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Mod 1 Flashcards

1
Q

Ultrafiltration

A

Fluid pushed through the semi permeable membrane

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2
Q

Convection

A

Solutes dragged across semipermeable membrane along with fluid

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3
Q

Diffusion

A

Particles move from area of high concentration to low concentration

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4
Q

Osmosis

A

Fluid moves from area of low concentration to high concentration

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5
Q

What are the kidney’s excretory functions?

A

To remove electrolytes, remove wastes, provide fluid and acid balance

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6
Q

How do we replace normal excretory kidney functions?

A

By normalizing electrolytes through the use of acid concentrate and providing fluid balance through ultrafiltration

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7
Q

What is the function of the acid concentrate?

A

Provides the concentration gradient for diffusion and helps normalize electrolytes

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8
Q

What is the function of bicarbonate in the dialysate solution?

A

Buffers the acid concentrate

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9
Q

What is the function of the bicarbonate in the patients blood?

A

Normalizes body pH

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10
Q

Signs and symptoms of hyperkalemia?

A

K > 5.5 mEq
Symptoms: extreme muscle weakness, abnormal heart rhythm and possible cardiac arrest

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11
Q

Signs and symptoms of hypokalemia

A

K < 3.5
Fatigue, muscle weakness, paralysis, and respiratory failure, cardiac instability, arrhythmias, cardiac arrest

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12
Q

What are the kidney’s endocrine functions?

A

Reinin secretion, erythropoietin secretion, vitamin D activation

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13
Q

How do we replace normal endocrine kidney functions?

A

Provide medications

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14
Q

Normal blood pH range

A

7.35-7.45

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15
Q

How much of normal kidney function is replaced by hemodialysis?

A

15%

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16
Q

What is uremia and how does it affect the body?

A

Uremia is a buildup of wastes in the blood due to kidney failure and affects all body systems.

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17
Q

What are the most common causes of CKD in the USA?

A

Diabetes
Hypertension
Polycystic Kidney Disease

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18
Q

Outline the treatment goals for a patient with CKD?

A

Slowing the progression of CKD
Managing comorbidities and complications
Controlling symptoms
Minimizing the effects of CKD on patients lifestyle
Kidney replacement therapy modality education
Encouraging patients to actively participate in their healthcare

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19
Q

Why is it important to know what caused your patients CKD?

A

So the nurse and PCT can inquire about possible problems during data collection and assessment

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20
Q

Signs and symptoms of fluid imbalance

A

Hypertension
Edema
Shortness of breath

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21
Q

Why is sodium balance important?

A

Leads to volume expansion, increased cardiac output, increased peripheral vascular resistance and increased blood pressure

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22
Q

Systemic effects of CKD what would you recommend?
Dry, itchy skin

A

Use hyper-fatted soaps and lotions

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23
Q

Systemic effects of CKD, what would you recommend?
Peripheral neuropathy

A

Monitor patient for changes in motor function, decreased strength in legs, complaints of restless legs, burning feet. Advise patient not to walk barefoot, have good foot care practices

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24
Q

Systemic effects of CKD what would you advise?
GI Problems (nausea/vomiting)

A

Inform RN and physician of any bleeding problems/constipation/diarrhea/ER visits, take medications as ordered (example stool softeners/ Imodium

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25
Systemic effects of CKD what would you do? Psychological problems
Verbalize struggles to IDT (core team) especially the social worker
26
What is a consequence of prolonged fluid overload?
Left ventricular hypertrophy
27
What is pericarditis?
Inflammation of the membrane (pericardial sac) around the heart
28
What is the treatment for pericarditis?
Decrease or stop heparin, more frequent dialysis
29
What is a common cause of hypertension in dialysis patients?
Fluid overload
30
Left ventricular hypertrophy leads to:
Ischemic heart disease, arrhythmia, myocardial infarction and sudden death
31
Why are dialysis patients anemic?
The lifespan of their RBC is 60 days, approximately 1/2 of the normal 120 days Primary cause: lack of the hormone erythropoietin (EPO) Secondary causes: inadequate iron stores, inadequate dialysis, malnutrition, blood loss during treatment
32
What can you do to avoid contributing to lower hemoglobin and blood loss in dialysis patients?
Verify correct erythropoietin stimulating agent (ESA) dose is administered, rinse back until venous line is pink tinged, and avoid repeat lab draws
33
What are the four key elements contributing to CKD mineral bone disorder (MBD)
Calcium, phosphorus, PTH, vitamin D (Calcitriol) all lead to CKD mineral bone disorder
34
What are symptoms of CKD-MBD in addition to bone disease?
Soft tissue calcification, itching, muscle weakness, pathological fractures, tendon rupture, compression of very, atherosclerosis, heart disease
35
What is your role in CKD-MBD management?
Report symptoms, urge patient to take medications (home and incenter) Report problems related to non adherence
36
Define the term AKI
Term incorporate a wide spectrum of kidney issues Includes acute kidney failure as well as less catastrophic kidney function changes May dialyze in an out patient facility until patient recovers
37
Give 3 examples of pre-renal causes of AkI
Obstruction, volume depletion, impaired cardiac function (basically anything to do with blood/ circulation)
38
Give 3 examples of intra-renal causes of AKI
Ischemic ATN, sepsis, acute interstitial nephritis, septic shock, anaphylaxis drugs, goodpasture syndrome, acute Glomerulonephritis, trauma, open heart surgery
39
Give 3 examples of post-renal causes of AKI
Obstruction, bladder rupture, pregnancy
40
Explain the difference between AKI and CKD
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 or genetic disorders (PKD)
41
Goals for AKI patients dialyzing in out patient facility
Restore kidney function Keep them free from infection (catheter site) Protect kidneys from further injury
42
How to help restore kidney function AKI
Find the cause of the AKI
43
What do you need to consider in regards to their vascular access AKI
Patients will typically have a dialysis catheter, be careful to avoid catheter related infections
44
How do you protect kidneys from further injury AKI
Avoid substances to the kidneys which may be toxic (radiographic contrast, amphotericin b, low dose aspirin, NSAIDs)
45
What is important when monitoring weight and BP AKI
Keep a little extra fluid on the patient so it is available to the kidneys when they start filtering/ultra-filtrating on their own
46
AKI patients are at increased risk for which complications?
Hypovolemia and hypotension
47
What is the difference between OSHA and CMS infection control requirements?
OSHA requires employers to provide workers with a safe workplace CMS concerned with patient safety
48
What a V tags and why are they important?
The state specific regulations to be met within a condition such as infection control, providing interpretive guidance for each regulation and citing deficiencies by tag #
49
Explain the acceptable hand hygiene technique when caring for a patient with active C diff
Handwashing with soap and water per policy is the only acceptable hand hygiene
50
What is the most common infectious complication in hemodialysis patients
Bacterial vascular access infections are the most frequent infectious complication
51
What organism causes the most common infections in hemodialysis patients
Methicillin resistant staphylococcus aureus (MRSA) Must pay attention to infection control. Proper hand hygiene, cleaning and disinfecting procedures to prevent the spread of infection (viable on surfaces for days)
52
What is the importance of wearing gloves
Reduces the risk of hand contamination and prevents the transfer of organisms already on hands to a patient
53
Why do you need to preform hand hygiene before and after wearing gloves
Gloves are not impervious and have microscopic pores
54
Who can use clean sinks for hand washing
Teammates and patients
55
Is a cleaned dialysis machine considered a clean area
No
56
How can you tell when an area or sink is clean or dirty in your facility
It is clearly labeled with a clean or dirty sign
57
What is a strike through of an external pressure transducer and why is it of concern
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
58
When should sharps containers be removed from the treatment floor
When they are 3/4 full
59
Explain the HBV classification and state which test is preformed monthly on HBV susceptible patients
HBsAG: hepatitis B surface antigen- tested monthly for susceptible pts and non-responders HBsAB (anti-HBs) hepatitis B surface antibody HBcAb (anti HBc) hepatitis B core antibody
60
How do surveyors verify teammates have completed infection control training and education
Documentation of infection control training in the teammates file or transcript
61
Which patient care assignments are appropriate when caring for hepatitis B patients
Caring for HBsAG positive and hepatitis B immune patients at the same time Caring for hepatitis B susceptible patients and those in the process of receiving the vaccination at the same time Caring for hepatitis B immune and susceptible patients at the same time
62
State 3 strategies recommended to decrease the risk of infection when working with a CVC
Using a face mask when lumens or exit site is exposed Wearing clean gloves and avoid touching exposed surfaces Minimizing catheter lumen or exit sites from being exposed
63
What is the most common transmission route for HAIs
Contact transmission
64
What is the reason that dialysis patients are at increased risk for acquiring a HAI at the facility
CKD patients are immunosuppressed and more vulnerable to infection. Infection is the second most common cause of death in dialysis patients
65
What contributes to hemodialysis patients being placed at increased risk for acquiring a HAI at the facility
Kidney failure weakens the immune system making patients more vulnerable to infection. Dialysis patients oftentimes have multiple comorbid conditions, which further weakens the immune system. The dialysis procedure itself requires prolonged access to the patients blood, especially those involving CVC accesses, making them more at risk
66
What is the correct procedure in regards to your hands when you have casual contact with a patient
Gloves are not necessary for casual contact, but hand hygiene is required after every direct contact with a patient and between patient contacts, even if it is casual
67
What is the most important intervention you can do to prevent HAI
Preforming hand hygiene
68
What is the total proportion of dialysate used at Davita (mixture of specific proportions of acid, bicarbonate, and dialysis quality water
45x
69
What are the two most frequent physician potassium strengths of dialysate concentrate used at Davita
2.0 K and 3.0 K
70
Which part of the kidney functions similarly to the dialyzer’s semi permeable membrane to provide filtration and removal of fluids
Glomerulus
71
What are the two waste products removed by dialysis that we monitor with monthly labs
Blood, Urea Nitrogen BUN Creatinine
72
How often are dialysis machine alarm tests performed
Before initiation of each patient treatment
73
Checking independent conductivity
The manual conductivity value must match +/- 0.4 mS on the Fresenius (FMC) 2008K and k2 dialysis delivery system displayed conductivity in Checking independent conductivity is not required when using Fresenius 2008T or T Blue Star models The B Braun machine does not require manual conductivity testing but conductivity must be verified on the ENDLF machine screen
74
What is the safe dialysate pH range
Between 6.9-7.6
75
Why is it important for patient care teammates to know when the water treatment system disinfection was preformed
Brother end to end disinfection process will also introduce the disinfectant solution to the dialysis delivery systems through there water inlet lines
76
Following recirculation, how long can a dialyzer and blood lines be set up
2 hours
77
Why are the Dialyzer and blood lines not used for dialysis treatment once recirculating for longer than 2 hours
Because of the potential for bacterial growth
78
What is the correct procedure for residual bleach testing after the chemical disinfection of loops and equipment fluid pathways
 Residual, bleach testing should be performed after bleach, disinfection, and prior to equipment use

Davitia (3 decks)

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