CCHT Dialysis exam 2020 Study Guide Review Questions (238 Terms) with Definitive Solutions, Exams of Nursing

Download CCHT Dialysis exam 2020 Study Guide Review Questions (238 Terms) with Definitive Solutions and more Exams Nursing in PDF only on Docsity! CCHT Dialysis exam 2020 CCHT Dialysis exam 2020 Study Guide Review Questions (238 Terms) with Definitive Solutions Updated 2023- 2024. CCHT Dialysis exam 2020 What factors decrease K - Answer: Incorrxr pump speed, low BFR Factors that influence V - Answer: Height, weight, age, amputation, sex BFR for 17G needle - Answer: 200-250 BFR for 16G needle - Answer: 250-350 BFR FOR 15G needle - Answer: 350-450 BFR for 14g needle - Answer: >450 Post BUN lab draw steps - Answer: Turn off UF, bring down dialysate flow rate to 50, wait 15 seconds, obtain sample form arterial port False KT/v (increase) - Answer: BFR not decreased, did not wait 15 seconds before drawing, drew from venous line Low KT/V causes - Answer: Diluted sample(saline) Why is weight and BP important when monitoring AKI patients - Answer: Keep them wet so they don't dry out! CCHT Dialysis exam 2020 Conditions for coverage - Answer: A CMS regulation that the dialysis provider must meet A surveyor sees a covered vascular access, and this can result in a - Answer: IJ(immediate jeopardy) What precautions do you take when handling lab specimens - Answer: Universal precautions(everything is infectious) Lavender tubes - Answer: Inverted, no clotting, no shaking What do you do if a tube breaks in the centrifuge? - Answer: Take sleeve out, remove opposing sleeve Importance of V tags - Answer: Infection control, CMS regulation Most frequent infectious complicaitons - Answer: Vascular access infection Most common germ we experience - Answer: MRSA Why do we wear gloves? - Answer: Reduces risk of hand contamination Why preform hand hygiene before and after gloves? - Answer: Microscopic holes CCHT Dialysis exam 2020 CVC KDOQI Strategy - Answer: Masks, gloves, aseptic technique Rules for spinning samples - Answer: Balance centrifuge, use dummy tubes if needed LVH is associated with - Answer: Hypertension Hyperkalemia symptoms - Answer: Arrhythmia, muscle weakness, possible cardiac arrest. Hyperkalemia causes - Answer: usually treatment related, impaired renal function, hypoaldosteronism, tissue trauma, acidosis Why are patients anemic - Answer: Lack of Erythropoietin What is pericarditis - Answer: Inflammation around the heart We would limit this patient's heparin if they have this - Answer: Pericarditis Systemic effects of CKD - Answer: Dry itchy skin, use hyper fat lotion Four key elements of MBD - Answer: Calcium, phosphorus, parathyroid, vitamin D CCHT Dialysis exam 2020 Who controls the target weight - Answer: Physician only Hypervolemia risks and consequences during treatment - Answer: Increased mortality rate due to hypotension Conductivity range PH - Answer: No greater than .4 Temperature is too hot - Answer: Causes homolysis Temperature is too cold - Answer: Hypothermia Intervention for power alarm - Answer: Determine cause, remove Venous line clamps, returned with a hand crank High arterial pressure alarm - Answer: Kink in the arterial tubing High Venus pressure alarm - Answer: Clamped or kinked line A low Venus pressure alarm - Answer: Severely clotted dialyzer, Incorrect blood flow rate, separation from tubing Clotting in the Venus trip - Answer: High venous pressure Severely clotted dialyzer - Answer: Low Venous alarm CCHT Dialysis exam 2020 Importance of limiting phosphorus and went to take binders - Answer: Bone damage, itching, mineral vital to energy production MBD - Answer: Remember binders and phosphates Hypotension causes - Answer: blood loss, dehydration, anemia Organ stunning impaired tissue perfusion Intervention for muscle cramps - Answer: Turn the UF off, stretch the muscle Definition of fever - Answer: Temperature over 100°, or a rise of 2° of baseline temperature pyrogenic reaction - Answer: Sudden onset of fever, chills, backache, headache, nausea, and vomiting as a result of being exposed to foreign proteins, such as those found in bacteria or fungi. Typically happens between 45 and 75 minutes of the treatment seizures and interventions - Answer: Discontinue dialysis only if patient has no response CCHT Dialysis exam 2020 Dialysis Disequilibrium Syndrome - Answer: Discontinue treatment for severe symptoms. Patient please don't miss treatments Do not return the blood if - Answer: Hemolysis Disinfectant Infusion - Answer: Pain at the Venus Needle site, tingling around lips You would place a patient and left side Trendelenburg position if - Answer: There is an air embolism The threePrinciples of patient self management - Answer: Dealing with the consequences of the illness and not just the physical disease What is health literacy? - Answer: the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions Auditory learner tips - Answer: Word associations are mnemonics The three medications a PCT can administer - Answer: Heparin, saline, lidocaine Preservative medications need to be discarded after - Answer: 28 days The wait time for Heprain bolus - Answer: 3 to 5 minutes CCHT Dialysis exam 2020 And outflow stenosis a.k.a. narrowing - Answer: Water hammer, whistling sound Use of tourniquet - Answer: AVF only Pseudo aneurysm and aneurysms are caused by - Answer: Poor site rotation Site rotation and healing time - Answer: Two weeks Flipping needles tips - Answer: Only for a cause not just because. Not typically on an arterial needle Hemostat sponges rules - Answer: PD order only. Do not allow to leave the clinic with a surseal dressing on The patient will be in a supine position for - Answer: CVC care Chlorine in water causes - Answer: Hemolysis and anemia When is hardness testing done - Answer: At the end of each day two types of peritoneal dialysis - Answer: CAPD and CCPD Clinical pyramid - Answer: Fundamentals, complex programs, effectiveness CCHT Dialysis exam 2020 Hyperkalemia can lead to - Answer: Cardiac arrest What are the possible consequences of poor or incomplete documentation - Answer: 1. personal and business liability 2. career threatening 3. it makes you a "STAR" at a disposition or trial 4. Reputational injury 5. Compromised patient safety What are the 5W's to be used when completing a REM - Answer: What happened, when did it happen, what was the result, where did it happen, who was involved What are the three things you should not include on a REM - Answer: Personal opinion, speculation, vendettas What does TRAMP stand for - Answer: Right time, right route, right amount, right medication, right patient What are the four consequences of sodium loading during dialysis - Answer: 1. Increased thirst, fluid intake between treatments 2. Increased fluid, weight gain and blood pressure between treatment 3. Higher UF rates required CCHT Dialysis exam 2020 4. More hypotension during treatment requiring saline administration What are the consequences if a patient is consistently fluid overloaded - Answer: Insufficient blood flow to vital organs can damage the heart and brain- ischemia What are the consequences and risks of hypovolemia during treatment - Answer: Increased mortality rate due to hypotension What is the appropriate intervention for a blood leak detector - Answer: Blood leak test strip, test dialysate from arterial portion of dialyzer. If positive do not return blood to patient Acceptable pH range - Answer: 6.9- 7.6 Acceptable conductivity range - Answer: 13 to 15.5 Dialysis delivery system must be within this range of acceptable conductivity - Answer: +/-0.4 MS What happens if dialysate is too hot - Answer: Hemolysis What are V-tags - Answer: CMS regulations that govern our policy and procedure CCHT Dialysis exam 2020 Why is it important to know what caused your patients CKD - Answer: To assist with treating any complications, to inquire about possible problems during data collection What are the most common causes for CKD in the USA - Answer: Diabetes and hypertension What treatment factors decrease K - Answer: Low blood flow rate, incorrect pump speed What factors influence V - Answer: Height, weight, amputation, age, sex What is the role of the PCT prior to treatment initiation - Answer: Collect data before treatment and report any abnormal findings to the charge nurse make observations When is a pre-treatment assessment by the licensed nurse required? - Answer: If there are abnormal findings, AKI patients, state mandate What are the risks of doing it your way - Answer: Not with in an ordinary standard of care. Civil liability Examples of post Reno causes of AKI - Answer: Bladder tumors, kidney stones, anything that blocks the ureters, enlarged prostate CCHT Dialysis exam 2020 Topical spray - Answer: Clean before using topical spray, spray until skin blanches Severely clotted dialyzer - Answer: Low venous pressure Fluid overload and hypertension lead to LVH - Answer: Hypotensive episodes are more likely to occur during dialysis LVH - Answer: Heart muscle is larger, the more you work at the bigger it gets more fluid= enlarged and weaker heart Take phosphorus binder with a snack - Answer: MBD-CKD management PCT role in anemia management - Answer: Rinse back as much blood as possible Hypovolemia during treatment - Answer: Insufficient blood flow to organs/loss of residual renal function What function does bicarb and the dialysate serve - Answer: Correct metabolic acidosis normal blood pressure - Answer: 120/80 0.1 or less - Answer: Chlorine levels in test Can be no higher than CCHT Dialysis exam 2020 Primary device for purifying water in dialysis - Answer: R/O reverse osmosis, purify Hypertension/diabetes - Answer: CKD Excretory functions of the kidney - Answer: Fluid balance, electrolyte balance, waste removal, acid/base balance Excretory functions of dialyzer - Answer: Removal of excess fluid based on the pt's TW, Normalizing electrolytes, waste removal, reduce metabolic acidosis Endocrine functions of the kidney - Answer: Blood pressure regulation, anemia, CKD- MBD Endocrine functions of dialysis - Answer: Antihypertensive medications, Epogen and IV iron, phosphate binders, vitamin D, calcimimetics 4 AVF evaluations- Rule of 6's - Answer: <o.6 cm depth below skin 6-8 week post-op >0.6 cm diameter Access BFR >600 ml/min CCHT Dialysis exam 2020 Immediate jeopardy - Answer: Potential for actual harm to patient Distance between Needles - Answer: 1 1/2 to 2 inches Chlorine testing - Answer: Every morning prior to first treatment, every four hours health literacy - Answer: The degree to which individuals have the capacity to obtain, process and understand basic information and services needed to make appropriate health decisions Standard deficiency - Answer: Failure to meet the CMS requirements in one or more areas Hyperkalemia - Answer: Arrhythmia, muscle weakness, possible cardiac arrest, hemolysis Four key elements affected in CKD-MBD - Answer: Calcium, phosphorus, parathyroid hormone,vitamin D Intervention for anaphylaxis - Answer: Left Trendelenburg position Intervention for chest pain - Answer: Notify charge nurse, decrease blood flow rate, turn UF off, nitroglycerin, oxygen, Saline, if hypotensive restore BP CCHT Dialysis exam 2020 The fundamentals and complex programs - Answer: The clinical pyramid shows that you must do what for patient to achieve their highest quality of life Denial, depression, bargaining, anger, acceptance - Answer: Five stages of grief Benefits of PD - Answer: Homebase, flexible schedules, preserved residual renal function, improved transplant outcomes, active lifestyle, less anemia, needle free, steady Benefits of home hemodialysis - Answer: Homebase, flexible, if your dietary restrictions, improved clinical outcomes, may allow for easier travel, independent treatment Reasonable and prudent standard of care concepts - Answer: Care where you give Sam Kerr under similar circumstances. Do you the actions a reasonable and prudent nurse what do you as well as being avoided. Follow standard care to avoid negligence. When supervising non-licensed people it is the RN job to make sure they are following the standard of care Beginner cannulation level - Answer: Less than six months of practice less than 10 successful cannulations CCHT Dialysis exam 2020 Intermediate cannulator - Answer: Six months or more of practice more than 10 cannulations Advanced cannulator - Answer: Complete our competencies on NFACT checklist, expert assessments, and cannulation skills documented Difference between aneurysm and pseudo aneurysm - Answer: AVF- aneurysm AVG- Pseudo aneurysm Putting all of the machines in bypass mode - Answer: Response to water quality alarm Tactile learner - Answer: Background music, highlight important information, short lectures, hands on, frequent breaks, role-playing Visual learners - Answer: Notes, quiet surroundings, visual aids, short lectures, I contact Auditory learner - Answer: Repeat info, read notes out loud, word associations, watch videos, discuss and explain Volume of water in patient's body - Answer: V CCHT Dialysis exam 2020 HBV nomenclature and which test is performed monthly on patients - Answer: HBsAg- surface antigen. If positive isolation and monthly test left ventricular hypertrophy - Answer: Hypertension can lead to this pH of urine - Answer: 4.5-8 Normal heart rate - Answer: 60-100 bpm What is in acid concentrate - Answer: Sodium, calcium, dextrose, potassium, magnesium, chloride Dialysate with a high pH - Answer: Metabolic alkalosis Dialysate with a very low pH - Answer: Metabolic acidosis What is in bicarb concentrate - Answer: Bicarb sodium, act as a buffer, forms acetate ions in carbon dioxide Blood pH - Answer: 7.35-7.45 Excretory functions of kidney - Answer: Fluid balance, Electrolyte balance, waste removal, acid/base balance