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Medical Surgical Nursing: Uremic Syndrome and Hemodialysis

This post will cover the Uremic Syndrome and Hemodialysis.

Before we start, be sure to download the free PDF study guide with this post to enhance your learning. The link is listed here.

Uremic syndrome is a pathological clinical and laboratory manifestation of end stage kidney disease. This is caused by an accumulation of nitrogenous waste products inside the blood due to kidney failure.

What are the signs and symptoms of Uremic syndrome?

Signs and symptoms are oliguria, the presence of protein, red blood cells, and casts in the urine. Additionally, hypotension or hypertension, changes in consciousness, electrolyte imbalances, stomatitis, fatigue, vomiting, diarrhea, and constipation are also good indicators.

Remember in the previous video we talked about gathering an urine sample? With uremic syndrome, an elevated urea, uric acid, potassium, and magnesium levels in the urine are also indicators.

Interventions for Uremic Syndrome include:

  • monitoring vital signs for signs of hypertension and tachycardia

  • monitoring for an erratic heart rhythm.

  • monitoring electrolyte levels

  • monitoring intake and output, as well as oliguria

The recommended diet will be a high-quality protein, low sodium, nitrogen, potassium, and phosphate diet.

So when a patient has uremic syndrome, what are possible treatments that will help the patient. The main treatment of choice is Hemodialysis. Let’s learn more about hemodialysis.

Hemodialysis is an intermittent renal replacement procedure that involves the cleaning of the client's blood. It entails the movement of dissolved particles from one fluid compartment to another through a semipermeable membrane.

In hemodialysis, the client's blood flows into one fluid compartment of a dialysis filter while the dialysate flows through another.Hemodialysis is a procedure that drains the blood of waste materials that have collected over time. It also eliminates byproducts of protein synthesis such as urea, creatinine, and uric acid.

It also eliminates extra body fluids when maintaining and restoring the body's buffer system. This corrects the body's electrolyte ratios.

What is the hemodialysis membrane made of? A semipermeable membrane.

The hemodialysis semipermeable membrane is a thin, porous cellophane membrane. The membrane's pore size enables small molecules like urea, creatinine, uric acid, and water molecules to move through. Proteins, viruses, and certain blood cells are too large to cross the membrane.

The client's blood flows into the dialyzer via osmosis, and contaminants transfer from the blood to the dialysate via the concepts of osmosis, diffusion, and ultrafiltration.

Do you know the difference between osmosis and diffusion?

Osmosis is the passage of fluids over a semipermeable membrane from a low particle concentration region to a high particle concentration area.

Tip to help remember Osmosis. Think of Moses and the splitting of the sea which is water.

Now, diffusion is the flow of particles from a high-concentration region to a low-concentration area, while ultrafiltration is the movement of material over a semipermeable membrane as a result of an artificially generated pressure gradient.

Tip to help remember diffusion. Think that diffusion starts the letter D so think D for dirty particles.

The Dialysate Bath

Water and big electrolytes make up a dialysate bath. Since bacteria and viruses are too large to migrate through the pores of the semipermeable membrane, the dialysate does not need to be sterile. However, the dialysate must follow strict requirements, and the water must be filtered to ensure a clean water source.

Due to the slight warmth of the blood from the dialysis system, the client's temperature may rise.

Additionally, before, during, and after dialysis treatments, it is important to monitor laboratory values such as BUN, creatinine, and red blood cell count.

Now let's go over interventions for hemodialysis.

Interventions include:

  • Evaluating the person for fluid excess prior to dialysis and for fluid volume loss after dialysis. This is done by weighing the patient.

  • Inspecting the blood access system before, during, and after dialysis.

  • Administering heparin in order to prevent clots from forming in the dialyzer or blood tubing,

  • Monitoring for hypovolemia, which occurs because of blood loss or excess fluid and electrolyte removal during dialysis.

  • Very important: Withhold antihypertensives and other drugs that may influence blood pressure or cause hypotension until hemodialysis is complete.

  • Additionally, do not administer drugs that may be removed through dialysis, such as water soluble supplements, some antibiotics, and digoxin.

So here's what we learned in this video. We went over uremic syndrome, it’s signs and symptoms and nursing actions. We also went over the purpose of hemodialysis, how it works, complications and nursing interventions.

Thank you for reading!

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