Kidney Failure - Hemodialysis & Peritoneal Dialysis, Nursing Care NCLEX RN & LPN

Hemodialysis Overview and Potassium Management
📌 Dialysis is the machine version of the kidney, cleaning blood by filtering waste and excess fluid/electrolytes; the memory trick is "dial" like soap cleans.
🧪 Missing hemodialysis sessions (usually 3-4 times a week) significantly increases the risk of excess potassium and waste in the blood.
❤️ For high potassium, the priority intervention is administering calcium gluconate to stabilize heart muscles, followed by IV regular insulin to push potassium into the cells.

Hemodialysis Pre-Procedure Assessment and Medications
🩺 Priority pre-dialysis assessments include checking fluid status (weight comparison, vitals, edema, heart/lung sounds) and fistula assessment.
👂 For the fistula (shunt), it is critical to feel a thrill (vibration) and hear a bruit (swoosh); absence indicates potential clot formation requiring immediate HCP notification.
💊 Hold antihypertensives (ACEs/ARBs, Beta Blockers, CCBs, Diuretics) and vasodilators before dialysis, as fluid removal can cause hypotension.
💧 Water-soluble vitamins (B, C, Folic Acid) are dialyzed out and should be held; conversely, calcium supplements are okay to give to help lower phosphorus levels.

Dialysis Disequilibrium Syndrome (DDS)
🚨 DDS is a deadly complication where solutes are removed too fast, causing brain cells to swell, leading to increased Intracranial Pressure (ICP), restlessness, disorientation, vomiting, and headache.
🛑 The priority action for DDS is to stop or slow the infusion and report to the provider; do not place the client in Trendelenburg position as it worsens ICP.

Fistula Care and Complication Monitoring
💪 Client education for fistula care involves squeezing a rubber ball several times daily to promote blood flow and strengthen the site; pitting edema in the arm is normal initially.
🛑 Do not apply pressure to the arm with the fistula; avoid BP checks, restrictive clothing, sleeping on the arm, or lifting over $5$ pounds.
🩸 Teach clients to check daily for a thrill (vibration), which confirms adequate blood flow and rules out stenosis or thrombosis.

Peritoneal Dialysis (PD) & Complications
♨️ PD involves filling the peritoneal cavity with hypertonic solution for a $\approx 30$-minute dwell phase; the solution must be warmed before infusion.
🦠 The deadly complication is peritonitis (infection), signaled by fever, tachycardia, and cloudy drainage; sterile technique is paramount during setup.
🌬️ Respiratory distress (crackles, rapid respirations) from overfilling requires the priority intervention of raising the head of the bed (prioritizing breathing over blood pressure).

PD Insufficient Outflow Management
➡️ For insufficient outflow, the procedure is: 1) Assess the patient (abdomen for distension), 2) Assess the device (catheter kinks), and 3) Reposition to sideline position; do not flush tubing initially.
🍎 After dialysis, increase protein in the diet because the washing process results in low protein levels in the body.

Key Points & Insights
➡️ For hyperkalemia in hemodialysis, the priority drug is calcium gluconate to "glue down" the heart muscles, followed by IV insulin to push K⁺ intracellularly.
➡️ Immediately report the absence of a thrill or bruit at the AV fistula site, as this signifies potential clotting that could lead to limb loss.
➡️ When managing potential Dialysis Disequilibrium Syndrome (DDS), the first step is to slow the infusion and contact the HCP, actively avoiding positioning that increases ICP (like Trendelenburg).
➡️ For Peritoneal Dialysis, the critical infection signs are fever, tachycardia, and cloudy drainage, necessitating immediate reporting.

📸 Video summarized with SummaryTube.com on Feb 02, 2026, 23:35 UTC