Chapter 49: Hemodialysis
Which of the following methods should be used to help minimize dialytic hypotension?
A. Increase the time on dialysis
B. Increase the ultrafiltration rate
D. Increase the patient’s dry weight
E. Increase the dialysate blood flow rate
The answer is A. Dialysis hypotension can be decreased by decreasing the ultrafiltration rate, which is accomplished by increasing the time on dialysis. Sodium modeling will worsen hypotension by causing larger interdialytic weight gain. Increasing the patient’s dry weight is not an optimal method of minimizing hypotension as it could lead to chronic volume overload and hypertension. Increasing the dialysate flow rate should not have any significant influence on dialytic hypotension.
All of the following can be used to increase the dose of dialysis except for:
A. Increase the blood flow rate
B. Increase the dialysate flow rate
C. Increase the time on dialysis
D. Use a dialysis membrane with a larger surface area
E. Increase the ultrafiltration rate
The answer is E. Methods that can be used to increase the dose of dialysis include increasing the blood flow rate, increasing the surface area of the dialyzer and increasing the dialysis flow rate. If these methods are ineffective, then the time on dialysis can be increased. Increasing the ultrafiltration rate will not significantly increase the dialysis dose.
Complications of a type A dialyzer reaction include all of the following except:
The answer is C. Anaphylaxis, dyspnea, urticarial, and diarrhea can all be seen with a type A anaphylaxis reaction. Hemolysis can be secondary to either physical damage to erythrocytes due to a narrowing or blockage of the blood passages, including the dialysis tubing, catheter or needle or to issues with the dialysis solution. Hemolysis can be due to hypotonic dialysis solutions, solutions contaminated by chemicals in the water supply that have not been removed during the preparation of dialysate.
Indications to start chronic dialysis therapy includes all of the following except: