Download CCHT Exam Questions and Complete Solutions: Water Treatment, Dialysis, and Kidney Function and more Exams Medicine in PDF only on Docsity!
CCHT EXAM Questions
and Complete Solutions
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Why is water treatment necessary for dialysis? - Answer: -Patient safety *very large exposure volume *little or no renal excretion *dialyzer membrane is sole barrier -Prevent equipment damage How much water does the average person drink per week? - Answer: 10-14L What is the average amount of water a dialysis patient is exposed to per week? - Answer: 360L Water contaminants aluminum, chloramines, copper, and zinc can cause what symptom? - Answer: Anemia Water contaminants aluminum and fluoride can cause what symptom? - Answer: Bone Disease Water contaminants chloramines, copper, and nitrates can cause what symptom? - Answer: Hypertension Water contaminants calcium and sodium can cause what symptom? - Answer: Hypotension Water contaminants sulfates and low pH can cause what symptom? - Answer: Metabolic Acidosis
Water contaminants bacteria, calcium, copper, endotoxin, low pH, magnesium, nitrates, sulfates, and zinc can cause what symptom - Answer: Muscle weakness Water contaminant aluminum can cause what symptom? - Answer: Nausea and Vomiting Who sets the recommended standards for water used in the hemodialysis procedure? - Answer: - International Organization of Standardization(ISO) -Association for the Advancement of Medical Instrumentation(AAMI) What is the acceptable level of water/dialysate culture parameters? - Answer: 50 cfu/ml What is the action level for water/dialysate culture parameters? - Answer: 50-99 cfg/ml What is the unacceptable level for water/dialysate culture parameters? - Answer: 100 cfg/ml What is the acceptable water endotoxin parameter level? - Answer: Below 0.12 EU/ml What is the action level for water endotoxin parameter? - Answer: 0.12 EU/ml to less than 0.25 EU/ml What is an unacceptable level for water endotoxin parameter? - Answer: 0.25 EU/ml or greater What is an acceptable level for dialysate endotoxin parameters? - Answer: Below 0.25 EU/ml What is the action level for dialysate endotoxin parameters? - Answer: 0.25 EU/ml to less than 0. EU/ml What is the unacceptable level of dialysate endotoxin parameters? - Answer: 0.50 EU/ml or greater What are the water treatment processes? - Answer: 1. Pre-Tx -before the RO
What are the purification components? - Answer: -RO and UF -Deionization and UF Reverse Osmosis (RO) - Answer: the primary purification device that utilizes a semi-permeable membrane and pump to produce purified water used in dialysis What does the RO remove? - Answer: -Organic/Inorganic contaminants -Bacteria & endotoxin Osmosis - Answer: fluid moving from an area of low solute concentration to an area of high solute concentration How often is AAMI analysis required? - Answer: Annually, unless required more frequent by state Deionization - Answer: 1. Ion exchange process forms water form cations (+) and anions (-)
- Produces water of highest ionic quality
- Highly dangerous when exhausted
- Typically increases bacterial and endotoxin levels Ion exchange - Answer: As cations come in H+ ions are sent off (exchanged). As anions come in, hydroxyl ions are exchanged. H+ and OH- then form pure water Endotoxin - Answer: a substance on bacteria that can be released and cause fevers When is the water hardness test performed? - Answer: End of day What are some AKI pre-renal issues? - Answer: -Volume depletion: hemorrhage, burns -Decrease in cardiac output: ❤ failure, cardiac tamponade -Vasodilation that leads to hypotension: sepsis, anaphylaxis
-Renal vascular obstruction: renal artery thrombosis or stenosis -Rhabdomyolosis What are some AKI intra-renal issues? - Answer: -Acute interstitial nephritis -Acute tubular necrosis -Acute glomerulonephritis -Contrast induced -Chemotherapy -Complications from antibiotics or anti-inflammatory meds -Ingesting antifreeze/other poisons What are some AKI post-renal issues? - Answer: -Bladder/Ureteral malignancy -Kidney Stones -Benign prostatic hyperplasia Oliguric - Answer: Urine output of 400 ml/day or less Glomerular Filtration Rate (GFR) - Answer: Test that estimates how much blood passes through the glomeruli each minute Glomeruli - Answer: Tiny filters in the kidneys that filters waste from the blood What are some CKD pre-renal conditions - Answer: -Prolonged shock (very low BP) -Injury w/ significant blood loss -Massive internal bleeding -Renal artery stenosis What are some CKD intra-renal conditions? - Answer: -Diabetes & Hypertension -Glomerulonephritis (infection/inflammation in kidneys)
How do we calculate the Urea Reduction Ration (URR)? - Answer: How much urea is removed during dialysis: Pre-dialysis BUN - post-dialysis BUN ------------------------------------------ x 100 Pre-dialysis BUN What factors affect clearance "K"? - Answer: -Dialyzer SA/membrane characteristics -Adequate anticoagulation -BFR -BVP -DFR -UF Goal What is the correct pump speed to prime a dialyzer w/ saline? - Answer: 150ml/min Revaclears 100ml/min What happens when you prime a dialyzer at a higher speed? - Answer: Air bubbles can get trapped in the fibers and affect the ability of the dialyzer to remove toxins and also may cause clotting in dialyzer Needle Sizes - Answer: 17G (200-250ml/min) -no more than -150mm/Hg 16G (250-350ml/min) -no more than -200mm/Hg 15G (350-450ml/min) -no more than -220mm/Hg 14G (>450ml.min) -no more than -260mm/Hg
Adequate dialysis replaces what percentage of normal kidney function? - Answer: < 15% BUN Lab Draws - Answer: 1. Turn off/decrease UF to 50ml/hr
- Decrease DFR to 300 or place machine in bypass
- Reduce BFR to 100
- Wait 15 seconds for AVF/AVG/CVC
- Obtain from arterial line Anastomosis - Answer: Where the artery and vein connect in an AVF AVG - Answer: -Are prone to stenosis -Higher risk of infection -Shorter lifespan than fistulas -No maturation needed AVF - Answer: -Takes 4-6 weeks to mature -23% of the time they fail to grow/clot Bruit & Thrill - Answer: Bruit =heard w/ stethoscope Thrill =felt w/ hand Arterial & Venous Needles - Answer: -Arterial pulls blood from the pt to the dialyzer -Venous returns blood to the patient's body How should the arterial needle be placed? - Answer: In antegrade (direction of blood flow/toward the heart) Retrograde (against the flow) doesn't change adequacy of tx, but can damage fistula
Hypokalemia - Answer: Too little potassium in the blood Symptoms: tingling/numbness, fatigue, weak muscles/muscle damage, fainting, changes in heart rhythm Hypercalcemia - Answer: Too much calcium in the blood Symptoms: fatigue, vomiting, weakness, muscle twitches, confusion Hypocalcemia - Answer: Too little calcium in the blood Symptoms: muscle cramps, irregular heartbeat, tetany (muscle spasms, tremors, facial twitches, muscle pain) Hyperphosphatemia - Answer: Too much phosphorus in the blood Symptoms: severe itching Hypophaosphatemia - Answer: Too little phosphorus in the blood Symptoms: muscle weakness, coma, RBC function issues Uremia - Answer: A build-up of wastes in the blood Anemia - Answer: A shortage of RBCs Symptoms: fatigue, weakness/lack of energy, feeling cold all the time, mental confusion, pale skin/gums/fingernails
Causes of Hypertension - Answer: -Fluid overload -Renin response -Not following med schedule -EPO side effect -Anxiety/Tension Symptoms: headache, dizziness, irritability, blurred vision, nervousness, edema Causes of Hypotension - Answer: -Rapid fluid loss -High BP meds -Low blood volume -Food Ingestion Symptoms: SOB, nausea/vomiting, clammy skin, restlessness, rapid/shallow respirations, excessive yawning, dizziness upon standing, tachycardia Causes of Muscle Cramps - Answer: -Rapid/excessive fluid removal Symptoms: painful cramps Causes of Fever/Chills - Answer: -Systemic infections -Access infections -Contamination of blood/dialysate compartments Symptoms: nausea/vominting, headache, hypotension, tachycardia Causes of a Pyrogen Reaction - Answer: Occur upon exposure to pyrogens/endotoxins Symptoms: fever/chills, nausea/vomiting, back pain
First Use Syndrome - Answer: A group of symptoms that occur shortly after starting a tx with a new dialyzer. Symptoms: Nervousness, Chest pain, Back pain, Palpitations, Itching, Funny taste in mouth Disinfectant Infusion - Answer: A result in disinfectant being infused into the patient's blood stream Symptoms: Pain at venous needle, Itching, Restlessness, Respiratory distress, Flushing, Chest pain, Tingling around lips, Back pain Common Dialysis Blood Tests - Answer: -RBC count =# of RBCs -Serum Albumin =protein in the blood -Calcium =bone mineral balance -Phosphorus =bone mineral balance -PTH =parathyroid hormone level Solubility - Answer: How completely a solute will dissolve into a solvent Solvent =fluid Solute =substance that can be dissolved High Flux Membranes - Answer: More permeable, more prone to back filtration which could lead to endotoxin reactions
