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]