ESPINO, EMILYN E.

MARCH 4, 2021
BSN-III

A. Renal Replacement Therapy

1. Research on the different renal replacement therapy (RRT).
 Hemodialysis
Used for patients who are acutely ill and require short-term dialysis for days to
weeks until kidney function resumes and for patients with advanced CKD and
ESKD who require long term or permanent renal replacement therapy. The
objectives of hemodialysis are to extract toxic nitrogenous substances from the
blood and to remove excess fluid.
 Continuous renal replacement therapies (CRRT)
CRRT is a slower type of dialysis that puts less stress on the heart. Instead of
doing it over four hours, it is done 24 hours a day to slowly and continuously
clean out waste products and fluid from the patient. It requires special
anticoagulation to keep the dialysis circuit from clotting.

 Continuous vevovenous hemofiltration (CVVH)

Often used to manage AKI. Blood from a double-lumen venous
catheter is pumped through a hemofilter and then returned to the
patient through the same catheter. Continuous venovenous
hemofiltration (CVVH) removes larger volumes of fluid mainly via
convection. Replacement fluid is added. No dialysate is used. CVVH is
effective method for removal of large molecules.

 Continuous vevovenous hemofiltration (CVVHD)

Continuous venovenous hemodialysis (CVVHD) removes fluid mainly
by diffusion using dialysate. No replacement fluid is used. CVVHD is
effective method for removal of small to medium sized molecules.
 Peritoneal dialysis
Peritoneal dialysis is a type of dialysis which uses the peritoneum in a person's
abdomen as the membrane through which fluid and dissolved substances are
exchanged with the blood. It is used to remove excess fluid, correct electrolyte
problems, and remove toxins in those with kidney failure.

 Acute intermittent peritoneal dialysis

Indications for acute intermittent PD include uremic signs and
symptoms, fluid overload, acidosis and hyperkalemia. It permits more
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gradual change in the patient’s fluid volume status and in waste

product removal.

 Continuous ambulatory peritoneal dialysis (CAPD)

CAPD is performed at home by the patient or a trained caregiver who
is usually a family member. Allows patient to have freedom and
control of daily activities but requires a serous commitment to be
successful.

 Continuous cyclic peritoneal dialysis (CCPD)

Uses a machine called cycler to provide fluid exchanges. Most
common approach involves frequent continuous ‘cycling’ of dialysate
during the night, while the child is asleep & then leaving in a small
volume of dialysate during the daytime. The automated device
minimizes the need for extensive manual manipulation and hence
reduces the risk of peritonitis. The patient can carry out day to day
activities.

 Kidney surgery
A patient may undergo kidney surgery to remove obstruction that affect the
kidney (e.g. calculi or tumor), to insert a tube for draining the kidney or to
remove the kidney involved in unilateral kidney disease, renal carcinoma or
kidney transplantation.

2. Compare and contrast the different kinds of catheter used

for RRT.
 Tunneled catheter (Hemodialysis)
A tunneled catheter is a thin tube that is placed under the skin in a vein,
allowing long-term access to the vein. There are two types of tunneled
catheters, cuffed or non-cuffed. Non-cuffed tunneled catheters are used for
emergencies and for short periods (up to 3 weeks). Tunneled cuffed catheters, a
type recommended by the NKF for temporary access, can be used for longer
than 3 weeks when an AV fistula or graft has been placed but is not yet ready
for use and there are no other options for permanent access. For example,
when a patient’s blood vessels are not strong enough for a fistula or graft.
 PD catheter
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The peritoneal dialysis catheter is composed of a flexible silicone tube with an

open-end port and several side holes to provide optimal drainage and
absorption of the dialysate. The extraperitoneal component of the catheter has
either one or two Dacron cuffs. The most widely used is the POLYURETHANE
TROCAR CATHETER which is available is many sizes.
3. Discuss your nursing responsibilities before, during and after each
procedure.
 Before the procedure:
 Explain the procedure to the patient
 Assist in obtaining informed consent
 Obtain baseline vital signs, serum electrolyte levels
 Weigh the patient daily to assess fluid removal.
 Prepare the equipment needed such as the set and tubing using
aseptic technique

 During the procedure:

 Monitor the patient’s vital signs, the dialyzer and the dialysate
bath
 Monitor for possible complications
 Monitor fluid and electrolyte balance
 Make the patient comfortable

 After the procedure:

 Monitor patient’s vital signs
 Monitor electrolyte and fluid
 Place patient on desired and comfortable position
 Educate patient about self-care
 Promote pharmacologic therapy that are prescribed by the doctor
 Promote nutritional and fluid therapy
 Manage discomfort and pain
 Protect vascular access/catheter site. Recommend daily or 3 to 4
times weekly routine catheter site care
 Prevent infection
 Provide psychological support, provide opportunities to express
patient’s feelings and reaction and to explore option

4. Why is RRT important?

Renal replacement therapy is a therapy that replaces the normal blood filtering
functioning of the kidneys. It becomes necessary when the kidneys can no
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longer remove wastes. It is used to maintain electrolytes and regulate fluid

balance.

B. Summarize the different diagnostic procedures, laboratory tests and

assessment/assessment tools used for neurologic examination and EENT.

 CT scan
This imaging test uses a combination of X-rays and computer technology to
make horizontal images of the body. A CT scan shows detailed images of any
part of the body, including the bones, muscles, fat, and organs. CT scans are
more detailed than general X-rays.

 Electroencephalogram (EEG)
This test records the brain's continuous electrical activity through electrodes
attached to the scalp.
 MRI
This test uses a combination of large magnets, radio waves, and a computer to
make detailed images of organs and structures within the body.
 Electrodiagnostic tests, such as electromyography (EMG) and nerve
conduction velocity (NCV)
These tests evaluate and diagnose disorders of the muscles and motor
neurons. Electrodes are inserted into the muscle or placed on the skin
overlying a muscle or muscle group. Electrical activity and muscle response are
recorded.
 Positron emission tomography (PET)
This test measures the metabolic activity of cells.
 Arteriogram (angiogram)
This X-ray of the arteries and veins detects blockage or narrowing of the
vessels.
 Spinal tap (lumbar puncture)
During this test, a special needle is placed into the lower back, into the spinal
canal. This is the area around the spinal cord. The pressure in the spinal canal
and brain can then be measured. A small amount of cerebrospinal fluid (CSF)
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can be removed and sent for testing to find out if there is an infection or other
problems. CSF is the fluid that bathes the brain and spinal cord.
 Evoked potentials
This test records the brain's electrical response to visual, auditory, and sensory
stimuli.
 Myelogram
This test uses dye injected into the spinal canal to make the structure clearly
visible on X-rays.
 Neurosonography
This test uses ultra-high-frequency sound waves. It allows the healthcare
provider to analyze blood flow in cases of possible stroke.
 Neurologic exam
Also called a neuro exam, is an evaluation of a person's nervous system that
can be done in the healthcare provider's office. It may be done with
instruments, such as lights and reflex hammers. It usually does not cause any
pain to the patient. The nervous system consists of the brain, the spinal cord,
and the nerves from these areas. There are many aspects of this exam,
including an assessment of motor and sensory skills, balance and
coordination, mental status, reflexes, and functioning of the nerves.