Dialysis Complications and Emergency Management Flashcards

A patient on peritoneal dialysis presents with cloudy dialysate effluent, abdominal pain, and fever. What is the most likely diagnosis?

Answer: Peritonitis

Cloudy effluent, abdominal pain, and fever are the classic triad of peritonitis, the most serious complication of peritoneal dialysis.

What is the minimum white blood cell count in peritoneal dialysis effluent that is diagnostic of peritonitis?

Answer: 100 WBC/mm³ with >50% neutrophils

ISPD guidelines define peritonitis as effluent WBC ≥100/mm³ with >50% polymorphonuclear cells after a minimum two-hour dwell.

During hemodialysis, the blood pump stops and blood is observed to be dark in the arterial line. What is the most likely cause?

Answer: Arterial needle clotting or dislodgement

Dark, de-oxygenated blood backing up in the arterial line suggests the arterial needle has clotted or dislodged, severely limiting blood flow.

What is the primary goal of sodium profiling during hemodialysis?

Answer: Reduce intradialytic hypotension while limiting thirst and interdialytic weight gain

Sodium profiling uses higher dialysate sodium early in treatment to maintain hemodynamic stability, then lowers it to limit post-dialysis thirst and fluid intake.

A patient with end-stage renal disease on hemodialysis suddenly becomes unresponsive with no palpable pulse. What is the nurse's immediate priority?

Answer: Initiate CPR and activate the emergency response system

Cardiac arrest requires immediate initiation of CPR and emergency system activation; all other dialysis-specific actions are secondary to life support.

Which finding during hemodialysis requires the nurse to immediately stop the blood pump and clamp all lines?

Answer: Visible air bubbles detected in the venous drip chamber

Visible air in the venous drip chamber indicates a risk of air embolism, requiring immediate cessation of blood flow and line clamping.