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A comprehensive set of questions and answers related to kidney function, dialysis, and related medical procedures. It covers topics such as the anatomy and physiology of the urinary system, the stages of kidney disease, the different types of dialysis, and the complications associated with dialysis. Suitable for healthcare professionals, particularly those working in dialysis units, as it provides a valuable resource for understanding the basics of kidney function and dialysis.
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The urinary system is made up of? - answer - kidneys, 2 ureters, a bladder, and a urethra What is a nephron? - answer -Functional units of the kidney What is the nephron composed of? - answer - Glomerulus, Bowman's capsule, and tubules What are the 7 functions of a kidney? - answer -Acid/Base balance Water balance Electrolyte balance
Toxin removal Blood pressure regulation Erythropoietin production Vitamin D metabolism What are the functions of a healthy kidney? - answer -Remove waste Regulates fluid balance, blood volume, electrolytes and acid base balance, synthesize calcitriol Secrete erythropoietin - stimulates bone marrow to make RBCs Release renin - increases bp What is GFR in the 5 stages of kidney disease? - answer -Stage 1 - Normal function 90+ Stage 2 - Mild reduced 60- Stage 3 - Moderately reduced 30- Stage 4 - Severely reduced 15-
Hemodialysis - usually outpatient setting, can be done at home Peritoneal dialysis - done in the patients home When is it known that a patient has developed sensitivity to a dialyzer? - answer - Patients develop mild to severe reactions in some cases, usually seen the first half hour of treatment. Sneezing, itching, pain at the access site, chest pain, rashing, hives, fever. What are the body fluid compartments? - answer -Intracellular - inside the cells Extracellular - outside the cells Intravascular
Osmosis - answer -lower to higher concentration Ultrafiltration - answer -Uses both negative and positive pressure to remove excess fluid Why is water used for dialysis treatment? - answer -Water contains contaminants, electrolytes, and impurities. Patients are exposed to large volumes of water during dialysis treatment, removed to protect patient What is chloramine and how is it different from chlorine? - answer -Chloramine - bleach and ammonia Chlorine - bleach What is the diasafe filter? - answer -Found on back of hemodialysis machine that allows for the delivery of ultrapure dialysate.
What happens when the dialysate flow is turned off during the treatment? - answer - Blood is not cleaned and adequacy will decrease. What are the compartments of the dialyzer and what separates them? - answer -Blood compartment separated by a semi-permeable membrane. What is a semi-permeable membrane? - answer -Membrane made from protein, with small pores and holes. RBCs and proteins are too large to pass. Urea, sodium, potassium, and water can pass. What is a countercurrent flow? - answer - Blood and dialysate that flow in opposite directions.
What are three types of solutions? - answer - Hypotonic - containing less particles Isotonic - containing equal parts Hypertonic - containing more particles What is pH? - answer -pH less than 7 - acidic pH greater than 7 - alkaline PH equal to 7 - equal normal blood pH is 7.35-7. What is conductivity? - answer -Ability of a solution to transmit or "conduct" an electrical current. Used to calculate the electrolyte concentration. Safe range - 0.5 +/- 13.5-14.5 mEq/L What is dialysate? - answer -Non-sterile solution, removes waste products from the blood and balance electrolytes.
Negative residual chlorine after machine disinfection How is dialysis delivered? - answer - Hemodialysis machine When are bloodlines replaced? - answer - When contaminated, when clotted, when defective All machines must pass which two tests before each patients treatment? - answer - Alarm safety and pressure holding tests What categories of alarms are monitored during the treatment? - answer -Blood leak Air detector Venous pressure Arterial pressure TMP Blood pressure
Conductivity What causes arterial pressure alarms? - answer -Kinks or clamp in lines BFR exceed vascular access flow Needle gauge size Needle placement Clotting, stenosis, vasoconstriction, or vasospasms Malposition of catheter tip, constricting sutures at insertion site or CVC thrombosis Hypotensive Poor cardiac output Increased blood viscosity due to high Hgb or ultrafiltration What causes venous pressure alarms? - answer -Kinks or clamps in line Infiltration or poor needle placement
When should conductivity and pH of dialysate be checked? - answer -Prior to initiation of every treatment using a phoenix meter How is weight gain, available weight, target weight, and mL/kg/hr calculated? - answer - dry weight x tx time x EDW Air embolism - COLT - answer -Clamp venous line Off with the blood pump Left side positioning Trendelenburg Four things you can teach a patient to prevent their access from clotting? - answer - Avoid tight fitting clothing or jewelry on access arm Avoid sleeping on access arm Avoid lab draws or blood pressures checks on access arm
Avoid carry heavy objects with their access arm Remember to engage the needle safety device while removing a needle from the access. - answer - What evaluation is performed on the vascular access pretreatment? - answer -Look, listen, and feel When admitting a new patient what is performed before taking a blood pressure reading? - answer -Both arms are examined to evaluate for the presence of a vascular In what direction are fistula needles placed? - answer -Venous needles always go with the flow of blood Arterial needles can be placed in either direction
Cannulate above venous needle infiltration, stop pump, follow guidelines for needle gauge and pump speed with new AVFs Treat with intermittent ice x 24hrs Prolonged bleeding S/S - answer -Bleeding continues 20 minutes post needle removal Notify physician, stenosis, arrange for imaging Monitor access daily and report changes in thrill to staff What is needle flipping? - answer -Found to damage the intimal lining of the vessel and is no longer a recommended practice. From what compartment is fluid removed? - answer -Intravascular space
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 the dialyzer Improper priming Lower than ordered BFR Incorrect dialyzer size Lower than ordered DFR What patient education is provided when a patient requests early termination of tx? - answer -To prevent medical complications How can we measure how well we clean our patients' blood? - answer -BUN
Why is the extracorporeal circuit primed with normal saline? - answer -Is to purge the system of any sterilant or particulate matter from the manufacturer and air that is in the system Priming at the rate of 150mL/min How much saline should be infused through the E-beam dialyzer and the extracorporeal circuit? - answer -Approximately 300mLs to prime the dialyzer and circuit, normal fresh fill uses 50mLs through the arterial line, and 250mLs through the venous line At what point during the priming process should the Hanson connectors be connected to the dialyzer? - answer -After the dialyzer and lines have been filled with saline
At what blood pump speed is the extracorporeal circuit primed? - answer - 150mL/min What position should the dialyzer be during circulation? - answer -Venous end straight up How is the E-beam dialyzer circulated? - answer -Turn BFR to 300-400mL/min, DFR to
