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Davita PCT exam May 2023 latest updated
Number 1 & 2 cause of (CKD) chronic kidney diease 1- diabetes 2-hypertension In (AKI) acute kidney injury it is better to keep patients? too wet, ... [Show More] rather than too dry with fluid removal goals 3 sub-groups of ckd? 1-pre-renal-interferes w/ BF to the kidneys, causes-injuries/renal artery clot 2-intra-renal-damages nephron directly, causes-diabetes/hypertension/PKD 3-post-renal-any condition interfering w/ urine leaving the bladder, causes-kidney stones/enlarged prostate Acceptable conductivity range of dialysate? 13-15.5ms +/- 0.4 Acceptable PH range of bicarb? 6.9-7.6 PH Hemodialysis (HD) replaces approximately how much of normal kidney function? 15% In patients w/ kidney failure, what is recommended to use if they are having issues w/ their skin, such as dryness? hyper fatted/super fatted soaps and lotions There is no specific tx for a patient w/ peripheral neuropathy, but it is recommended that a patient should? not walk barefoot check feet for cuts test bath water to ensure it is not too hot Filtration fluid passing through a semi-permeable membrane, controlled by hydrostatic pressure EX. coffee filter Ultrafiltration (UF) controlled fluid removal by manipulation of hydrostatic pressure Convection solutes dragged across the semi-permeable membrane along w/ the fluid Diffusion the process by which particles (solutes) move from an area of higher concentration to an area of lower concentration normal acid-base balance of the body? 7.35-7.45 PH How do kidneys control blood pressure? renin-angiotensin system Erythropoiesis function of the kidneys that control the production of red blood cells 3 functions of normal working kidneys? 1-endocrine system- a. renin-angiotensin-BP regulation b. erythropoiesis-RBC production, activation of vitamin D3 & serum Ca regulation 2-acid concentration- maintain normal body PH, excreting acids & reabsorbing bicarbonates 3-excretory functions- waste removal, acid-base balance, fluid/electrolyte balance Anemia medications? epogen IV iron 2 most common causes of death for a dialysis patient? 1-heart attack 2-infection Healthcare-associated infection (HAI) are mainly routed by? contact transmission of infection hands/surfaces Most common infectious complications among HD patients? vascular access infections How long can MRSA bacteria remain on a surface? for days, especially on plastic/vinyl Breakdown product of chlorine that causes hemolysis? chloramines Hemolysis the rupture or destruction of red blood cells blood is visibly cherry red kool-aid colored Chlorine + Chloramines = hemolysis What does the water softener remove? calcium and magnesium How often is carbon filter monitoring done? CM130 takes chlorine samples every 5 minutes When do you test the carbon filter monitoring? Prior to the first tx of the day, then within every 4 hours *RO must run 15 min. prior to testing What are the limits for carbon filter monitoring? 0.1mg/L or less What does reverse osmosis (RO) remove? organic/inorganic contaminants bacteria/endotoxins Primary device used for water purification in dialysis? Reverse Osmosis 3 responses to final water quality alarm? 1-put all machines in bypass mode 2-notify RN, FA, Biomed 3-if water quality cannot be restored, terminate all treatments D.A.R.N. Desire Ability Reasons Need W.E. C.A.R.E Welcome Empathize Connect Actively listen Respect Encourage Fever-when to notify RN a rise in the temperature of the body greater than 100 degrees F or an increase over baseline of 2 degrees F w/ symptoms Dialysis Disequilibrium Syndrome (DDS) rare but life threatening complication during initial stage of hemodialysis prevention-slowing rate of HD. HD can lead to excess fluid in brain, cerebral edema signs/symptoms-headache, restlessness, seizure How a patient is to be positioned if they have an air embolism? left side Trendelenburg NFACT New fistula assessment and cannulation team NFACT defines an intermediate cannulator as? at least 6 months of AVF cannulation experience & at least 10 successful cannulations on established fistulas When cannulating, the tips of the needles should be at least 1.5" or the width of 2 fingers apart Kt/V K= clearance T= time V= volume Kt/V goal equal to 1.2 or higher Factors in Kt/V that influence V (volume)? height weight sex amputations needle gauge suggested BFR Factors in Kt/V that influence T (time)? longer blood/dialysate contact time more frequent tx extra tx TX factors that decrease K (volume)? DFR UF goal BVP adequate anti-coagulation How do you estimate the blood volume removed (BVR)? BFR x minutes dialyzed=estimated BVR What is the wait time for heparin bolus prior to starting tx? 3-5 minutes 17g needle 200-250 BFR 16g needle 250-350 BFR 15g needle 350-450 BFR 14g needle >450 BFR Procedure for post BUN lab draw (green top tube) UF decreased to 50ml place in bypass decrease BFR to 100 ml/pm draw from arterial line Accidentally diluting the pre-treatment BUN lab draw w/ saline would cause the Kt/V reading to be? falsely too low Waiting only 5 Seconds between lowering the blood pump speed and drawing the post-treatment blood sample could cause the Kt/V reading to be? falsely too high Waiting longer than 15 seconds between lowering the blood pump speed and drawing the post-treatment blood sample could cause the Kt/V reading to be? falsely too low If a tube in the centrifuge breaks while spinning, what should you do? Remove the sleeve it is inside of, remove the opposite tube/sleeve to create the correct weight balance If a patient wants to take OTC medications, what should they do first? consult their physician When is the best time for a patient to take their phosphate binders? w/ meals, first bite of their food sometimes taken w/ snacks When should renal vitamins be taken? after a dialysis tx CKD-MBD? abnormalities in Ca, PO4, PTH, & Vitamin D metabolism w/ soft tissue calcification & bone disease Increase sodium intake causes? increased thirst, hypotension What does overindulging in foods w/ high potassium cause? extreme muscle weakness & abnormal heart rhythm Albumin essential for growth, maintenance, preventing infection & anemia Prevents the formation of aneurysms & pseudoaneurysms good needle site rotation 3 steps in the complete access assessment? Look, listen, feel Symptoms of disinfectant infusion? Pain at the venous needle site, tingling around the lips, & difficulty breathing Health literacy a person's capacity to understand basic health information What is basic principle of patient self-management? dealing W/ the consequences of illness, rather than just the physical disease D.A.R.N Desire Ability Reason Need Educational tip for auditory learners? using word associations & mnemonics What is HbsAg? test to be performed monthly on patients susceptible for Hepatitis B What is 15 minutes? The time the RO must be running prior to performing the first chlorine/chloramine test? Water softener works only w/ a sufficient amount of salt pellets Why would you place all machines into bypass? how you would respond to a final quality alarm What do DI tanks do? produces highly dangerous water when exhausted What is the target weight in a patient w/ AKI? being "wet" is better than being too dry R.U.L.E Resist Understand Listen Empower 5 stages of grief 1. Denial 2. Anger 3. Bargaining 4. Depression 5. Acceptance 3 learning styles visual, auditory, kinesthetic/tactile What do you do if a patient wants to get off early? Educate, document, draw labs, notify RN Role of PCT prior to treatment? Data collection 4 reasons to document for medical records 1-proof care was rendered 2-provides data continuity/planning of patient care 3-permanent legal record 4-communication tool Post treatment data collection is done? after tx, not during rinse back What is a URR & what is this used for? urea reduction rate, percentage of urea removed during a tx Why is protein intake so important? maintains health, helps fight infection, prevents anemia, maintains muscle, heals wounds Purpose of DQI & how is it achieved? to encourage continuous improvement across a broad range of disease management. managing patients first, scores will follow Why is hand hygiene important? prevent the spread of infection what does sodium loading contribute to? increased thirst, large fluid gains, more ischemic events during tx, hypertension, headaches What can cause DDS? Urea transfers slowly from the blood to the brain, causes fluid in the brain, which causes it to swell How do you care for a patient who is having a seizure? protect pts. access, treat hypotension, DDS, hypoglycemia, administer oxygen, provide airway support, discontinue tx if unresponsive How do you initially care for anaphylactic reaction? stop meds, blood pump, and tx. Do not return the blood, notify RN, call EMS Signs, symptoms, & intervention of disinfectant reaction? pain at venous needle site, itching, restless, back pain, tingling around lips, respiratory distress. interventions-discard bicarb/rinse mixer, no tx until all tests are negative What does intradialytic hypotension cause? organ stunning [Show Less]
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Real PCT davita final exam questions and answers scored A+ updated 2023
Which of the following statements is not an underlying assumption of self management People with complex chronic kidney conditions such ass ESRD have more... [Show More] difficulties with successful self management Which of the following is a basic principle of self management Dealing with the consequences of the illness rather than just the physical disease its self Andragogy takes into account That adults desire to take responsibility for what they learn In order to detect problems as early as possible a thorough evaluation of a new fistula four to six weeks after creation should be considered mandatory true Vessel mapping should be performed on all new patients when possible true The goal of vascular mapping is to assure that every new patient receives a fistula if possible true A juxta-anastomotic stenosis is considered an "outflow" stenosis (inhibits the blood from flowing out of the access vessel). inflow The salvage (success) rates for endovascular therapy in early AV fistula failure cases are around 20%. false 84-98% Venous stenosis is the most common cause of late fistula loss. true Persistent swelling of the access arm and prolonged bleeding after needle withdrawal are signs of an inflow stenosis (inability for blood to enter the access) true A secondary AV fistula is defined as a fistula that is created following the failure of a graft or fistula. true A catheter that is not able to deliver at least 400 ml/minute should be evaluated for dysfunction. true The most serious catheter related complication is infection true 3 processes that make up the water treatment system pre treatment, water-purification, distribution 3 roles of davitas pnp play a standard of care best demonstrated practice prima facieevidence 4 ways to prevent contributing to excess blood loss eveluate effectiveness of of heparin rinse back blood till lines are pink hold acess site forappropriate time dont waste blood in redraws acronym used when communicating SMART simple meaningful actual read teach adequacy of dialysis is represented by kt/v antibiotic that should be administered over a period of at least 60 min vancomycin what factors influence k bvp what happens when arterial pressure becomes greater than -260 hemolysis what happens if total Cl is collected before the minimum time the RO should be operating rsults could be falsely negative what happens to the TMP if clotting occurs in the dialyzer it decrease what happens when bleach an parecitc acid are mixed a toxic cl gas is produced wjat is a good adequacy goal for 3 times per week HD KTV of atleast 1.2 URR of at least 65% what is KDQOL 36 used to asses physical health, mental health effects in dialy living symptoms burden of kidney disease what not to include in AOR personal opinion specu;ation vendettas what shou;d you do if pt needs a bathroom break return blood and recirculate machine when is a pyrogenic reaction most likely to occur during the first 45-75 mins when is risidual bleach testing done after bleach dis infection and prior to use when to chart in medical record change in baseline assesment or pt condition procedure or treatment medication administration pt teaching care plan when to give hep b booster when HBsAB drops 10 when to use directing communication when trainning pts when to use folowing communication when pt need time to process or digest something when to use guiding communication when creating an action plan what bacteria requires hand washing instead of alcohol rub c diff which direction should arterial needle be placed anti or retro who cares which direction should the venous needle be placed antegrade with flow of blood who educate pt on treatment modality neph, SW and CN to evaluate if pt is stable before discharge nurse must complete post treatment assessment pre treatment required by nurse? if abnormal findings for AKI pt pretreatment always required if a pt with acute kidney injury dialyses in the out pt facility one task of the pt care TM is to monnitor blood pressure and weight closely why? HYPOvolemia and HYPO tensives episode can cause RENAL ISCHEMIA and can further damage the kidneys CKD can have its origin pre renal, intra renal, or post renal. which of the following conditions is an intrs renal cause of CKD hypertension pt with cardiac disease are ten times more likely to experience intradailytic hypotension LVH offering a pt this is an example of sodium loading broth what is an intra cellular or intersistial symptom of fluid overload edema this electrolyte is often elevated in pts who experience severe itching phosphorus [Show Less]
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DaVita PCT Clinical Exam, questions and answers graded A+
diffusion movement of dissolved PARTICLES across a semipermeable membrane from the side of HIGHER concentration TO side of LOWER concentration (across con... [Show More] centration gradient). at equilibrium, no net transport takes place & dialysis fluid needs to be exchanged. ultrafiltration removes water from the blood by PUSHING it across the semipermeable membrane from the blood side within the dialyzer's hollow fibers to the dialysate side; pressure is added to the dialyzer to get the fluid out. TMP transmembrane pressure; pressure in dialyzer. (+ TMP can show a clot). osmosis movement of WATER across a semipermeable membrane from the side of LOWER solute concentration to the side with the HIGHER solute concentration, until equilibrium is reached. osmotic pressure gradients drive ultrafiltration. when drawing the post-BUN sample at the completion of the treatment... 1) turn off the UFR 2) decrease the dialysate flow rate to 300 ml/min or place the machine in bypass 3) reduce BFR to 50 ml/min 4) then wait 15 seconds 5) draw the BUN blood sample from arterial sample port (venous port can give falsely low readings). the post-BUN blood sample is related to the patient's _____ reading Kt/V two possible causes in inaccurate Kt/V results include: 1) blood sample was drawn before correct time interval and access recirculation makes the Kt/V falsely high. 2) blood sample was drawn after correct time interval was completed, urea rebound makes the Kt/V falsely low. optimal dialysate temperature 36.6 maximum recirculation time after a machine has been set up prior to tx cannot exceed: 2 hours why do limit recirculation time? limiting bacterial growth in machine what is the procedure for blood strikethrough of an external transducer protector? finish pt tx, remove machine from floor and take to biomed, fill out an REM. if bleach and peracetic acid are mixed, a chemical reaction occurs, producing: toxic gas what are the two requirements that must be met prior to initiating water system disinfection? 1) tx floor is free of pts. 2) no other processes are using dialysis water. what must be done to indicate the presence of disinfectant in the machines during water system disinfection? test strips the dialysate is a mixture of: 1) dialysis quality water, 2) acetic acid concentrate with electrolytes, 3) bicarbonate concentrate solution electrolytes present in the acid concentrate: sodium, calcium, magnesium, chloride, potassium, and glucose. if dialysate conductivity is out of range, it causes: serum electrolytes to increase or decrease to non-physiological levels & HEMOLYSIS OCCURS. if the dialysate temperature becomes too hot: it can hemolyze RBCs arterial pressure (AP) must be: NEGATIVE, because it is pulling blood from vascular access. blending valve (water tx) mixes hot and cold water to allow the RO system to function at the most efficient temperature (77 F, but definitely between 60-85 F). backflow preventer (water tx) prevents pre-treated water and disinfectants from backing up into the city water supply. booster pump (water tx) "boosts" increases incoming water flow and pressure, maintains water pressure needed for components operation, and eliminates wide pressure fluctuations. multimedia or depth filter (water tx) filters out suspended particles like silt and sand in the water and traps solutes and other substances. water softener (water tx) "softens" hard water by removing calcium and magnesium from the incoming water. Works with the brine tank (salt) to prevent hard mineral deposits from accumulating and potentially damaging the RO membranes. replaces Ca & Mg with Na. carbon tanks (water tx) essential for removing chlorine/chloramines from the city water. carbon tanks are installed in pairs for a primary and backup secondary. sample port for water testing is located right after second tank. RO pre-filter (water tx) removes fine carbon particles, resin beads and other debris; is placed just before the RO unit. RO unit (water tx) purification of water by removing bacteria, viruses, endotoxins, salt, particles, and other solutes, resulting in dialysis-quality water. RO membranes are very permeable to water but not to chemicals are solutes; 90-99% of solutes are rejected from the water. observations and test results listed on the Daily Water Treatment Log are entered each facility day _____ to the start of dialysis tx. prior who reviews the Daily Water Treatment Log for completeness and verifies that all parameters are within specified limits? RN total chlorine testing is done on a daily basis prior to the first pt tx and every ____ hours until all use of dialysis water is done for the day. 4 limit for chlorine/chloramine testing (aka an acceptable result): ≤0.1 mg/L(ppm) all chlorine samples are to be drawn only after the water system has been operating for at least _____ minutes. 15 hardness testing is done on water leaving the water softener at the ______ of tx day end hardness testing results that are greater than _______ must be reported to biomed and FA to initiate corrective actions. 1 grain/gal [Show Less]
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DaVita PCT Study Guide questions and answers latest updated
Ultrafiltration Fluid pushed through the semipermeable membrane Convection Solutes dragged across semipermeable membrane along with fluid D... [Show More] iffusion Particles move from area of high concentration to low Osmosis Fluid moves from area of low to high concentration What are the kidneys' excretory functions? To normalize electrolytes, remove wastes, provide fluid and nutrient balance What are the kidneys' endocrine functions? Renin secretion, erythropoietin secretion, vitamin D activation What is the function of the acid concentrate? Provides the concentration gradient for diffusion What is the function of bicarbonate the dialysate solution? Buffer the acid concentrate What is the function of bicarbonate when it diffuses into the patient's blood? Normalizes body pH How do we replace normal excretory kidney functions? Normalizes electrolytes, provide fluid balance through ultrafiltration How do we replace normal endocrine kidney functions? Provide medications Outline the treatment goals for a patient with chronic kidney disease (CKD) -slowing the progression of ckd -managing comorbidities and complications -controlling symptoms -minimizing the effects of ckd on patients' lifestyles -kidney replacement therapy modality education -encouraging patients to actively participate in their healthcare What are the most common causes for CKD in the USA? Diabetes Hypotension Polycystic Kidney Disease Why is it important to know what caused your patient's CKD? So the nurse and PCT can inquire about possible problems during data collection and assessment Signs and Symptoms of fluid imbalance Hypertension Edema Shortness of breath What does hypertension lead to? Left Ventricular Hypertrophy Why is sodium balance important? Leads to volume expansion- increased CO- increased peripheral vascular resistance- increased BP Signs and symptoms of Hyperkalemia >6.5 mEq symptoms: extreme muscle weakness, abnormal heart rhythm, and possible cardiac arrest Signs and symptoms of Hypokalemia <3.5 mEq symptoms: fatigue, muscle weakness, paralysis, and respiratory failure, cardiac instability, arrhythmias, cardiac arrest Why are dialysis patients anemic? The lifespan of their RBC is 60 days or approx 1/2 of normal 120 days Primary cause: lack of the hormone erythropoietin (epo) Secondary cause: inadequate iron stores, inadequate dialysis, malnutrition, blood loss during treatment How can you prevent contributing to lower hemoglobin levels and blood loss in dialysis patients? Ensure Epogen dose is correct and administered, rinse back blood completely, avoid repeat lab draws What is pericarditis? Inflammation of the membrane (pericardial sac) around the heart What is included in its treatment? decrease or stop heparin give more frequent dialysis Systemic effects of CKD Dry, itchy skin -> what do you do? use hyper-fatty soaps and lotions caution patient re; safety at home, provide emotional support, control diabetes and phosphorus Systemic effects of CKD Peripheral Neuropathy (nerve pain in extremities) -> what do you do? monitor patient for changes in motor function, decreased strength in legs, C/O restless legs, burning feet. advise patient not to walk barefoot, have good foot care practices Systemic effects of CKD GI problems -> what do you do? inform rn and md of any bleeding problems/ constipation/ diarrhea/ er visits, take meds as ordered ex: stool softness/ Imodium Systemic effects of CKD Psychological problems -> what do you do? anxiety or depression verbalize struggles to IDT ex: the social worker What are the 4 key elements affected in CKD-Mineral Bone Disorder (MBD)? Calcium Phosphorous PTH Vitamin D (Calcitrol) All lead to CKD-MBD when they are abnormal What are the symptoms of CKD-MBD in addition to bone disease? Soft tissue calcification, itching, muscle weakness, pathological fractures, tendon ruptures, compression of vertebrae, atherosclerosis, heart disease What is your role in CKD-MBD management? report symptoms, urge patients to take meds at home and at treatment report noncompliance problems related to non adherence How much of normal kidney function is replaced by HD? 15% Define Acute Kidney Injury (AKI) term incorporates 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 kidney function recovers Pre-renal causes of AKI obstruction, volume depletion, impaired cardiac function Intra-renal causes of AKI ischemic ATN, sepsis, SIRS, septic shock, anaphylaxis drugs, good pasture syndrome, acute glomerulonephritis, trauma, open heart surgery Post-renal causes of AKI obstruction, oliguric, bladder rupture, pregnancy Treatment goals for a patient with AKI: How do you help in restoring kidney function? find the cause of AKI Treatment goals for a patient with AKI: How do you protect kidneys from further injury? avoid substances to the kidney which may be toxic (radiographic contrast, amphotericin B, low dose aspirin, NSAIDS) Treatment goals for a patient with AKI: What is important when monitoring weight and BP? keep a little extra fluid on them so it is available to the kidneys when they start filtering/ ultra-filtrating on their own Treatment goals for a patient with AKI: AKI patients are at increased risk for which complications? hypovolemia and hypotension Treatment goals for a patient with AKI: What do you need to consider in regards to their vascular access? patients will typically have a dialysis catheter, be careful to avoid catheter related infections 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, genetic disorders (PKD) What makes dialysis patients more susceptible to HAIS? immunosuppressed and more vulnerable to infection which leads to the 2nd most common cause of death in this population Why are dialysis patients at increased risk for acquiring a HAI at the facility? dialysis procedure itself requires prolonged access to the patient's blood and bacterial infections especially those involving vascular accesses (CVC) What is the most common transmission route for HAIs? contact What is the most important intervention you can do to prevent HAIs? hand hygiene What is the most common infectious complication in hemodialysis patients? vascular access infection What germ causes the most common infections in hemodialysis patients? MRSA- must pay attention to infection control proper hand hygiene, cleaning an disinfecting procedures to prevent spread of infection Why is wearing gloves so important? reduce the risk of hand contamination and prevent the transfer of organisms already on hands Why do you need to perform hand hygiene before and after wearing gloves? gloves are not impervious and have microscopic pores 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 care and patient safety What are V-tags and why are they important? they state specific regulations to be met within a condition such as infection control, providing interpretive guidance for each regulation and citing deficiencies by tag # Is a cleaned dialysis machine considered a 'clean area'? no When should sharps containers be removed from the treatment floor? when they are 3/4 full State the 3 strategies recommended by KDOQI to decrease the risk of infection when working with a CVC? - using facemarks when lumens or exit site is exposed - wearing clean gloves and avoid touching exposed surfaces - minimizing catheter lumen or exit sites from being exposed Who can use sinks dedicated for hand washing? teammates and patients What is the correct procedure in regards to your hands when you have casual contact with a patient? no gloves- but hand hygiene required How can you tell when a sink is clean or dirty in your facility? it is labeled Explain the HBV classification and state which test is performed monthly on HBV susceptible patients? HBsAg: Hepatitis B surface antigen - tested monthly for susceptible its and non-responders Anti-HBs: Hepatitis B surface antibody Anti-HBclgM: Hepatitis B Core AB-IGM How often are machine alarm tests performed? As part of the priming procedure and before the initiation of each patient treatment How long can a dialyzer be set up for once recirculation is complete? 2 hours and no longer because bacteria can grow then The manual conductivity value must match +/- _______ on the Fresenius (FMC) dialysis delivery system displayed conductivity. +/- 0.4 mS What is the safe dialysate pH range? between 6.9 and 7.6 What is "strikethrough" of an external pressure transducer and why is it of concern? 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 Why is it important for patient care teammates to know when the water treatment system disinfection was performed? because the end-to-end disinfection process will also introduce the disinfectant solution to the dialysis delivery systems through their water inlet lines The "reasonable and prudent" standard of care for nephrology nursing key concepts are: - the standard of care is that care which a reasonable and prudent nephrology nurse would give under the same or similar circumstances - the standard of care includes actions a reasonable and prudent nephrology nurse would do, as well as actions the nurse would avoid doing - in general, the standard of care for nephrology nursing is keyed to this specialty and the skills and knowledge expected of a nephrology nurse - following the standard of care makes the care given defensible and avoids negligence when supervising non-licensed, assistive personnel, it is the responsibility of the licensed nurse to ensure these teammates also meet the standard of care What role does DaVita's P&P play? standard of care best demonstrated practice prima facie evidence What are the risks of doing it your way? negligence proximate cause damages What are the four reasons why we document in the medical record? proof care was rendered provides data for continuity and planning of patient care communication tool permanent legal record List six occurrences when to chart: 1. baseline assessment 2. change from baseline assessment 3. change in patient's condition 4. procedure or treatment 5. medication given and patient response 6. patient teaching What are the appropriate times for documentation? pretreatment vitals and data collection observations during treatment post treatment vitals and data collection What are the possible consequences of poor or incomplete documentation? entries may be discarded it unable to read, can be left open to interpretation or attack on your care What are the 6 items included in charting administered medications? time and date route of administration reason for giving medication dosage reason for administering patient response What does SMART communication stand for? S- simple: keep message clear M- meaningful: think about what and why you are sending the message A- actual: just report the facts R- read: make sure you are sending the message you intend T- teach: others about SMART What are the 5 W's to be used when completing a REM? what when where why witness What are the 3 things you should not include in REM? personal opinions speculation vendettas What is the difference between data collection and assessment? Who does what? Assessment- Nurse - determining depth of edema - rate, rhythm, quality of heart sounds - respiration rate, difficulty, identifying unusual sounds Data Collection- PCT - nothing presence of edema - heart rate and rhythm - respiration rate, recognizing unusual sounds - machine parameters, safety checks What is the role of the PCT prior to treatment initiation? complete data collection and PCT must notify the RN if there are any abnormal findings prior to initiation of treatment What is the role of the RN prior to treatment initiation? access abnormal findings from data collection, determine appropriate interventions (based on physician orders) and contact physician if needed When is pre-treatment assessment by the RN required? based on state law (may be before or in first hour of treatment) or if data collection has abnormal findings for patients with AKI- a pretreatment assessment is always required What BP reading error can be caused by an incorrect cuff size? cuff too small- reading may be higher than actual BP cuff too large- reading may be lower than actual BP When is post-treatment assessment by the RN required? required by some states if there were unusual findings Target weight: - determined by physician order - TW is the physician-prescribed weight post-dialysis that the patient can safely and reasonably achieve -TW should be modified by the physician based on the patient's tolerance, ongoing signs of fluid overload, and changes in fluid status -must be adjusted in a timely manner so that the physician's most recent order is taken into account for each treatment. you may not adjust the TW retroactively Interdialytic Weight Gain (IDWG) Calculation: Pre weight - last post weight UF Goal Calculation: Pre weight - target weight + rinse back UFR Calculation: UF goal / tx hours What are the 4 consequences of sodium loading during dialysis? increased thirst large fluid gains more hypotension and ischemic events during treatment State 3 ways we can contribute to sodium loading during dialysis broth normal saline, hypotonic saline increased sodium in dialysate (high setting in machine or sodium modeling) What are the consequences if a patient is consistently fluid overload (hypervolemia)? LVH, increased CVP, hypertension, increased mortality, pulmonary edema, increased hospitalization rate [Show Less]
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PCT test (Davita) questions and answers with rated solution
what is REM and what is used to submit? Risk Event Management and unsafe condition, near miss, and an adverse event Sterile means free of all livi... [Show More] ng microorganisms and spores clean means not sterile, but disinfected such as a clean dialysis chair contaminated means that a sterile or clean item has come in contact with non-sterile object dirty means neither sterile or clean, but visibly contaminated Alcohol-bases hand rubs must contain 60-95% ethyl alcohol, isopropyl alcohol, or a combination of both How long should you wash your hands for? 20 seconds PPE includes what? gloves, gowns, masks, protective eye gear environmental surfaces are cleaned with appropriate disinfectant such as a bleach solution 1:100 one part bleach and 99 part water for visible blood or gross blood spills, a ______ bleach solution must be utilized 1:10 1 part bleach and 9 parts water when preparing patient assignments, teammates who care for confirmed or suspected hep B surface antigen (HBsAg) positive patient(s) will only be assigned to simultaneously care for surface antibody positive (immune) patients Although dialysis is a complex procedure, it is based on simple principles use of a semipermeable membrane, diffusion, ultrafiltration, convection, and osmosis what are the 3 treatment goals to achieve in dialysis? 1. Remove waste from the blood 2.remove excess water from the blood 3. balance blood electrolytes semipermeable membrane thin sheet of natural or synthetic material that allows some small particles to pass through, while blocking other, larger ones. what is a dialyzer and the 2 compartments artificial kidney and blood site and dialysate site what happens if the blood site and dialysate site mix? = blood leak what is dialysate (3 things)? RO water, acid bath, and bicarbonate what is an extracorporeal circuit? bloodline, saline, and dialyzer=set up What is diffusion? movement of dissolved particles across a semipermeable membrane from the side with the higher concentration to the side with the lower concentratio n. What is ultrafiltration? removes water from the blood by pushing it across the semipermeable membrane What is convection? or solute drag is when solutes move with the water across the semipermeable membrane. What is osmosis? is the movement of water across a semipermeable membrane from the side with the lower solute concentration to the side with the higher solute concentration After a chemical disinfection with bleach, how do you verify that the machine is free of residual bleach before you start setting up? check the fluid from the drain hose with residual chlorine test strip What is an acceptable test result when verifying the absence of residual bleach? less than or equal to 0.5ppm What is strikethrough? Saline rises in transducer allows for inaccurate readings. The back of transducer is checked for wet. If wet can contaminate machine. Pull for bio med. what is the only fluid we use to prime the blood lines and dialyze? sodium chloride 0.9% (normal saline) what is proportioned dialysate? even amounts of RO water, acid bath and bicarbonate The manual conductivity must match the dialysis delivery system displayed conductivity_________ +/- 0.4 mS of the theoretical conductivity (TCD) for Fresenius delivery systems The maximum recirculation time after a machine has been set up prior to treatment initiation cannot exceed _____ hours. 2 hours What is the rationale for limiting recirculation time? bacterial proliferation in the extracorporeal circuit may occur Some blood lines are equipped with external transducer protectors. What is the correct procedure to be followed once strikethrough of an external transducer protector has occurred? upon completion of treatment, the delivery system is to be removed from service and labeled with date, time, description of problem and name the teammate reporting the problem. the internal transducer protector will be changed by boomed tech. and delivery system will be disinfected prior to return use The acceptable range for proportioned dialysate pH is ____________ 6.9-7.6 When are dialysate conductivity and pH testing required to be performed? prior to initiating a treatment and whenever dialysate concentrate(s) (acid or bicarb) are changed or replaced during the course of the treatment If bleach and peracetic acid are mixed, a chemical reaction occurs, producing toxic chlorine gas What are the two requirements that must be met prior to initiating system disinfection? the treatment area must be patient free and no other processes are using the dialysis quality water What must be done to indicate the presence of disinfectant in the machines during system disinfection? notification of the type of disinfection is prominently displaced on each delivery system How do we verify the absence of chemical disinfectant following system disinfection on the first treatment day following the disinfection? facility teammates perform an independent chemical residual test prior to beginning the daily activities What is an acceptable test result when testing for the absence of peracetic acid? a level or less than or equal to 1 ppm Dialysate with a conductivity that is too low causes.... hemolysis, the bursting of RBCs. The color of hemolyzed blood is cranberry red. Dialysate with a conductivity that is too high causes... crenation, a shriveling up of RBCs. The color of the blood will be dark. The transport mechanism of osmosis is responsible for.... hemolysis and crenation as water leaves or enters RBCs. If the dialysate temperature becomes too hot... it can hemolyze RBCs. A dialysate temperature too cold s not life threatening but can chill the patient and cause hypothermic symptoms and may decrease diffusion Dialysate Flow Rate (DFR) is ordered by the physician as part of the prescription blood leak detector? checks for blood in dialysate during the treatment, air bubbles can cause false alarm during set up and priming and to correct check Hansen connectors and verify they are tight transmembrane pressure (TMP) equal to the venous pressure minus the dialysate pressure measured in mmHg. Blood Flow Rate (BFR) resistance to the flow establishes the pressures in the extracorporeal circuit Arterial Pressure (AP) blood pump pulls blood from the vascular access, this pressure is negative Venous Pressure (VP) After the blood leaves the dialyzer and is pushed through the venous drip chamber and back into the body, the pressure reading becomes positive water makes up about.. 90% of dialysate what are the 3 processes that make up the water treatment? pretreatment, water purification, and distribution what does AAMI stand for? Association for the Advancement of Medical Instrumentation pretreatment consist of? blending valve, black flow preventer, booster pump, depth filter, water softener, carbon tanks, RO pre-filter blending valve? Mixes hot and cold water to allow the RO to function at the most efficient temperature, which is 77 F for conventional systems. between 65 F to 85 F Backflow Preventer Prevents pre-treated water and disinfectants from backing up into the city water supply booster pump expectation tank catches additional pressure booster pump gives off [Show Less]
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Davita Final exam ,questions and answers with complete rated solutions
Per Davita policy, fever and chills is defined as a. Any temperature greater than 99°F or increase over baseline of 1°F with symptoms b. Any temperatur... [Show More] e greater than 99°F or increase over baseline of 1°F without symptoms c. Any temperature greater than 100°F or increase over baseline of 2°F with symptoms d. Any temperature greater than 100°F or increase over baseline of 2°F without symptoms c. Any temperature greater than 100°F or increase over baseline of 2°F with symptoms Documentation in the medical record a. Includes caregiver opinion. b. Belongs to the patient. c. Is a permanent legal record of the care provided d. Is not subject to review by surveyors c. Is a permanent legal record of the care provided The PCT notes that a patient still has considerable edema in her legs when performing the post-treatment data collection. In addition to informing the nurse, what should the PCT document? a. Leave the data collection entry blank b. Document "RN to assess" c. Document the noted swelling and that the RN was informed d. Document "N/A" since the nurse will assess and document c. Document the noted swelling and that the RN was informed When the patient's calculated UF Goal exceeds the maximum UFR ordered by the nephrologist a. The calculated UF Goal should be entered into Snappy and the UFR adjusted once the patient shows signs of becoming hypotensive b. The patient must give permission to exceed the ordered maximum UFR since fluid overload is harmful and every effort should be made to reach the ordered target weight c. The calculated UF Goal must be adjusted to not exceed the ordered maximum UFR and the reason documented d. The charge nurse must assess the patient prior to treatment initiation to determine a safe UF Goal for the patient c. The calculated UF Goal must be adjusted to not exceed the ordered maximum UFR and the reason documented DQI (Davita Quality Index) is achieved by a. Managing individual patients first and allowing scores to follow b. Knowing each team member's role in improving DQI scores c. Using the CQI process to help identify trends and make improvements d. All of the above d. All of the above Per the CDC, which is the most common factor contributing to bacteremias in dialysis patients? a. Inappropriate skin preparation prior to vascular access needle insertion b. The use of catheters for hemodialysis c. Poor needle site rotation when cannulating an internal vascular access d. Exposing needle insertion sites to unclean environment areas, e.g. contaminated chair side tables during dialysis b. The use of catheters for hemodialysis Which statement is true about sinks used for hand washing? a. Patients may not use sinks that are dedicated for teammate hand washing, but should have their own sinks b. Hand washing sinks may be used to discard clean solution such as left-over normal saline in a sterile bag c. Hand washing sinks must be dedicated for hand washing purposes only and should remain clean d. Hand washing sinks may be used to discard bleach solution since the solution kills germs and has the added benefit of disinfecting the sink c. Hand washing sinks must be dedicated for hand washing purposes only and should remain clean If a patient presents with dialysis associated pericarditis, treatment includes more frequent dialysis and a. Heparin restriction to prevent bleeding into the pericardium and tamponade b. A higher potassium bath to prevent dysrhythmias c. A lower BFR and DFR to prevent dialysis disequilibrium syndrome d. An increased BFR and DFR to increase toxin removal a. Heparin restriction to prevent bleeding into the pericardium and tamponade If your facility dialyzes Hepatitis B positive patients, which assignment would NOT be an appropriate patient care assignment a. Caring for HBsAg positive and Hepatitis B immune patients at the same time b. Caring for HBsAg and Hepatitis B susceptible patients at the same time c. Caring for Hepatitis B susceptible patients and those in the process of receiving the vaccination at the same time d. Caring for Hepatitis B immune and susceptible patients at the same time b. Caring for HBsAg and Hepatitis B susceptible patients at the same time The best way to help patients successfully change behaviors is to a. Scare them through describing serious health risks of the current behavior b. Tell them how to accomplish the desired change c. List medically sound reasons why change is necessary d. Inspire behavior change through support, compassion, and empathy d. Inspire behavior change through support, compassion, and empathy Your patient complains of dry itchy skin. You would advise her to a. Take frequent hot showers b. Rub skin completely dry after a bath c. Use hyper-fatted soaps and lotions d. Eat foods rich in fatty acids c. Use hyper-fatted soaps and lotions Which statement is true regarding the stages of grief? a. To come to a place of "Acceptance" one must follow the right way to work through the stages b. Some people can get stuck in a stage c. Once acceptance is achieved even complications like access problems cannot start the grief process anew d. Patients go through a common stepwise progression through each stage of grieving process b. Some people can get stuck in a stage The acronym DARN stands for a. Desire, Ability, Reason, Need b. Deficiency, Ambition, Rationality, Neediness c. Design, Aspiration Requirement, Negativity d. Demand, Accomplishment, Requisite, Necessary a. Desire, Ability, Reason, Need Convection is defined as a. Solutes are dragged across the semipermeable membrane along with fluid b. Controlled fluid removal by manipulation of hydrostatic pressure c. Particles move from an area of higher solute concentration to an area of lower solute concentration d. Fluid moves from an area of lower solute concentration to an area of higher solute concentration a. Solutes are dragged across the semipermeable membrane along with fluid The three core communication skills used in motivational interviewing are a. Monitoring, persuading, advising b. Explaining, comprehending, adapting c. Asking, listening, informing d. Inquiring, directing, informing c. Asking, listening, informing hemodialysis helps normalize body pH through a. Diffusion of acids from the blood into the dialysate b. Convection of bicarbonate during backfiltration c. Diffusion of bicarbonate from the dialysate into the blood d. Stimulation of the respiratory system to increase exhalation of acids c. Diffusion of bicarbonate from the dialysate into the blood The excretory function of the kidney is: a. Erythropoietin production b. To bind to phosphorus c. To absorb vitamins d. To normalize electrolytes d. To normalize electrolytes Unless otherwise directed by the manufacturer or state specific pharmacy regulations, when must medications containing a preservative be discarded? a. At 28 days after opening b. At 25 days after opening c. At 23 days after opening d. At 21 days after opening a. At 28 days after opening Educational tips for visual learners include a. Providing soft background music b. Selecting quiet surroundings c. Using lively hand gestures when delivering long lectures d. Allowing plenty of time for the patient to talk b. Selecting quiet surroundings An optimal nutrition status is evidenced by a. An appropriate amount of energy, ability to sleep well at night, serum potassium of no greater than 5.5 mEq/L, and a BUN of 60-80 mg/dl b. A 30 minute exercise tolerance, calcium 8.4-10.2 mg/dl, phosphorus 3-5.5 mg/dl and PTH intact 150-600 pg/ml c. Patient report of feeling well, no excess fluid weight gains, bringing appropriate snacks to dialysis, and taking phosphate binders with every meal d. A stable, desirable target weight, adequate fat stores and muscle mass, appropriate appetite and intake, and a serum albumin of equal to or greater than 4 gm/dl d. A stable, desirable target weight, adequate fat stores and muscle mass, appropriate appetite and intake, and a serum albumin of equal to or greater than 4 gm/dl When comparing the FMC dialysis machine's conductivity reading to your manual reading, policy states that the difference between these two readings is to be a. No greater than +/- 0.4 b. No greater than +/- 0.3 c. No greater than +/- 0.2 d. No greater than +/- 0.1 a. No greater than +/- 0.4 Which statement is true regarding the "Reasonable and Prudent" Standard of Care? a. The Standard of Care is based on providing highly specialized care after a caregiver is certified b. Caregivers who are doing it "their way" without regard to DaVita P&P can easily defend their actions in the event of an adverse patient outcome c. The Standard of Care only includes actions a nephrology nurse would do, but not those the nurse would avoid doing d. When supervising patient care technicians an other non-licensed personnel, it is the responsibility of the licensed nurse to ensure these teammates also meet the Standard of Care d. When supervising patient care technicians an other non-licensed personnel, it is the responsibility of the licensed nurse to ensure these teammates also meet the Standard of Care What is an important action prior to returning a patient's blood using the hand crank in the event of a power failure? a. Take the patient's blood pressure b. Check for a blood leak c. Place the machine into bypass d. Remove the venous line from the line clamp d. Remove the venous line from the line clamp The KDOQI (Kidney Disease Outcomes Quality) Rule of 6s a. Provides guidelines for use of a new AV fistula b. Provides guidelines for use of a new AV graft c. Provides guidelines for use of a new AV fistula and a new AV graft d. Provides guidelines for use of a tunneled CVC a. Provides guidelines for use of a new AV fistula During cannulation of all AV fistulas a. A tourniquet is to be applied to increase vein engorgement and stabilize vessel b. A tourniquet may be applied to increase vein engorgement if deemed necessary by the cannulator c. A tourniquet to increase vein engorgement is not necessary if the AVF is well developed d. Tourniquets should not be applied to decrease the risk of AVF clotting a. A tourniquet is to be applied to increase vein engorgement and stabilize vessel At what time do you perform water hardness testing? a. At the beginning of each day prior to the first treatment b. About halfway through your treatment day c. Every four hours d. At the end of the treatment day d. At the end of the treatment day [Show Less]
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Final Version of Davita test, questions and answers with rated solutions
what treatment factors decrease K in the Kt/v to decrease? not waiting 3-5 minutes after heparin, decreasing BFR, DFR, and BVP what factors influen... [Show More] ce "V" in Kt/v accurate data entry by nurses in snappy, sex age, weight, and amputation what are the needle gauges and prescribed blood flow rates? they are inversely related 17g 200-250 15g 250-350 15g 350-400 14 g 400 - 450 what is the procedure for post BUN lab draw? if pt wants off early, still draw the labs and educate patient about the risks. Redraw next time a pt runs full tx to show pt difference what lab draw mistakes would falsely increase Kt/V not waiting the full 15 seconds What is important when monitoring weight and BP in AKI patients? keep patients wet (hydrated) and avoid hypotensive episodes = cause renal ischemia What do you need to consider in regards to CVCs? follow P&P b/c the risk of infection is so high Why is it important to know what caused a patients chronic renal failure? we need to know about possible problems during data collection and assessment What is the role of the PCT prior to tx initiation? assessment of pt if any abnormal findings or if the pt is in an acute condition what happens in the BP cuff is the wrong size loose BP--> high reading tight BP --> low reading why is it so bad to squeeze the BP cuff if its connected to the machine? it can damage the internal BP mechanism Why is it so important that we document in the medical record? it provides data for continuity and planning of care when do pre-treatment data collection and assessment take place? collection: before tx assessment: w/in 1 hr if pt is stable when is post-treatment data collection and assessment performed? post treatment-- not before treatment or when they are disconnected what are the consequences of poor or incomplete documentation can open attack on your care What are the six items needed in charting meds? 1. med/dosage 2. date/time 3. route 4. reason (remember this!) 5. pt response 6. signature What are the 5 Ws to be used when completing an AOR? who what when where why how What are the 4 consequences of sodium loading during dialysis? 1. increased thirst 2. increased fluid intake 3. increased intradialytic weight gain = htn 4. increased UFR what is the purpose of UF profiling? change the way fluid is remodeled during the tx and allows for vascular refilling what are the consequences of hypovolemia during tx? attempting to remove a lot of fluid --> hypovolemia during tx --> loss of renal function, ischemia, and increased mortality rate what must the machine's conductivity and pH reading supposed to be? machine and manual conductivity: w/in +/-0.4 pH range: 6.9 - 7.6, measured to verify acid/base balance is in acceptable range at what temperature does hemolysis occur? 42 degrees C What do we do in a power outage? remove venous line from air detector, clamp, before starting hand crank and be diligent in watching for air in blood lines what causes a high venous pressure alarm? kink in tubing, clotting in venous drip chamber, infiltration, venous stenosis what are the risks of doing things "your way" and not the P&P way? it can lead to civil liabiliy what makes dialysis pts more susceptible to healthcare acquired infections? prolonged access to pts blood, and immunocompramised why are dialysis pts at an increased risk for acquiring HAIs at the facility? contact transmission what is the most common transmission route for HAIs contact transmission--> hands what is the most important invention you can do to prevent HAIs? handwashing what is the most common infectious complication in hemodialyisis pts? per the CDC, the most common factor contributing to bacteremia is use of CVCs What germ causes the most common infections in hemodialysis pts? MRSA which can remain on surfaces for days w/ plastic vinyl being most favorable to their survival why is wearing gloves so important? decrease risk of hand contamination and prevent transfer of organisms already on hands what is the correct procedure in regards to your hands when you have causal contact w/ a pt no gloves but must perform hand hygiene before care on pts Successful lab draw must knows follow order the lab draws to prevent specimen from being contaminated w/ other tube additives, double labeling tubes prohibits processing rules for spinning samples only spin tube of some kind of size and fill level and should be placed opposite of each other What are the symptoms of hyperkalemia? extreme muscle weakness abnormal HR, cardiac arrest what are the symptoms of hypokalemia? fatigue, muscle weakness, respiratory failure what is the primary cause of erythropoietin? primary cause how can you prevent contributing to blood loss? --adequate heperanization --ensure epo given -- completely rinse back blood --avoid repeat lab draws what is pericarditis? what is included in its treatment? w/ dialysis hold or decrease heparin systemic effects of CRF what should you do for a pt that complains of dry, itchy skin use hyperfatted soaps and lotions what should you do for a pt that complains of peripheral neuropathy? educate pt not to walk barefoot, frequent foot checks, check temp of bathwater What are the four key elements affected in CKD-MBD Ca2+ PO4 parathyroid hormone vitamin D what are the symptoms of CKD-MBD in addition to bone disease? soft-tissue calcification what is the best way to help pts successfully change behaviors? inspire behavior change through support, compassion, and empathy What does DARN stand for? desire, ability, reason, need FYI from Meghan: know the questions at the end of the motivational interviewing hand out (one of the PCTs at Red Hawk told me this_) fyi when should the communication style "directing" be used? best used when training to perform procedures what are the three core communication skills to be used w/in the communication style? asking listening informing what is the righting reflex? automatic intervention of a healthcare practitioner who observes pt doing something detrimental to his/her health What is reflective listening? includes main aspects of what the pt said during the entire communication what are the four transport mechanisms that play a role in hemodialysis? ultrafiltration convection diffusion osmosis what is important when monitoring pt weight and BP? keep patients wet and avoid hypotensive episodes b/c it can cause kidney injury what do you need to consider in regards to their vascular access? follow P&P to prevent infections why is it important to know what caused your patient's CRF? to inquire about possible problems during data collection and assessment how often do we screen for Hep C? yearly for patients and teammates tips to remember for successful lab draws 1) follow order of lab draws to prevent specimens from being contaminated with other tube additives 2) double labeling tubes prohibits processing rules for spinning samples only spin tube of same kind, size, and fill level and should be placed opposite of each other systemic effects of CRF what would you advise for a pt who complains of dry, itchy, skin hyperfatty soaps and lotions systemic effects of CRF- what would you advise for a patient who complains of peripheral neuropathy? no walking barefoot, check water temp before baths what would you advise for a patient who complains of psychological problems? depression, brain fogginess what are the foru key elements affected in CKD-MBD Ca2+ Phosphorus Calcitrol Parathyroid what are symptoms of CKD-MBD in addition to bone disease? soft tissue classification what is your role in CKD-MBD in addition to bone disease? soft tissue calcification what is your role in CKD-MBD management? pt education how much normal kidney function is replaced by HD? 15% What does DARN stand for? D-- desire A-- ability R-- reason N--need One component of the directing style is: a) being in charge b) seeing through the other person's eyes c) understanding through listening a) being in charge One component of the following style is a) eliciting behavior through patient's own insights and motivations b) giving instructions c) understanding through listening c) understanding through listening One component of the guiding style is a) allowing to sort things out in one's own time b) being a knowledgeable resource c) expecting compliance b) being a knowledgeable resource The three core communication skills used in motivational interviewing are? a) monitoring, persuading, advising b) explaining, comprehending, adapting c) inquiring, directing, following d) asking, listening, informing d) asking, listening, informing The four guiding principles in motivational interviewing can be remembered by the acronym a) GUIDe b) RULE c) PRINce d) MOTIv b) RULE The righting reflex is defined as the automatic intervention of a healthcare practitioner who observes a patient doing something detrimental to his/her health The EPE (elicit-provide-elicit) approach allows the healthcare professional to work with the patient and emphasizes patient's active involvement in his/her own healthcare Summarizing during reflective listening a) recalls the patient's resistance statements to change and summarizes reasons for change b) summarizes strategies for change based on the practitioners expertise c) includes main aspects of what the patient said during the entire communication d) includes the practitioners opinion of what the patient said during the entire conversation a--> not 100% sure but pretty sure The best way to help patients successfully change behaviors is to a) scare them through describing serious health risks of the current behavior b) inspire behavior change through support, compassion, and empathy c) tell them how to accomplish the desired change d) list medically sound reasons why change is necessary b) inspire behavior change through support, compassion, and empathy Which of the following statements is NOT an underlying assumption of self management? a) regardless of the chronic condition, people have similar challenges with self-management b) people can learn the skills needed to better manage their diseases day to day c) people with complex chronic conditions such as ESRD have more difficulties with successful self-management d) people who understand and take control of their condition will be healthier and happier c) people with complex chronic conditions such as ESRD have more difficulties with successful self-management Which of the following is a basic principle of patient self-management? a) focusing primarily on dialysis prescription and adherence to treatment b) dealing with the consequences of illness, rather than just the physical disease c) taking on responsibility of the medical management of the illness d) allowing care providers to help with the day-to-day management of the disease b) dealing with the consequences of the illness, rather than just the physical disease Andragogy takes into account a) that adults desire to take responsibility for what they learn b) that adults are more set in their ways and need more direction than children c) the adults recognize the instructor's expertise and responsibility for the curriculum d) that adults depend on the instructor's instructions when learning complex skills a) that adults desire to take responsibility for what they learn Motivational Interviewing a) is based on the healthcare provider's motives to assist patients in making good healthcare decisions b) allows healthcare providers to motivate patient's to making better healthcare decisions c) assists healthcare providers in confronting patients harmful beliefs d) helps healthcare providers understand the patient's concerns and perceptions about living with ESRD d) helps healthcare providers understand the patient's concerns and perception about living with ESRD The definition of health literacy includes a) the degree to which individuals understand basic health information b) the degree to which individuals are knowledgeable in healthcare terminology c) the degree to which individuals an perform appropriate self-care d) the degree to which individuals understand their rights and healthcare consumers a) the degree to which individuals understand basic health information healthcare professionals can help patients with low health literacy by: a) asking patients if they can read before giving them written instructions b) organizing information so that the most important points stand out and repeating this information c) asking simple questions that a patient can answer with a "yes" or "no" b) organizing information so that the most important points stand out and repeating this information Educational tips for visual learners include: a) providing soft background music b) using lively hand gestures when delivering long lectures c) allowing plenty of time for the patients to talk d) selecting quiet surroundings d) selecting quiet surrounding Educational tips for auditory learners include: a) providing background music of the patient's choice b) incorporating the patient's secondary learning style c) using word associations and mnemonics d) minimizing use of written materials c) use word association and mnemonics educational tips for kinesthetic learners include: a) taking short breaks allowing your patient to get up and walk around b) allowing the patient to doodle during long lectures c) using outlines, pictures, graphs, charts, and diagrams whenever possible d) letting the patient watch videos a) take short breaks and allow your patients to get up and walk around What is the 2-4-8 rule for teaching patients complex skills? 2 hours: maximum length of uninterrupted training 4 hours-- maximum total of training per day 8 days-- minimum number of training days Organ donation in the US adheres to a) the "opt-in" principle b) presumed consent a) the "opt-in" principle Which of the following is NOT a task of organ procurement organizations a) recover the organ from deceased organs for transplantation b) collaborate w/ health care professionals to approach families of potential organ donors c) manage the national transplant waiting list, matching donors to recipients d) educate the public about organ donation I think it's b, but I'm not completely sure [Show Less]
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Davita, questions and answers with rated solutions
-How did you hear about DaVita? A few months ago, I was researching various career paths in healthcare in order to map out goals for myself. Through my re... [Show More] search, I stumbled upon a web page about Dialysis Technicians and it immediately grabbed my attention. After learning more about the job field and what the role would entail, I got excited because it had every aspect that I had been looking for in a job, and I knew I had finally found the perfect role for myself. So I began looking for schools in my area, and the number one name that kept popping up was DaVita. I noticed that the name sounded really familiar, and I realized it was because there is a clinic right here in East Lansing and I had seen a job posting on Indeed back when I started looking into healthcare positions. As I learned more about DaVita, it quickly became the number one company that I wanted to work at. So I set a job alert on indeed specifically for DaVita, and that's how I ended up seeing the PCT job posting. -Why do you want to work for DaVita? ... -Tell me about yourself? ... -Tell me about what your doing now? ... What does a leader mean to you? ... -Do you mind working long hours and or arriving to work at 4:30am. ... How much are you looking to get paid an hour. ... Why i wanted to work there. where did i see myself in 5 years ... What were my goals for the future/what I felt like I would bring to the company? ... How I felt about body fluids? ... How much direct patient care experience I had? ... describe a situation in which you had to adapt your style to fit the people involved. (over 20 years ago for a different position) ... Why did I apply for this position? (asked in 2016) ... I had to tell them a little bit about myself. When would I be able to start? ... Where do I see myself in 10 years? ... What are some of my long term goals? ... how do you handle stress ... Know your talents and learn how to highlight them. prepare for the interview, know about the company. they will also place you through several different types of interviews ... Notes on interview process::: I had a phone interview and in person interview the same day. The next day I completed my 3 hour shadow. Two days later I received a job offer contingent to passing a drug/ background check. The background check took a little over a week. Unlike most jobs checking for a criminal background check, they contact all employers you worked for within the last 7 years. If they are unable to do so, you will need to provide W2's or check stubs as proof of employment. This was the most stressful part of the process for me. They also contact schools to verify HS Diploma or any degrees obtained. For me, I was hired within 9 days. Can be one on one with the FA or another individual, you also get phone screened by the recruiting team. Know your talents and learn how to highlight them. prepare for the interview, know about the company. they will also place you through several different types of interviews Application, phone interview, face-to-face first interview, call back for a second interview. Job offer is based on your shadow day and if the current techs like you and feel you would be a good fit ... skillz that you have DATA ENTRY EXPERIENCE - PROVEN ACCURACY personal assistant and currently DSP at origami \ ... When someone ask you in a interview what don't you like about yourself what are you suppose to say? ... What are some tips for doing well at the panel interview? Commitment and knowledge of kidney failure Be prepared with questions beforehand and be familiar with the company. Be honest, as it's the best policy. Ask about specific job roles, hours, weekends, growth within the company. Describe yourself?How do you handle the pressure? ... Most questions ask about your educations, experience, certifications and problems you have faced during your career. ... POSSIBLE PHONE INTERVIEW QUESTIONS!! How was you handle the pressure when there is work load? Where do you see yourself in 5 years with this company? ... A couple of questions like: tell me the day when you.... this kind of questions are not helpfull at all for the interviewer to know the candidate because the question not always apply to you but they do not accept negative answer so you have to make it up and lie. ... [Show Less]
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DaVita's PCT Final Exam, questions and answers graded A+
Ultrafiltration is defined as: Fluid pushed through the semipermeable membrane If a patient with acute kidney injury (AKI) dialyzes in the outpatie... [Show More] nt facility, one task of the patient care teammates is to monitor blood pressure and weight closely. Why is this important? Hypovolemia and hypotensive episodes can cause renal ischemia and can further damage the kidneys. ***The underlying cause of prerenal kidney failure is hypovolemia or poor perfusion. Care must be taken to understand patients who are at high risk. Your role in anemia management includes: Rinsing back as much of the patient's blood as you can at the termination of each treatment. During dialysis, the movement of bicarbonate from the dialysate into the blood: The diffusion of bicarbonate helps the patient to achieve acid-base balance by buffering the hydrogen ions. The transport mechanism when particles move from an area of higher solute concentration to an area of lower solute concentration is called: Diffusion Convection: solutes dragged across SPM Osmosis: low to high TRUE OR FALSE: Hemodialysis patients are at increased risk of contracting Hepatitis B. True, the virus can be transmitted from the use of multidose drug vials and contamination of medical equipment. Dialysis patients are immuno-suppressed. A common reason how Hepatitis B is transmitted from a patient to a healthcare worker is: 1. Penetration of the skin by sharps 2. Contact of blood with broken skin or mucous membranes If your facility dialyzes Hepatitis B positive patients, which assignment would NOT be an appropriate patient care assignment? Caring for HBsAg and Hepatitis B susceptible patients at the same time Appropriate personal protective equipment (PPE) should be worn whenever there is potential for contact with blood or bodily fluids, hazardous chemicals, contaminated equipment, and environmental surfaces. PPE includes: Gloves, gowns, mask and eye protection (full face shield or goggles). Handwashing at a designated clean sink should be performed for a minimum of: 20 seconds Contact transmission is the most important route through which infections are spread. Contact transmission is defined as: Transmission of microorganisms through healthcare workers hands. Per the CDC, which is the most common factor contributing to bacteremias in dialysis patients? The use of catheters for hemodialysis. Teammates caring for a patient with active Clostridioides difficile (C-diff) infection are required to: Perform frequent hand washing with antimicrobial soap, as alcohol-based hand gels may not be effective to eliminate C. Diff. To prepare a 1:100 bleach solution, you would Add 1 part bleach, 99 parts water. A 1:10 bleach solution is used to Clean up visible blood or gross blood spills According to Policy and Procedure, gowns: Must be fully snapped up (or tied at the neck and waist) and wrists covered. Why is a "strikethrough" of an external pressure transducer protector of concern? Fluid could have entered the machine and contaminated the internal pressure transducer protector providing a reservoir for microorganisms and causing subsequent patient blood infections. What is the safe range for dialysate pH? The desired pH range is 6.9-7.6. What is the correct procedure for residual bleach testing after chemical disinfection of distribution loops and equipment fluid pathways? Residual bleach testing is performed after bleach disinfectant and prior to use. Which is a true statement regarding the monitoring, testing, and verification of conductivity prior to each patient treatment for all Fresenius machine models and the B Braun system? B Braun Conductivity: ENDLF, N/A->13.0-15.5 range Fresenius Conductivity: ? To avoid bacterial proliferation (rapid reproduction) within the extracorporeal circuit, once primed the recirculation of saline within the dialyzer and blood lines should not exceed______ prior to initiating the hemodialysis treatment. 2 hours Machine alarm tests are performed: Before the initiation of each patient treatment. TRUE OR FALSE? Procedures provide a step-by-step series of actions, processes, or measures to be taken to implement or address a particular activity, system, or problem. True When using an automatic blood pressure cuff on a patient with an irregular heartbeat The recorded blood pressure may be inaccurate. This electrolyte plays a major role in muscle contraction and high or low levels can lead to weakness or cardiac arrest. Potassium Post-treatment, a patient complains of a headache and there was a noted temperature increase to 98.8°F from the pre-treatment baseline of 96.6°F. What follow up is required before patient discharge? This is considered a fever which should be investigated A post treatment patient assessment -Is completed to verify that the patient is stable, to determine the patient's discharge status, and to evaluate the effectiveness of the treatment plan. -Is compared to the patient's pre treatment assessment findings -Requires the licensed nurse to notify the physician as needed of changes in patient status For a patient who can stand, a post-treatment blood pressure reading of _______ is considered an abnormal finding and should be reported to a licensed nurse, per DaVita Policy Normal range: 120/80 mm Hg or less Orthostatic hypotension: drops by at least 20 mmHg during transition from lying down to standing up, or when diastolic blood pressure (the bottom reading) drops by at least 10mmHg within three minutes after standing. What is considered a normal heart rate? 60-100 bpm A patient has an adverse reaction within minutes of treatment initiation. The patient's pre-treatment data screen shows no patient information entered. What should have occurred prior to initiating treatment according to DaVita policy and procedure (P&P)? There's no proof that pre-treatment safety checks were completed or the patient had been properly assessed. The pre-treatment patient assessment by the licensed nurse is required It is required before treatment is initiated. TRUE OR FALSE? All pre-treatment data findings and machine safety checks are required to be entered into the IT Clinical System before treatment initiation. True TRUE OR FALSE? If a PCT documents the extent of a patient's edema as +3, the PCT is performing an assessment that is not within their scope of practice under local, state, or federal regulations. True Why is it important post-treatment to document the dialyzer appearance and hemostasis duration (the time it takes to stop actively bleeding) after removal of the needles from the arteriovenous fistula (AFV)/arteriovenous graft (AVG)? Making sure the treatment went smoothly & no clots are in the dialyzer (Appearance: streaked, clear, light, dark). Making sure the patient is safe to leave (sitting/standing bp, temperature, BVP). Patient vital signs, well-being evaluations, and machine checks must be performed a minimum of: Interval of 30 minutes. The purpose of documentation is to provide - proof that care was rendered - provides continuity - permanent legal record - communication tool When to chart (6 occurrences) - change from baseline assessment - change in pt's condition - pt underwent a procedure or treatment - medication given and response - pt teaching - care plan review and interventions Preventing hypotensive episodes during dialysis treatment is important because hypotension is associated with Higher mortality rate Removing too much fluid during a treatment may cause: Hypovolemia... during treatment which increases mortality, Ischemia and damage to vital organs( organs stunning)- loss of residual renal function. Mrs. Thirsty's target weight is 73kg. Her pre-dialysis weight is 76.3kg. Her last post-weight was 74.2 kg. What is Mrs.Thirsty's UF goal today (not including prime & rinseback)? PW - TW = UF GOAL 76.3 - 73 = 3.3 kg (not including prime & rinseback) What common symptoms would alert you that a patient's target weight may need to be decreased? Hypertension, peripheral edema, lung congestion What three common symptoms would alert you that a patient's target weight may need to be increased? Excessive nausea and vomiting, diarrhea, returning to clinic after hospitalization An arteriovenous fistula (AVF): A surgical connection between and artery and a vein beneath the skin of an arm or leg to provide access to the blood. The venous needle is placed: Antegrade or with the flow of blood. Which statement is true about Providone Iodine? Effective contact time is 30 seconds and air drying time is 2 minutes Which of the following is NOT an acceptable way of dressing cannulation sites post-treatment? Wrap and encircle the access extremity with tape or gauze When cannulating an arteriovenous fistula (AVF)/arteriovenous graft (AVG), the needle tips should be At least 1.5 inches apart [Show Less]
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final exam davita, questions and answers| latest updated
what is the difference between data collection and assessment? who does what? data collection:yes or no assessment: the extend. what is the role o... [Show More] f pct prior to treatment initiation? data collection notify nurse of any abnormalities what is the role of the licensed nurse prior to treatment initiation? nurse assessment when us a pre-treatment assessment by the licensed nurse required? if vitals were abnormal when is post treatment assessment by the licensed nurse required? up normalities during treatment. note about bp squeezing the auto blood pressure cuff to speed deflation can damage machine internal bp module. why do we document in the medical record? 4 reasons 1.proof that care was rendered 2.provide data continuity 3.permnent legal record 4.communication tool list 6 occurrences when to chart? 1.change from baseline assessment 2.change in patient condition 3.procedure for treatment 4.medication given 5.patient teaching 6.care plan review and intervention pre-treatment data collection/ assessment before treatment intuition assessment within one hour if pt is stable for nurse post treatment data collection/assessment post treatment only what are possible consequence of proof or incomplete documentation? poor or incomplete documentation can open an attack on your care what are the 6 items included in charting administered 1.medication dosage 2.data and time 3.route for administeration 4.pt response 5.signiture of teammate adminsteration 6.allergies always check the allergy screen in screen in falcon for a list of your pt. how do you document charting errors single line sign and date what does SMART communication stand for Simple and clear Meaningful Actual Read Teach what are the 5 w's to be used when completing an AOR what where who when why what are the four consequence of sodium loading during dialysis .thirst 2.fuid intalle 3.idwg;headaches +hypertenstion 4.ufr what treatment factors decreases K? not waiting 3-5 minutes after giving Heprin what factors influence V? on average a persons body composed of 50-55 % water. a person height weight sex,age and amputation are included in calculating V lab draw mistakes that would falsely increase kt/v? not waiting 15 second when is post treatment blood sample draw too high? waiting only 5 seconds between lowering the blood pump speed and drawing post treatment blood sample would cause the kt/v reading to be too high is it okay for pt to come off early on lab day? If pt wants to get off early educate pt risk involved.and still draw lab and re-draw on full treatment (every time) what is important when monitoring weight and bp? acute patient only-keep pt wet and avoid hypotensive episodes. what do you need to consider in regards to their vascular access? follow p and p to prevent infection why is it important to know what caused your patients CRF? its important to know to help inquire about possible problem during data collection and assessment. what is the purpose of uf profilling? purpose of uf profiling the way fluid removed during treatment allow time for vascular refilling what are consequence if patient is consistently fluid overloaded(hypervolemia)? hypertension, left ventricular hypertrophy, cardiovascular disease what can cause hypovolemia ? attempting to remove large amount of fluid weight for patient can lead to hypovolemia what are conductivity and ph alarm causes? machine conductivity ad manual reading can be no greater or less then 0.4 difference. after test use phenix meter to: measure ph in dialysate to verify acid base balance with acceptable range what are temperature alarm causes? hemolysis occurs at 42 Celsius or higher. power appropriate intervention 1.remove venous line from air detector clamp before starting Hand cracked. 2.be delight watching for air venous pressure high alar causes more positive cinck in tubing/clamp,infilteration,venous stenosis. clotting in venous drip chamber the reasonable and prudent standard of care for nephrology nursing: key concept when supervising non license personal.it is the responsibility of the license nurse to ensure also teammate meet standard of care. what role does Davita p&P play? policy is guide lines principle "the why" what are the risk of doing it your way ? civil liability what makes dialysis patient more susceptible to HAIs? weakened immune system prolong accès to pt blood why are dialysis pt at increased risk for acquiring a HAI at the facility? contact transmition wha tis the most common transmition route for HAIs? contact transition what is the most important intervention you can do to prevent HAIs? hand hygiene wha tis the most common infectious complication in hemodialysis pt? 1.vascular access infection 2.per cdc the most common factor contributing to bacteriumia is use of cvc. what germ causes the most common infections in hemodialysis pt? MRSA MRSA can remain on service for days. being most favorable to survival why is wearing gloves important? function of gloves decrease the risk of hand contamination. successful lab draws know the 20 tips follow the order of draw to prevent specimens from being contaminated with other tube additive double labeling tubes prohibits processing what is rule of spinning samples? balance, spin tubes of same kind size fill level and should be placed opposite of each other. what are signs and symptoms of hyperkalemia high potassuim-muscle weakness, abnormal heart rate what are signs and symptoms of hypokalemia low potassium-muscle cramp abnormal heart rate cold how can you prevent contributing to blood loss? 1.adequte heparinzation giving heprin why are patients anemic ? lack of (ego)erythropoietin what is pericarditis? what is included in its treatment ? no heparin hold or decrease heparin peripheral neuropathy check temperature of bathwater don't walk bare feet frequent foot check what are the 4 key elements affected in CKD-MBD? 1.calcium 2.phosphorous 3.parathyroid hormone 4.vitment D what does the acronym DARN stand for? desire ability reason need when should the communication style directing be used? when training to perform procedure what are the 3 core communication skills to be used within the communication styles asking, lisening,involving what is the best way to help pt successful change behavior? the best way to help pt successfully change behavior is to inspire behavioral change through support, compassion and empathy. summarizing skill includes main aspect of what the pt said during the entire communication writing reflex in automatic intervention of health care practitioner who absorbs a pt doing something detrimental reflex. is there an order to work through the 5 stages of grief? NO what is KDQOL 36? kidney disease quality of care of life it is an assessment tool used for social workers to identify barriers what is KDQOL used for? social worker complies result and develops goals with the pt are social workers available to caregiver? social worker available for caregivers strangling to meet demands of pt treatment regiment 4 transport machisms that play role in hemodialysis 1.ultrafilteration 2.convection 3.diffustion 4.osmosis what is ultrafilteration? controlled fluid removed by manipulation.removes fluid only what is convection? salutes are dragged with water. saluts and water what is diffusion ? particles move from high concentration to low construction.only particles what is osmosis ? fluid from lower to high.zuccni what are the kidney endocrine function? 1.produce renin.regulate 2.erythropoetin 3.activiation of fitment d which convert (calibrated bone disease what is the function of bicarbonate? diffusion of bicarb from dialysate to blood helps normalize body ph consequence of organ stunning? hypotension can have many adverse affects includes impaired tissue prevention of vital organs. muscle cramps intervention decrease or turn off uf offer to stretch we don't want to dialoged clot. fever and chills defention any temperature greater then 100 fahernhit or increase over baseline of 2 fahrnihit with symptoms. 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