Download Fresenius Exam Prep: Kidney Function & Dialysis and more Exams Nursing in PDF only on Docsity!
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What are the functions of a healthy kidney? Answer- REGULATE, SYNTHESIS, ENDOCRINE: Regulate fluid balance, blood volume, electrolytes, acid-base balance, synthesize calcitrol (active vitamin D), secrete erythropoietin and release renin what is the glomerular filtration rate in the five stages of kidney disease? Answer- flow rate of filtered fluid through the kidney stage 1: 90+ stage 2:60- 89 stage 3: 30- 59 stage 4: 15- 29 stage 5: < what are the types and stages of kidney failure? Answer- acute renal failure: sudden onset, severe, usually reversible. can be caused by drug toxicity, dehydration, or motor vehicle accident Chronic renal failure: slow onset, progressive, permanent. can be caused by diabetes, hypertension, or genetic disease such as glomerulonephritis or nephrosclerosis what are the signs and symptoms of renal failure or uremia? Answer- elevated serum levels of BUN/Creatinine, phosphorus, potassium. anemia, nerve damage, yellow-gray appearance of skin, fluid overload, dyspnea, edema, hypertension, proteinuria, uremia, lethargy, weakness, headache, itching, fatigue, nausea restlessness, mental change, loss of appetite. what is anemia and how is it treated? Answer- lack of RBC (decreased or lack of erythropoietin production). iron binds with hemoglobin in RBC and transports oxygen. it is treated using erythropoieting stimulating agents and usually administered IV. which of the functions of healthy kidneys are replaced by dialysis? Answer- removal of waste products and regulation of fluid balance. dialysis does not regulate endocrine production
list briefly and describe three modalities of treatment for end stage renal disease Answer- Hemodialysis: uses vascular access to draw blood from patient and send to dialyzer and into semipermeable membrane where diffusion removes waste products and ultrafiltration removes fluid. provides approximately 15% of the normal function of the kidney. peritoneal dialysis: continuous cycling peritoneal dialysis and continuous ambulatory peritoneal dialysis. both types use permanent catheter in highly vascularized peritoneal cavity. dialysate is infused into peritoneal space and allowed to dwell and then drained. excess fluid and waste is removed through osmosis and diffusion what is the difference between hemodialysis and peritoneal dialyisis? Answer- Hemo: outpatient, dialyzer is used to remove waste from blood via diffusion and fluid is removed through ultra filtration. peritoneal: home setting, peritoneal membrane is the semipermeable membrane that filters waste and fluid removal occurs via osmotic pressure and concentration gradients caused by the dextrose solution and dwell times. when is it known that a patient has developed sensitivity to a dialyzer? Answer- seen within the first half hour of treatment. sneezing, itching, pain at access site, chest pain, rashing, hives, fever are symptoms. alarm conditions Answer- Blood: blood leak, air detector, venous/arterial pressure, TMP. stops the blood pump therefor blood is not cleaned and no ultrafiltration. potential for clotting due to stagnant blood Dialysate: conductivity high/low, temperature. dialysate goes into bypass so no cleaning of blood. uf continues. what are the body fluid compartments? Answer- 50-70% of body is water. intracellular, extracellular, intravascular, interstitial. what is diffusion Answer- movement of solutes across semipermeable membrane from high concentration to low concentration. solutes include urea, electrolytes, creatinine, drugs what is osmosis? Answer- movement of fluid from lower concentration of solutes to a higher concentration. what is ultrafiltration? Answer- use of both negative and positive pressure to pull excess fluid from the patient why is water used for dialysis treated? Answer- water contains contaminants, electrolytes, and impurities. these must be removed bc the patients are exposed to large volumes of water during tx what is chloramine and how is it different from chlorine Answer- combination of chlorine and ammonia what is the diasafe filter? Answer- found on back of hemodialysis machine that allows for the delivery of ultrapure dialysate.
(K), calcium (Ca), magnesium (Mg), and chloride (Cl)
4 ways dialysate is checked to ensure safety Answer- ph, conductivity, machine temp, negative residual chlorine after machine disinfection and before first treatment after disinfection how is dialysis delivered? Answer- The Hemodialysis Machine. two sub sections: blood delivery system (circulates pt blood) and dialysate delivery system (mixes and circulates dialysate) when are bloodlines replaced? Answer- when contaminated (dropped on floor or placed in prime bucket with open ends), clotted (line or drip chamber), or found defective what causes increased arterial and venous presssures? Answer- kinks, bfr exceeds vascular access flow, incorrect needle gauge size compared to bfr, needle placement, clotting stenosis, vasoconstriction of vasospasms, malposition of catheter tip, hypotension, poor cardiac output (increased blood viscosity due to high hgb or ultrafiltration) how do you test for a small blood leak? Answer- dipping test strip into dialysate obtained from outflow (arterial/red). test strip will change color if positive for blood. do not return blood if test is positive or if ther are visible signs of blood in dialysate. how is a large/major blood leak treated? Answer- dialysate will apear bloody or blood tinged. do not return blood. what are the two most commonly changed electrolytes in dialysate/ Answer- potassium and calcium- makes changes based on pt's current monthly lab results steps for treating an infiltrated access Answer- 1. establish that infiltration has occurred
- sto pdialysis turn off blood pump, clamp bloodlines.
- notify rn
- disconnect bloodlines from fistula lines and recirculate blood. flush non-infiltrated needle with normal saline
- if infiltration occurred after heparin administration: cap end of needle and secure (to be removed at end of tx). apply ice
- if fistula is infiltrated, rest fistula for one treatment when ordered by nephrologist. next cannulation should be above infiltrate
- instruct pt to apply ice for 24 hours and watch for complications such as (pain, reoccurrance of bleeding, elevated temp, additional swelling, absence of a thrill) 8. when should conductivity and ph of dialysate be checked? Answer- prior to initiation of every tx, before hanson connectors are attached to dialyzer how is weight gain, available weight, target weight and ml/kg/hr calculated? Answer- Today weight-EDW=ADW ADW+0.5kg=UF goal UF Goal/EDW/Time= ml/kg/hr (this value must be less than 13 to initiate tx
what evaluation is performed on the vascular access pretreatment Answer- look- color, clean incisions, dry and intact, no sx of infection, prior cannulation sites healing listen= audible whoosh heard same throughout access. low pitched and louder on arterial side feel= feel for a thrill (vibration or buzz throughout length of access), pulse, and consistent temp when admitting anew pt what is performed before taking a blood pressure reading? Answer- both arms are xamined to evaluate for the prsence of a vascular access in what direction are fistula needles placed? Answer- venous always go with flow of blood, arterial can be in either direction what is needle flipping? Answer- prior to back eyes, needles were flipped to prevent needle from lodging against side of vessel. flipping has been found to damage intimal lining of vessel and is no longer recommended from what compartment is fluid removed? Answer- fluid wastes and electrolytes are evenly distributed between intravascular, interstitial, and intercellular spaces. during dialysis, fluid is only removed from intravascular space. as wastes/electrolytes are pulled from intravascular space, these move from interstitial space into the intravascular space to promote homeostasis. if uf rate is higher than pt's ability to refill intravascular space, then pt becomes intravascularly dehydrated and will experience complications needle gauge size and corresponding bfr Answer- <300= 17 300-350=
350-450= 450= access flow goals Answer- fistula: 400 graft: > what is adequacy of dialysis? Answer- Measurement of how well we are cleaning waste from the patients blood what can negatively impact adequacy? Answer- inadequate heparin, access recirculation, shortened tx time, air in dialyzer, improper priming, lower than ordered bfr, incorrect dialyzer size, lower than ordered dialysate flow rate how can we measure how well we clean our pt's blood Answer- blood urea nitrogen levels is measured to calculate the adequacy of a tx. by measuring the amount of wastes in the pt's blood before and after dialysis, the clearance can be calculated. what four items impact clearance (adequacy of tx) Answer- tx time, bfr, dfr, dialyzer size (surface area). dialyzer size has most impact on dialyzer clearance how is clearance best described? Answer- amount of urea cleared from
blood in milliliters per minute. this is a measurement of dialyzer effectiveness
how many kecn tests can be programmmed into olc? Answer- 3-6 tests, if tx is 3-4 hours 6 tests should be programmed
what does a steady decline in kecn test results signify? Answer- dialyzer clearance of waste from blood is decreasing, could be from inadequate heparinization, clotted dialyzer fibers. decrease in kecn can also be from obstructed arterial flow when is the machine temperature checked? Answer- when conductivity and temp are stable, document before tx is started what items are considered when administering medications to renal failure pts? Answer- kidneys are major route of excretion for drugs/ metabolites. caution must be used bc loss of renal function will decrease elimination of medications and could potentially cause toxicity, increased potency/duration of drug's effects, and increased frequency of side effects. can medications be pre-drawn? Answer- up to 4 hours prior to administration. must be labeled and kept under preparer's control or locked in designated medication storage area or refrigerated if necessary what if the patient doesn't come for treatment and the medications were pre drawn? Answer- could be relabeled and administered to another pt if it has not left the medication preparation area and the dose matches physician's order what lab is evaluated to determine adequacy of tx? Answer- blood urea nitrogen levels are evaluated to determine adequacy of tx what is the procedure for drawing post tx lab work (post bun)? Answer-
- turn off UF (turn off dialysate flow and bfr is decreased to 100 for 15 seconds)
- stop blood pump
- clamp arterial and venous needle lines
- clean arterial port with alcohol wipe and collect sample
- invert sample 5-10 times
- turn dialysate flow on
- open clamps on needle lines
- return blood per termination procedure what complications require rn involvement and assessment? Answer- all findings outside normal and expected pt evaluation findings are reported to rn. rn is responsible for assessment, nursing intervention, and implementing emergency responses. what is bradycardia and whom is it reported? Answer- pulse less than 60 bpm. is concidered severe when 50 bpm or less. all episodes of bradycardia must be reported to rn why do some pts become hypoglycemic and what are the signs and symptoms? Answer- some glucose is removed during tx and pt may experience sx of hypoglycemia (faitness, double vision, irritability, hunger) what can lead to hemolysis? Answer- hypotonic solution, chlorine/chloramine breakthrough, high temp, kinks in bloodlines
Parathyroid senses low bp (from no renin) so excretes PTH to signal calcium excretion from bone marrow what is estimated dry weight? Answer- weight of the pt if all excess fluid is removed and bp is normotensive. the leading cause of death in esrd pt is related to cardiac function and fluid. excess and removal plays a vital role in cardiac function what is the difference between available weight and target weight? Answer- aw is available fluid weight that needs to be removed from pt during today's tx. aw is calculated by substracting edw from pretreatment weight target weight is the weight loss plan including aw, priming/rinseback, and any fluid pt will receive during treatment to ensure pt safety and prevent hemolysis or crenation, the final dialysate is checked to verify that the dialysate is compatible with the human biochemistry. the following components are checked Answer- ph, conductivity, temp what are the details about checking ph and conductivity? Answer- when: prior to all tx initiated or anytime concentrates are changed. should be completed before the hanson connectors are attached to the dialyzer. why: to validate machine settings are correct expected result: ph range 6.9-7.6, conductivity range +-0. what are the details about checking residual bleach post machine disinfection? Answer- when: prior to each shift of pt treatments why: to ensure no bleach remains in fluid pathway how: using residual test strips according to manufacturer's instructions for use what are the details about checking total chlorine routine testing? Answer- when: prior to each shift of pt treatments and not to exceed 4 hours where: post gac tank # why: to ensure chlorine and chloramine levels are within aami standards how: sample collected after water system has run for 15 min. rpc test strip swished in sample for 60 seconds, strips conpared to color chart on container. results less than .10 is safe for treatment, if higher, breakthrough testing initiated. what are the details about checking total chlorine breakthrough Answer- when: every 2 hours when total chlorine levels equal 0.10 or higher post gac tank #1 where: post gac # why: ensure total chlorine levels remain less than 0. if result less than 0.10 it is safe to continue, if 0.10 or higher, immediately notify rn and sto treatments to avoid accidental pt exposure what are dialysis precautions? Answer- set of standard infection control practices that are used in all situations in the dialysis setting when caring
for dialysis pts or performing related activities. dialysis precautions have been shown to reduce infectious disease transmission and are recommended by cdc
hep e: oral and fecal route, from fecal contaminated food or water sources (uncommon in dialysis patients) hep b dialysis requirements Answer- isolation room, dedicated equipment and supplies, door closed during activities that could cause spurting of blood, all equipment remains in isolation room (stethoscope and bp cuff). patients surrounding isolation room must have immunity to create buffer zone what blood test indicates infection with hep b? Answer- HbsAg test for Hep B antigen, indicates actual viral presence, infection with hep b, requires pt isolation and implementation of buffer zone what blood test indicates presence of immunit against hep b? Answer- anti-hbs and anti hbc required to reflect susceptibility/ immunity status. if greater than 10mlU/mL, pt is immune. positive anti hbc coupled with anti hbs greater than or equal to 10 indicates person previously and hbv and immune system fought against virus and person is no longer infections (lifelong immunity). negative hbc with hbs 10 or hgiher reflect immunity gained through vaccination. these individuals must have titers checked annually to ensure levels remain immune. which vaccine provides long-term immunity to hep b? Answer- series of multiple injects from recombivax or engerix b. these vaccines stimulate immune system to produce hep b antibodies, helping to protect against getting hep b virus. what actions are necessary when a patient is suspected of having active tb? Answer- have patient don mask and call physician how is tb prevented in dialysis clinic? Answer- pt who have active pulmonary or laryngeal tb cannot dialyze in the clinic. pt must have 3 consecutive negative sputum cultures before returning to clinic for dialysis. ppd testing and chest x ray performed. active tb is airborne is considered contagious. tb that is contained does not have to be treated as active (tb of bone or organ) how is tuberculosis spread? Answer- tb is caused from tuberculosis bacteria, which is spread by droplet nuclei produced from infected individuals when they cough, sneeze, sing, or speak. positive tuberculin skin test or exposure to tuberculosis Answer- patients with active tb are contagious. latent tuberculosis is not contagious but can become active without tx tuberculosis signs and symptoms Answer- night sweats, productive persistent cough, unexplained weight loss, chills, fever, blood tinged sputum. what is documented if the pt is stable and resting Answer- pt status, changes in vs, security of connections, and no unusual findings were observed Why is QAI so important? Answer- Improve pt outcomes is required by
Federal regulations. Identify problems, create plans to correct, improve care, and to review
air (expansion/bladder) tank Answer- assists in maintaining minimum water pressure
chemical feed pumps Answer- adjusts the ph of water sediment/multimedia filter Answer- removes larger particles from the incoming water (10 microns or larger) carbon tank Answer- removes chlorine, chloramines, and other organic material through adsorption (adhesion of molecules/ions from liquid gas or dissolved solid onto a surface) EBCT Answer- empty bed contact time, length of time that the water is exposed to carbon AAMI requires 10 min, FKC requires 12 min water softener Answer- removes calcium and magnesium through process of ion exchange RO product water exits the RO and meets AAMI standards for water to be used for dialysis Answer- performance measured by % rejection, membranes must be replaced at 80% rejection. membrane must be replaced bc ability to remove dissolved solids is too low. TDS (total disolved solids) is measured and documented daily. water exceeding he TDS alarm limit is diverted to the drain ultrafilters Answer- remove bacteria and endotoxin and are located after the RO machine "final step" UV Light Answer- form of invisible radiation, kills bacteria Product water divert valvue Answer- sends water to drain when it exceeds the tms alarm limit deionization tanks Answer- method of water treatment used during RO failure and are part of the "alternate water supply plan" total chlorine testing Answer- 1. RO machine runs 15 minutes before performing any total chlorine testing
- must be performed and documented by 2 qualified staff members (one pct and one nurse)
- 100 ml is the correct amount of water to collect (must rinse sample container 3 times)
- RPC ultra low total chlorine test strips are immersed in sample for 60 seconds
- total chlorine tested prior to initiation of tx and at least every 4 hours
- rpc ultra low chlorine test strips are used to test for total chlorine in water after carbon tank and post ro
- safe range is 0.00-0.09 ppm
- documentation in tms
- first total chlorine sample should be taken from post carbon tank (worker), second sample taken post RO
