membrane.
III. Hemodialysis.
A. Uses principles of diffusion.
B. Remove electrolytes and excess water.
C. Remove blood across a semipermeable membrane.
D. Vascular access may be temporary or perminate.
1. A/V fistula.
a. Connect vein and artery together.
b. Takes up to 2 months to mature.
*c. Determine patiency.
*1) Should hear bruit.
*2) Should feel thrill.
E. Dialysis takes 2-3 hours and must be done 2-3 times per week.
F. Nursing.
1. Check vital signs, weight.
2. Check A/V fistula.
3. Check laboratory work.
*4. Watch for hypotension.
*5. Check for bleeding.
6. Infection - risk for HIV, hepatitis, cytomeglia virus.
*7. Weigh after dialysis.

IV. Peritoneal dialysis.
A. Peritoneum is a semipermeable membrane.
B. Fluid is instilled into the abdominal cavity.
C. Waste travels across the peritoneum.
D. Two types.
1. CAPD - Continuos Ambulatory Peritoneal Dialysis.
2. CCD - Continuos Cyclic Dialysis (done at night.)
E. Risk for peritonitis.
1. Cloudy foul smelling peritoneal fluid.
2. Tenderness.
3. Abdominal pain.
4. N/V.
F. Nursing.
1. Check weight.
2. Check laboratory values.
3. Warm fluid.
*4. Dwell time - how long fluid remains in abdomen.

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