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DaVita Patient Care Technician Training > Module 3 Medication & Pharmacology, Water Treatment/Testing & Dialysate, Patient & Machine Complications, Emergencies > Flashcards

Module 3 Medication & Pharmacology, Water Treatment/Testing & Dialysate, Patient & Machine Complications, Emergencies Flashcards

Medication & Pharmacology, Water Treatment/Testing & Dialysate, Patient & Machine Complications, Emergencies

1
Q

Labeling & Expiration of Multi-dose medication vials

A

Must be labeled with the initials of the person opening the vial and the date it was opened (must be discarded within 28 days after opening except when the manufacturer specifies differently such as Epogen at 21 days

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2
Q

Needle/Syringe/Vial of Multi-dose medication vials

A

The vial may be entered more than once but requires a new sterile needle and syringe to puncture each medication vial to avoid pooling of medication from different vials

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3
Q

Regarding single-dose medication vials:

A

Must be used for only one patient
Each vial should only be entered once and then discarded
The same syringe may be used to enter up to two single use vials of the same medication and concentration to constitute the prescribed patient dose

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4
Q

What are the six rights of medication administration?

A

Time
Route
Amount
Medication
Patient
Documentation

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5
Q

What are the four medications that PCTs can administer per DaVita P&P?

A

Normal Saline
Heparin (if allowed per state regulations)
Lidocaine
Topical Anesthetic Spray

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6
Q

At what time are medications containing a preservative discarded?

A

28 days (except when the manufacturer specifies differently such as Epogen multidose vial (MDV) at 21 days)

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7
Q

What size needle with the appropriately sized syringe should be used when drawing up heparin?

A

21g x 1in

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8
Q

Why would the nephrologist order a formulary exception of Citrasate or CitraPure dialysate concentrate?

A

To use as part of anticoagulation therapy during the dialysis treatment when heparin is contraindicated

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9
Q

How do you verify your needle is not in the access when administering Lidocaine?

A

Aspiration (pull back) of syringe plunger and you do not see blood in the syringe

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10
Q

How do you administer Topical Anesthetic Spray?

A

Wash Access site
Clean site per P&P
Spray topical anesthetic to each cannulation site for 4-10 seconds from a distance of 3-7 inches
the skin will begin to turn white

DONT FROST THE SKIN - Numbing effect occurs with blanching

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11
Q

What is the time frame during which single-use medications should be prepared and administered?

A

Within 4 hours (unless your state specifies another time limit)

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12
Q

What are two reasons for water treatment?

A

Prevent equipment damage
Patient Safety

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13
Q

Aluminum in water used dialysis causes

A

Anemia
Bone Disease
Nausea
Vomiting

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14
Q

Chlorine in water used hemodialysis causes

A

Hemolysis

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15
Q

Excess Calcium and Sodium in water used dialysis causes

A

Hypertension

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16
Q

Excess calcium and magnesium in water used for dialysis causes

A

Muscle weakness

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17
Q

What does the RO remove?

A

Organic and inorganic materials
bacteria
endotoxins

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18
Q

What are two concerns with using DI Tanks?

A

Exhaust quickly
When exhausted they dump/release previously removed ions back into the water

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19
Q

Response to Final Water Quality Alarm

A

Bypass
Notify Charge Nurse/FA/Biomed/Medical Director
If not restored must terminate treatments and complete REM

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20
Q

Water/Dialysate culture results

A

Acceptable level: below 50 cfu/mL
Action Level: 50-99 cfu/mL
Unacceptable level: 100 cfu/mL or >

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21
Q

Water endotoxin testing results

A

Acceptable level: below 0.12 EU/mL
Action Level: 0.12 to < 0.25 EU/mL
Unacceptable level: 0.25 EU or >

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22
Q

Dialysate endotoxin testing results

A

Acceptable level: <0.25 EU/mL
Action Level: 0.25 to <0.50 EU/mL
Unacceptable level: 0.50 EU/mL or >

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23
Q

How often are water and dialysate cultures drawn and monitored for bacteria and endotoxins?

A

Monthly

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24
Q

What removes chlorine/chloramines

A

Carbon Tanks

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25
Q

Chlorine/Chloramine testing

A

When: Always test while the RO is actively supplying water
- After the RO has operated for at least 15 minutes first thing in the morning, before the first shift of patients, and every 4 hours

Where: After primary carbon tank sample port

Acceptable result: Less than or equal to 0.1mg/L

Action if results are too high post-primary tank: Repeat the test - if still too high - move onto secondary port and test, remember to notify biomed and FA

F/U if secondary test results are within limits: Every 30 minutes

F/U if secondary test results are too high: Stop Dialysis by placing dialysis delivery system into bypass - do not rinse patients’ blood back

26
Q

What is the purpose of the water softener in Hardness Testing

A

To remove hard minerals such as calcium and magnesium

27
Q

What is removed and why is this important in Hardness Testing

A

For RO protection

28
Q

When do we test for Hardness

A

End of Day

29
Q

Who must be notified when a patient fall has been witnessed

A

The licensed nurse must be notified so the patient can be assessed

30
Q

Hypotension

A

Systolic BP <90
Diastolic BP<50 or drop in systolic more than 20 mm/hg

31
Q

Causes of Hypotension

A

Rapid or inappropriate fluid loss
Antihypertensive drugs
Low blood volume
Food ingestion
Unstable cardiovascular condition

32
Q

Symptoms of Hypotension

A

Flushing
Yawning
Dizziness
Ringing in the ears
Tachycardia
Anxious feeling
Nausea/vomiting
Cold clammy skin
Seizures
Cardiac arrest
Visual complaints

33
Q

Hypotension Intervention

A

Place patient in supine position
Decrease UFR to minimum or turn off
Water for less severe hypotension
100-200 mL NS for severe hypotension (NOTE: dialysis patient care technicians (PCTs) may give up to 200 ml of normal saline allowed per state and local Board of Nursing regulations)
Inform the licensed nurse for further evaluation and intervention
Monitor BP

34
Q

Hypotension Prevention

A

Frequent assessment of target weight
Limit UFR to </= to 13mL/kg/hr
UF profiling
Extend treatment time
Pure ultrafiltration

35
Q

Consequences of Organ Stunning

A

Heart: Acute stress on the cardiovascular system, development of left ventricular regional wall motion abnormalities (RWMAs), and arrhythmias, can lead to cardiac failure

Gut: Releases endotoxin into circulation, inflammation

Kidneys: Causes fibrosis, loss of residual renal function

Brain: Causes multiple sites with white matter injury

36
Q

Hypertension

A

Pre-dialysis adult BP is >140/90
Post is > 130/80

37
Q

Hypertension Causes

A

Disease process
Fluid Overload
Non-adherence with medication
renin-angiotensin cycle

38
Q

Hypertension Symptoms

A

No symptoms
Headache
Dizziness
Irritability
Blurred vision
Nervousness
Edema - Secondary to fluid retention

39
Q

Hypertension Intervention

A

Take medications as prescribed
Maintaining fluid balance (avoid excessive IDW gains)

40
Q

Hypertension Prevention

A

Promote fluid and medication adherence

41
Q

Muscle Cramps

A

Painful muscle contractions in extremities or abdomen

42
Q

Causes of Muscle Cramps

A

Rapid or excessive fluid removal
Hypo-osmolality
Tissue Hypoxemia/Ischemia
Electrolyte disorders or imbalances: low sodium, calcium, potassium, magnesium, any local irritating factor or metabolic abnormality of a muscle (e.g., severe cold, lack of blood flow, over exercise)

43
Q

Muscle Cramp Symptoms

A

Painful cramps usually occur late in dialysis

44
Q

Muscle Cramp Intervention

A

Massage or apply opposing force
Stretching of affected muscle
Discontinue UFR
Provide supplemental oxygen per nephrologist order
Assess target weight
For severe cramping: a Normal Saline bolus maybe be indicated as prescribed

45
Q

Seizures

A

Involuntary muscle spasms and loss of conciousness

46
Q

Causes of Seizures

A

Some patients have seizures as a dialysis side effect (severe hypotension, dialysis disequilibrium syndrome) or seizures may occur during dialysis as an adverse reaction to a problem such as the use of improperly prepared dialysate.
Some patients may have a pre-existing seizure disorder

47
Q

Seizure Symptoms

A

Change in level of consciousness
Twitching and jerking movements of the extremities

48
Q

Seizure Intervention

A

Protect patient and access arm from harm
Protect airway
Do not pry open clenched jaws once seizure has begun
Do not attempt to insert anything into the mouth
Treat hypotension
Dialysis disequilibrium syndrome
Hypoglycemia if indicated
Administer oxygen
Provide airway support
Discontinue Dialysis if no response to interventions

49
Q

Seizure Prevention

A

Prevent Hypotension
Prevent large drops in BUN
Monitor for therapeutic drug levels in patients with pre-existing condition

50
Q

Dialysis Disequilibrium Syndrome (DDS)

A

A condition in which rapid or drastic changes in the patient’s extracellular fluid affect the brain

51
Q

DDS causes

A

Missed treatment
Rapid drop in BUN

52
Q

DDS Symptoms

A

Headache
Hypertension
Nausea
Restlessness
Seizures
Confusion
Blurred Vision

53
Q

DDS Intervention

A

Slower BFR and DFR than CKD patients
Shorter Initial treatments

54
Q

DDS Prevention

A

Early Recognition of mild symptoms
Decrease efficiency of dialysis by:
- Use a less efficient dialyzer
- Decrease treatment time
- Decrease BFR and DFR during treatment
- Shorter, more frequent dialysis

55
Q

Fever & Chills

A

Any temperature greater than 100F (37.8C) or increase over baseline of 2F(1C) with symptoms

56
Q

Fever & Chills Causes

A

Systemic infections
Access infections
Contamination of blood or dialysate compartments
Pyrogenic reactions

57
Q

Fever & Chills Symptoms

A

Nausea
Vomiting
Headache
Hypotension
Tachycardia
Hot flushed skin
Dry mucous membranes

58
Q

Fever & Chills Intervention

A

The nurse must assess and evaluate the patient for a possible cause of fever

Notify the treating nephrologist and if ordered by the physician, obtain blood culture(s) per procedure and send them to the laboratory

Provide comfort measures, and administer antipyretics as ordered

Administer antibiotics as ordered

Schedule patient for permanent access evaluation

59
Q

Fever & Chills Prevention

A

Avoid use of femoral catheters
Evaluate teammates’ technique

60
Q

Pyrogenic Reaction

A

DaVita Patient Care Technician Training (4 decks)

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