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 [Show Less]