Module 6 Flashcards
What is the most important step you can take to prevent the spread of infection? A. Wear a mask B. Wear gloves C. Wear protective equipment D. Wash your hands
D. Wash your hands
What is aseptic? A. Free from all germs B. Free from disease-causing germs C. Blood poisoning D. Clean and sterile
B. Free from disease-causing germs
A pulse of 104 beats/min would suggest that the patient has: A. Bradycardia B. An arrhythmia C. Tachycardia D. Atrial flutter
C. Tachycardia
The normal range of resting respirations in an adult is: A. 12 to 16 breaths/min B. 20 to 40 breaths/min C. 30 to 50 breaths/min D. 50 to 60 breaths/min
A. 12 to 16 breaths/min
For whom would you use the stand and pivot technique to transfer from a wheel-chair or dialysis chair?
A. A patient who is brought into the dialysis clinic on a stretcher
B. A patient who can bear his or her weight once standing
C. A patient who can get out of the dialysis chair without needing any help
D. A patient who says he feels dizzy and nauseated
B. A patient who can bear his or her weight once standing
How can you prevent accidental needle sticks? (NOTE: choose all that apply.)
A. Recap needles carefully
B. Dispose of needles in a sharps box
C. Break or bend the needle
D. Leave needles on medicine carts after use
B. Dispose of needles in a sharps box
What is the purpose of priming bloodlines and the dialyzer?
A. To remove air and germicide from the blood lines and dialyzer
B. To be sure fibers are completely filled with germicide before starting dialysis
C. To assess ultrafiltration capacity of the dialyzers and check for leaks
D. To maintain fiber noncompliance until dialysis begins
A. To remove air and germicide from the blood lines and dialyzer
Mrs. Smith’s dry weight is 62kg. Her pre-treatment weight when she came in for treatment on Monday was 67kg. For her treatment the priming saline amount is 240mL, the rinseback amount is 200mL, fluid from medications is 100mL, and
she does not take in any fluids during treatment. What is the total amount of fluid weight to be removed during her treatment?
A. 5000mL
B. 5230mL
C. 5540mL
D. 5820mL
C. 5540mL
Based on Mrs. Smith’s total amount of fluid to be removed, what is the ultrafiltration rate per hour (mL/hr) for her 4 hour treatment: A. 1220mL/hr B. 1385mL/hr C. 1440mL/hr D. 1500mL/hr
B. 1385mL/hr
Which of the following is a cause of hypotension during and after dialysis?
A. Uremia
B. Patient forgets to take blood pressure pills C. Fluid overload
D. Removing too much fluid
D. Removing too much fluid
What is the cause when you see the Signs/Symptoms depends on the patient’s body position when the air is infused. May include: • Chest pain • Coughing • Blue lips, fingers, toes (cyanosis) • Trouble seeing • Confusion • Coma • Death
Air embolism
air bubbles block a blood vessel
What is the cause when you see the Signs/Symptoms
Symptoms usually occur in the first 5–10 minutes and get worse over time
• Trouble breathing (throat may close up)
• Hypotension
• Hives and itching
• Feeling anxious, restlessness
• Swelling around the eyes
• Numbness and tingling around the mouth
• Low back pain
• Tachycardia
• Cardiac arrest
• Burning and pain at venous needle site if
disinfectant is infused – usually happens quickly
Anaphylaxis
severe allergic reaction
What is the cause when you see the Signs/Symptoms
• Pain or tightness in chest, arm, or jaw
• Patient may be cold, sweating, and/or have
trouble breathing
• Patient may be hypotensive
Angina
chest pain due to low oxygen levels in the heart
What is the cause when you see the Signs/Symptoms
• Skipped or extra heartbeats
• Slow or fast pulse
• Patient has palpitations (strong heart beats)
• Anxiety
Arrhythmias
irregular heartbeats
What is the cause when you see the Signs/Symptoms
• No pulse
• No breathing
• Loss of consciousness
Cardiac arrest
the heart stops beating
What is the cause when you see the Signs/Symptoms
• Painful muscle cramps, often in the hands and feet or abdomen
Cramps
What is the cause when you see the Signs/Symptoms often occur during or towards the end of the treatment including: • Headache • Nausea • Hypertension • Restlessness • Irregular pulse • Confusion • Blurred vision • Seizures
Dialysis disequilibrium syndrome
brain swelling most often in patients with high Bun levels
What is the cause when you see the Signs/Symptoms
• Infection: fever/chills at start of dialysis
• Local infection: redness, swelling, tender- ness, warmth, or drainage from access or
other sites (e.g., feet, skin wounds)
• Pyrogenic reaction: afebrile at start and
fever/chills within 45–75 minutes after start
of dialysis
• Dialysate temperature: feeling hot (dialy-
sate temperature higher than patient’s core
body temperature) or
• Feeling cold without a fever (cold dialysate)
Fever and/or chills pyrogenic reactions
(Pyrogen: a substance that causes a rise in body temperature such as bacterial toxins)
Note: with a pyrogenic reaction, more than one patient may be affected at the same time!
What is the cause when you see the Signs/Symptoms of severe reaction usually occur in the first 5-10 minutes of treatment (20-40 minutes for mild reaction) and may include:
• Itching
• Chest and/or back pain • Shortness of breath
• Hypotension
• Nausea
• General discomfort
First-use syndrome
sensitivity to dialyzer membrane material or reaction to ethylene oxide, a gas used to sterilize some new dialyzers
What is the cause when you see the Signs/Symptoms
• Unusual bleeding around needles
• Longer than normal bleeding from needle
sites after treatment
• High BP readings
Heparin overdose
What is the cause when you see the Signs/Symptoms
• May have no symptoms
• Headache
• Nervousness
Hypertension
high blood pressure
What is the cause when you see the Signs/Symptoms Low BP reading Dizziness Tachycardia (rapid pulse) Loss of consciousness
Hypotension
low blood pressure
What is the cause when you see the Signs/Symptoms
Severe itching on and off dialysis
Red skin
Crusting on the skin
Pruritus (itching)
What is the cause when you see the Signs/Symptoms
Change in level of consciousness
Jerking movements of the arms and legs
Seizures
Air embolism
(air bubbles block a blood vessel)
How to prevent, and how to intervene?
How to Prevent: Arm the air detector throughout a treatment.
Tighten all connections in the extracorporeal circuit.
Check the normal saline level in the IV bag.
Return the patient’s blood with saline, with no air in the bloodlines.
How to Intervene
Clamp all blood line, OFF PUMP, put patient Left Side, Trendelenburg, O2, Call 911, CPR may be needed
Anaphylaxis
(severe allergic reaction)
How to prevent, and how to intervene?
How to Prevent:
Rinse dialyzers and bloodlines well during equipment preparation.
Avoid drugs the patient has a known allergy to.
How to Intervene
Manage S&S,
Terminate Treatment,
DO NOT RETURN BLOOD
Angina
(chest pain due to low oxygen levels in the heart)
How to prevent, and how to intervene?
How to Prevent: Monitor blood pressure closely to avoid hypotension. Calculate the fluid goal correctly. How to Intervene Manage S&S, O2, nitro, minimize UF to 300 ml/hr, treat hypotension
Cramps
How to prevent, and how to intervene?
How to Prevent:
Get an accurate weight before a treatment.
Correctly calculate the fluid goal.
Use the prescribed dialysate concentrate.
Encourage patients to follow their salt and fluid limits.
How to Intervene
Treat the symptoms:
Normal saline bolus up to 200 ml
Reduce UFR
Massage or apply opposing force
Assess dry weight
Dialysis disequilibrium syndrome
(brain swelling most often in patients with high Bun levels)
How to prevent, and how to intervene?
How to prevent,
Monitor the patient during treatment.
Tell the nurse right away about major vital sign changes.
In patients with high BUN (>150 mg/ml) a smaller dialyzer and/or slower blood and dialysate flows are preferred. Short, slow dialyses may be prescribed daily for a few treatments.
how to intervene?
Treat the symptoms:
Monitor new patients carefully for hypertension Decrease BFR
Treat N/V and headache per protocol
Be alert for restlessness, speech/mental changes
