Dialysate is kept in the temperature range of...
34.5-36.5°C
Too warm dialysate can...
Cause the patient's RBC's to burst (hemolysis), as well
... [Show More] as, cause hyperthermia.
Too cold dialysate can..
Cause the patient's to feel cold and less diffusion of dialysate will occur. However, slightly cool dialysate can help prevent deadly hypotension and organ stunning due to the constriction of blood vessels.
Conductivity definition
How well fluid conducts an electrical charge (should be isotonic).
Theoretical conductivity (TCD)
Based on the prescription. Should be close to the actual (+/- 0.5)
Low conductivity can cause...
Is diverted to drain too much H2O. Can cause RBC rupture which increases K+, and pt can have s/s of hypoxia due to hemolysis.
High conductivity can cause...
Hypertonic solution where there is too little H2O...H2O is leaving the cell to dilute sodium content outside the cell (crenation).
pH definition
Hydrogen ion concentration of a solution.
• Failed kidney's don't secrete bicarb and can't get rid of acid (CO2) so the pt is acidotic. Which is why bicarb is increased in the dialysate solution.
pH of dialysate is...
6.9-7.6
Use of a diasafe filter allows the production of?
ultrapure dialysate
Air is removed from the extracorporeal circuit before initiating treatment because it may cause ____ when trapped in the dialyzer.
Clotting
The most likely cause of contamination of the extracorporaeal circuit are ____ in the prime bucket ____ end caps.
bloodlines, open
A low-level arterial drip chamber can result in ____ entering the system causing an air embolism or clotting.
air
When blood escapes from the dialyzer blood compartment into the dialysate fluid compartment this is known as
blood leak (DON'T RETURN THE BLOOD)
When should alarm and Pressure Holding Tests (PHT) be performed on dialysis machines?
Before every treatment.
In addition to safety checks, what tests must you perform to ensure a safe patient environment?
Meter conductivity and pH.
Why do you compare machine conductivity setting to the meter conductivity results?
To ensure machine display is accurate.
The Transmembrane pressure (TMP) measures the ____ difference across the dialyzer membrane.
pressure
____ can be defined as the movement of particles through a semi-permeable membrane from a greater to a lesser concentration.
Diffusion
____ is the term used to describe the movement of fluid through an extra corporeal from an area of low solute concentration to an area of high concentration.
Osmosis
A major factor affecting ultrafiltration is ____
pressure
A rise in ____ during HD is likely to indicate clotted fibers.
TMP
Water in the dialysate may also be referred to as ___________ water
Reverse Osmosis (RO) water.
Counter current flow of blood and dialysate increases the rate of ____
diffusion. Get better clearance on the pt.
Individual acid containers must be ___________ with chemical content
labeled
Three solutes that may be present in a prescribed dialysate solution
K+,Na+, Ca
Besides potassium, an electrolyte that is commonly adjusted in the hemodialysis acid bath is _________.
calcium
The three components of the dialysate solution/bath are:
acid, bicarb, and H2O.
A major complication that can occur when the patient is dialyzed on hypotonic dialysate is ____
hemolysis (this can also be caused by an increase in arterial pressure, bleach, increase in dialysate temp).
Dialysis is affected by these 4 things : dialysate ___________ Dialysis ___________ Dialyzer __________ and blood _______ rate
flow rate, treatment time, surface area, flow
How to handle shingles in a clinic...
If it was disseminated (all over the body) they need to go to the hospital and not treated at the clinic.
How to handle MRSA at the clinic...
Is the wound contained? Needs to be covered. If it can be contained by dressing, he can just have standard precautions...if not they would be in dedicated isolation w/ contact precautions.
How to calculate...Available Weight (AW)
Pre-weight minus estimated dry weight (EDW)
Estimated dry weight (EDW) definition
An estimation of what the patient's weight would be if his or her kidneys functioned properly (is a doctor's order).
How to calculate....Target Weight (TW)
AW plus prime & rinseback and any additional fluids including what the patient is going to drink and an IV medications (abx) and NS flushes.
How to calculate Ultrafiltration (UF) goal...aka TW expressed in mL's.
Pre-weight - EDW + Fluids given during treatment (in kg...ex. 400 mL = 0.4 kg) = TW in kg, changing this to mL = the UF goal.
How to calculate the UF rate
Take the UF goal in mL / EDW / treatment time = hourly UFR. [Show Less]