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
... [Show More] influence "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]