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This study guide provides a comprehensive overview of hemodialysis and chronic kidney disease (ckd) management, focusing on key concepts, procedures, and patient care considerations. It includes a series of questions and answers covering topics such as transport mechanisms in hemodialysis, kidney functions, electrolyte imbalances, ckd-mineral bone disorder (mbd), acute kidney injury (aki), and infection control in dialysis patients. The guide is designed to aid pcts in understanding and applying essential knowledge related to hemodialysis and ckd management.
Typology: Exams
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List the four transport mechanisms that play a role in hemodialysis - VERIFIED ANSWER✔✔- Ultrafiltration Convection Diffusion Osmosis Explain ultrafiltration in hemodialysis - VERIFIED ANSWER✔✔-Fluid is pushed through the semipermeable membrane (SPM). Think: wringing out a wet rag. Explain convection in hemodialysis - VERIFIED ANSWER✔✔-Solutes DRAG across the semipermeable membrane with fluid Explain diffusion in hemodialysis - VERIFIED ANSWER✔✔-PARTICLES move from HIGH concentration to LOW concentration Explain osmosis in hemodialysis - VERIFIED ANSWER✔✔-FLUID moves LOW concentration to HIGH concentration What are the kidneys' excretory functions? - VERIFIED ANSWER✔✔-To normalize electrolytes, remove wastes, provide fluid and nutrient balance How do we replace normal excretory kidney functions? - VERIFIED ANSWER✔✔-By using acid concentrate to help normalize electrolytes and ultrafiltration to provide fluid balance What is the function of acid concentrate - VERIFIED ANSWER✔✔-Provides the concentration gradient for diffusion and helps normalize electrolytes
What is the function of bicarbonate in the dialysate solution? - VERIFIED ANSWER✔✔-It buffers the acid concentrate What is the function of bicarbonate when it diffuses into the patient's blood? - VERIFIED ANSWER✔✔-It normalizes body pH What are some S/Sx of hyperkalemia? - VERIFIED ANSWER✔✔-K+ > 6.5 mEq extreme muscle weakness, dysrhythmias, and possible cardiac arrest What are some S/Sx of hypokalemia? - VERIFIED ANSWER✔✔-K+ < 3.5 mEq fatigue, muscle weakness, paralysis, resp. failure, cardiac instability, arrhythmias, cardiac arrest What is the normal blood pH range? - VERIFIED ANSWER✔✔-7.35 - 7. What are the kidneys' endocrine functions? - VERIFIED ANSWER✔✔-Renin secretion Erythropoietin secretion Vitamin d activation How do we replace normal endocrine kidney functions? - VERIFIED ANSWER✔✔-By providing medications How much of normal kidney function is replaced by HD? - VERIFIED ANSWER✔✔-15% What is uremia? - VERIFIED ANSWER✔✔-Uremia is a buildup of wastes in the blood due to kidney failure What does uremia affect? - VERIFIED ANSWER✔✔-Uremia affects all body systems What are the most common causes of CKD in the US? - VERIFIED ANSWER✔✔-diabetes, HTN and polycystic kidney disease
List the treatment goals for a pt. w/ CKD - VERIFIED ANSWER✔✔--slowing the progression of CKD -managing comorbidities and complications -controlling symptoms -minimizing the effects if CKD on pt. lifestyles -kidney replacement therapy modality education -encouraging patients to actively participate in their healthcare Why is it so important to know what caused your pt.'s CKD? - VERIFIED ANSWER✔✔-So the RN and PCT can ask about possible problems during data collection and assessment List some S/Sx of fluid imbalance - VERIFIED ANSWER✔✔-HTN, edema, and SOB Why is sodium balance important? - VERIFIED ANSWER✔✔-Leads to volume expansion, increased cardiac output, increased peripheral vascular resistance and increased BP List some systemic effects of CKD - VERIFIED ANSWER✔✔--Dry, itchy skin -Peripheral neuropathy in the extremities -GI problems (N/V) -Psychological problems (anxiety, depression) What would you advise for a pt. with dry, itchy skin? - VERIFIED ANSWER✔✔--use hyper-fatted soaps and lotions -assess for safety at home -provide emotional support -control diabetes and phosphorus
What would you advise for a pt. with peripheral neuropathy? - VERIFIED ANSWER✔✔--Monitor pt. for changes in motor function, decreased strength in legs, C/O restless legs, and burning feet. -Advise not to walk barefoot -Practice good foot care What would you advise for a pt. with GI problems? - VERIFIED ANSWER✔✔--inform RN and MD of any bleeding problems, constipation, diarrhea
What are secondary causes of anemia in dialysis patients? - VERIFIED ANSWER✔✔--Inadequate iron stores, -inadequate dialysis, -malnutrition, -blood loss during Tx How can you prevent contributing to lower hemoglobin and blood loss in dialysis patients? - VERIFIED ANSWER✔✔--Verify epogen dose is correct and administered -Rinse back until venous line is pink tinged -Avoid repeat lab draws What are the four key elements contributing to CKD-Mineral Bone Disorder (MBD) - VERIFIED ANSWER✔✔--Calcium -Phosphorus -PTH -Vitamin D (calcitriol) can all lead to CKD-MBD when abnormal What are the S/Sx of CKD-MBD in addition to bone disease? - VERIFIED ANSWER✔✔--Soft tissue calcification -Itching -Muscle weakness -Pathological fractures -Tendon ruptures -Compression of vertebrae -Atherosclerosis -Heart disease
What is your role in CKD-MBD management? - VERIFIED ANSWER✔✔--report symptoms, -urge patients to take meds (home & treatment) -report noncompliance problems related to nonadherence Define AKI - VERIFIED ANSWER✔✔--Wide spectrum of kidney issues -Includes acute renal failure & renal function changes -May dialyze in an out-patient facility until kidney function recovers Give 3 examples of prerenal causes of AKI - VERIFIED ANSWER✔✔-Obstruction, volume depletion and impaired cardiac function Give 3 examples of intrarenal causes of AKI - VERIFIED ANSWER✔✔-Ischemic ATN, sepsis, SIRS, septic shock, anaphylaxis drugs, goodpasture syndrome, acute glomerulonephritis, trauma, open heart surgery Give 3 examples of postrenal causes of AKI - VERIFIED ANSWER✔✔-Obstruction, oliguria, bladder rupture and pregnancy Explain the difference between AKI and CKD - VERIFIED ANSWER✔✔-Eliminating the cause of the AKI can often lead to the return of kidney function. You cannot eliminate the cause of CKD which is HTN, Diabetes, genetic disorders (PKD) In the outpatient facility, how do you help in restoring kidney function? - VERIFIED ANSWER✔✔-Find the cause of the AKI In the outpatient facility, what do you need to consider in regards to pt. vasc. access? - VERIFIED ANSWER✔✔-Patients will typically have a dialysis catheter- be careful to avoid catheter related infections How do you protect kidneys from further injury? - VERIFIED ANSWER✔✔-Avoid substances to the kidney which may be toxic (radiographic contrast, amphotericin B, low dose aspirin, NSAIDS)
What is important when monitoring weight and BP? - VERIFIED ANSWER✔✔-Keep a little extra fluid on them so it is available to the kidneys when they start filtering/ultra-filtrating on their own AKI patients are at increased risk for which complications? - VERIFIED ANSWER✔✔-Hypovolemia and hypotension What makes dialysis patients more susceptible to HAIs? - VERIFIED ANSWER✔✔-They are immunosuppressed and more vulnerable to infection, which leads to the 2nd most common cause of death in this population Why are dialysis patients at increased risk for acquiring a HAI at the facility? - VERIFIED ANSWER✔✔-The dialysis procedure itself requires prolonged access to the patient's blood, especially those involving CVC vascular accesses, making them more at risk What is the most common transmission route for HAIs - VERIFIED ANSWER✔✔-Contact What is the most important intervention you can do to to prevent HAIs - VERIFIED ANSWER✔✔-Hand hygiene What is the most common infectious complication in hemodialysis patients? - VERIFIED ANSWER✔✔- Vascular access infection What is the most common cause of bacterial infections in dialysis patients? - VERIFIED ANSWER✔✔-• The use of catheters for hemodialysis treatments What germ causes the most common infections in hemodialysis patients? - VERIFIED ANSWER✔✔- Methicillin-resistant Staphylococcus aureus (MRSA) - Must pay attention to infection control! Proper hand hygiene, cleaning & disinfecting procedures to prevent spread of infection (viable on surfaces for days) Why is wearing gloves so important? - VERIFIED ANSWER✔✔-It reduces the risk of hand contamination and prevents the transfer of organisms already on hands
Why do you need to perform hand hygiene before and after wearing gloves? - VERIFIED ANSWER✔✔- Gloves are not impervious and have microscopic pores Explain the acceptable hand hygiene technique when caring for a patient with active C-diff - VERIFIED ANSWER✔✔-Handwashing with soap and water per policy is the only acceptable hand hygiene What is the difference between OSHA and CMS infection control requirements? - VERIFIED ANSWER✔✔-OSHA: Requires employers to provide workers with a safe workplace CMS: Concerned with patient care and patient safety What are V-tags and why are they important? - VERIFIED ANSWER✔✔-They state specific regulations to be met within a condition such as infection control, providing interpretive guidance for each regulation and citing deficiencies by tag # Is a cleaned dialysis machine considered a'clean' area? - VERIFIED ANSWER✔✔-No When should sharps containers be removed from the treatment floor? - VERIFIED ANSWER✔✔-When they are ¾ full State the 3 strategies recommended by KDOQI to decrease the risk of infection when working with a CVC - VERIFIED ANSWER✔✔-• Using facemasks when lumens or exit site is exposed
What do surveyors use to verify infection control training and education has been completed for teammates? - VERIFIED ANSWER✔✔-Documentation of infection control training in the teammate's file or transcript Explain the HBV classification and state which test is performed monthly on HBV susceptible patients - VERIFIED ANSWER✔✔-• HBsAg: Hepatitis B surface Antigen - tested monthly for susceptible pts and non-responders
What is "strikethrough" of an external pressure transducer and why is it of concern? - VERIFIED ANSWER✔✔-It is when fluid could have entered the machine and contaminated the internal pressure transducer protector providing a reservoir for microorganisms and causing subsequent patient blood infections Why is it important for patient care teammates to know when the water treatment system disinfection was performed? - VERIFIED ANSWER✔✔-Because the end-to-end disinfection process will also introduce the disinfectant solution to the dialysis delivery systems through their water inlet lines What are the key concepts related to "Reasonable & Prudent" Care? - VERIFIED ANSWER✔✔-• The Standard of Care is care which a reasonable and prudent nephrology nurse would give under the same or similar circumstances.
What are the four reasons why we document in the medical record? - VERIFIED ANSWER✔✔-• Proof care was rendered
o Heart rate and rhythm o Respiration rate, rhythm, recognizing unusual breath sounds o Machine parameters, safety checks What is the role of the licensed nurse prior to treatment initiation? - VERIFIED ANSWER✔✔-Assess abnormal findings from data collection, determine appropriate interventions (based on physician orders) and contact physician if needed When is a pre-treatment assessment by the licensed nurse required? - VERIFIED ANSWER✔✔-• For a CKD hemodialysis patient: Based on State law (may be before tx initiation or within an hour of tx initiation) or if data collection has abnormal findings
o Blood pressure o Heart rate o Temperature o Respiratory rate o Weight What are possible consequences of poor or incomplete documentation? - VERIFIED ANSWER✔✔-Entries may be discarded if unable to be read, can be left open to interpretation or attack on your care What policy should you refer to to document late entries - VERIFIED ANSWER✔✔-From Policy 3-02-02: Medical Record Preparation and Charting Guidance How do you document late entries - VERIFIED ANSWER✔✔-If unable to chart immediately after rendering a service or at the time of an observation, the teammate is to make the appropriate entry as soon as possible How do you document late electronic entries - VERIFIED ANSWER✔✔-If documenting within the electronic medical record, the notation will automatically contain your electronic signature, date and time How do you document late paper chart entries - VERIFIED ANSWER✔✔-o The late entry must be signed by the person making the late entry o The late entry must be timed and dated at the time it is entered
. How do you document charting errors? - VERIFIED ANSWER✔✔-When documenting on paper draw a single line through the entry, date/ signature/ teammate credentials, chart the correct information. If documenting in an electronic health record system follow facility procedure for that system. What is the preferred location for taking an accurate blood pressure? - VERIFIED ANSWER✔✔-Upper, non-vascular access arm
What BP reading error can be caused by a cuff that's too small - VERIFIED ANSWER✔✔-Reading may be higher than actual BP What BP reading error can be caused by a cuff that's too big - VERIFIED ANSWER✔✔-Reading may be lower than actual BP What is a normal pre-treatment blood pressure? - VERIFIED ANSWER✔✔-Systolic equal to or less than 180 mm/Hg or equal to or greater than 90 mm/Hg and diastolic less than 100 mm/Hg What is the normal heart rate range? - VERIFIED ANSWER✔✔-60-100 bpm What is the normal respiratory range? - VERIFIED ANSWER✔✔-12-16 breaths/minute What is a normal temperature? - VERIFIED ANSWER✔✔-Less than 100˚ Fahrenheit or 37.8˚ Celsius or less than 2˚F (1˚C) of baseline (pre-treatment temperature reading) The three words DaVita uses in order to easily recall the pre-treatment AVF/AVG access evaluation are: - VERIFIED ANSWER✔✔-'Look, Listen, Feel' When is post-treatment assessment by the licensed nurse required? - VERIFIED ANSWER✔✔-• If required by state law
What are the 3 things you should not include in a REM? - VERIFIED ANSWER✔✔-• Personal opinions
Describe the teammate's cannulation level: beginner - VERIFIED ANSWER✔✔-Less than 6 months experience or less than 10 successful cannulations. Describe the teammate's cannulation level: intermediate - VERIFIED ANSWER✔✔-6 months experience cannulation of AVF & 10 successful cannulations Describe the teammate's cannulation level: advanced - VERIFIED ANSWER✔✔-Has completed all the competencies for NFACT training, expert cannulation skills documented and can determine if rule of 6's have been met What is the difference between a tunneled and a non-tunneled CVC? - VERIFIED ANSWER✔✔-• Tunneled CVC has a cuff that the skin grows to for anchoring to the patient - it is kept in place longer. Sutures used at placement- but can be removed after site healed.
Definition of established AVF - VERIFIED ANSWER✔✔-Prescribed BFR and max needle size for 2 months Recommended needle gauge and max BFR for new AVF initial cannulation - VERIFIED ANSWER✔✔- 17 gauge & BFR not to exceed 250 ml/min Needle gauge and suggested BFR - VERIFIED ANSWER✔✔-17: 200- ml/min
Distance from anastomosis: - VERIFIED ANSWER✔✔-1.5 inches Distance between needle tips: - VERIFIED ANSWER✔✔-1.5 inches Needle Removal - VERIFIED ANSWER✔✔-• Angle: same angle as insertion (also follow manufacturer recommendations)
When not to refrigerate - VERIFIED ANSWER✔✔-Culturettes/swabs/ occult stool - follow directions Training requirements for shipping - VERIFIED ANSWER✔✔-IATA What is the goal for Single Pool (spKt/V) for 3x/week frequency of dialysis treatments? - VERIFIED ANSWER✔✔-Greater than or equal to 1. What is 'K' in Kt/V? - VERIFIED ANSWER✔✔-Clearance of urea What treatment factors decrease K? - VERIFIED ANSWER✔✔--Inadequate coagulation, -decreased BFR, -poor priming, -not following P&P, -patient not staying on tx as prescribed What treatment factors increase K? - VERIFIED ANSWER✔✔--Increased BFR, -correct DFR, -correct dialyzer, -correct target weight -amputation factor What is the goal for the urea reduction ratio (URR) lab result? - VERIFIED ANSWER✔✔-Greater than or equal to 65% What is 't' in Kt/V? - VERIFIED ANSWER✔✔-Time of dialysis session What factors influence 't'? - VERIFIED ANSWER✔✔--Running prescribed tx time, -follow physician orders- encourage pt. to run entire tx. Getting off early will impact time (missing tx also impact tx time).
What is 'V' in Kt/V? - VERIFIED ANSWER✔✔-Volume of urea distribution/volume of pts body water in which urea is distributed What factors influence 'V'? - VERIFIED ANSWER✔✔--Amputation, -height, -sex, -age, -and type of access (less efficient access reduces the volume process of a patient's blood) Procedure for Post BUN lab draw - VERIFIED ANSWER✔✔-• Turn off UFR or decrease it to 50 ml/hr
A sudden decrease in blood pressure can be an indication that the patient is losing intravascular fluid too quickly, this can be seen with a change in blood pressure equal to or greater than: - VERIFIED ANSWER✔✔-20 mmHg What are the four meds PCTs can administer per DaVita P&P? - VERIFIED ANSWER✔✔-• Normal Saline
Aluminum in water used for dialysis causes - VERIFIED ANSWER✔✔-• Anemia • Bone disease • Nausea • Vomiting Chlorine in water used for hemodialysis causes - VERIFIED ANSWER✔✔-Hemolysis Excess calcium and sodium in water used for dialysis causes - VERIFIED ANSWER✔✔-Hypertension Excess calcium and magnesium in water used for dialysis causes - VERIFIED ANSWER✔✔-Muscle Weakness What does the RO remove? - VERIFIED ANSWER✔✔-Organic and inorganic materials, bacteria and endotoxins What are two concerns with using DI Tanks? - VERIFIED ANSWER✔✔-• Exhaust quickly
Dialysate endotoxin testing results - VERIFIED ANSWER✔✔-• Acceptable level: <0.25 EU/ml