Three pieces of personal protective equipment that are mandatory for use in the patient care area are: - Gown, gloves, face shield
The function of
... [Show More] Erythropoietin is - Stimulate production of RBC's, tells bone marrow to make RBC's
Hepatitis is an inflammation of the liver caused by - most commonly a viral infection
Max Chlorine level in H2O room - 0.09 ppm
Albumin is - a protein that helps fight infections and aids in healing and tissue formation. Gets fluid back into the blood, an osmotic agent.
HD patient range for Albumin - ≥ 4.0
Potassium is - an electrolyte that regulates cardiac action
HD patient range for Potassium - 3.5-6.0
Hemoglobin is - what carries oxygen and iron from the lungs to vital organs
HD patient range for Hemoglobin - 10-11
Phosphorus is - what keeps bones and heart healthy if in balance, has an inverse relationship with Ca
HD patient range for Phosphorus - 3-5.5
spKT/V is - what tells if the patient is receiving adequate dialysis, clearance times time of tx in minutes divided by volume in (L) of urea distribution
HD patient range for spKT/V - ≥1.4
iPTH is - what balances Ca and Phos, elevated Phos causes elevated PTH, leads to bone and heart damage
HD patient range for iPTH - 150-600
Calcium (corrected) is - a mineral that keeps bones and muscles healthy
HD patient range for Calcium (corrected) - 200-300
Hep B may be transmitted in a dialysis unit because it is transmitted via - blood
There are specific procedures to control the spread of Hepatitis in the dialysis unit. What are they? - PPE use, hand washing, decontamination, disposal of supplies
The four organs of the urinary tract are - Kidney, ureter, bladder, urethra (this is the flow path order as well)
Osmosis is - Movement of FLUID through a semi-permeable membrane from and area of LOW SOLUTE to an area of HIGH SOLUTE concentration
Machines and chairs are cleaned with ____________ routinely. - bleach 1:100
1:10 bleach solution is used for spills of blood greater than - 10 mL
The dialysate should be checked for what 3 things prior to starting each treatment? - pH, conductivity and temperature
The kidneys inability to secrete what is the primary reason dialysis patients are anemic? - Erythropoeitin
Water softener exchanges _____________ and _____________ for sodium by _________________. - Calcium, magnesium, ion exchange
Anemia is a condition characterized by unusually low levels of - RBC's (hemoglobin)
During a power failure you would return the patients blood via - handcrank (6-10 rotations per min)
Max time to handcrank in power failure - 10-15 minutes
Is dialysate sterile? - NO
Heparin is a ___________ acting, _________ molecule. - short, large
Heparin is given _________ to __________ minutes prior to the initiation of treatment. - 3,5
Why is heparin given to minutes prior to the initiation of treatment? - In order for it to become systemic throughout the body
Venous pressure measures - resistance of blood return
Conductivity measures - ability of a substance to conduct heat, electricity or sound
What protects patients from receiving air? - Air detector
If the dialysate delivery system has been improperly disinfected what might occur? - bacteria and endotoxins can be in the dialysate which may cause pyrogenic reactions
What does the temperature monitor prevent? - Hemolysis, from too high dialysis temperature
Hemolysis occurs if the temperature is too - High
What are the two most life threatening conditions that can happen during treatment? - Air embolism and Hemolysis
When should sharps containers be changed? - when 1/2 ful
Order in which lab tubes should be drawn? - SST first, Lavender last, Post BUN after TX
Observable S/S of an infected access site - Redness, swelling, pain, discharge, crust, fever, chills
Diffusion is - the movement of PARTICLES through a semipermeable membrane from and are of HIGH SOLUTE to an area of LOW SOLUTE concentration
Ultrafiltration is - removal of additional fluid through a semipermeable membrane with the use of of added pressure (tea bag)
The blood lines and dialyzer are primed with what before dialysis is initiated? - Normal Saline
What blood test is done before and after hemodialysis treatment to determine adequacy of the treatment? - Pre and Post BUN
To ensure safety during treatment, a key point to remind the patient is - to keep their access visible
Three assessments that must be completed on a fistula or graft: - Look, Listen, Feel
External access refers to - a catheter
Internal access refers to - a fistula or a graft
Listen for the - Bruit
Feel for the - Thrill
What do you do to assess if there is good blood flow through an internal access? - Bruit and thrill
What part of the water treatment system should NEVER be bypassed - Carbon tanks
Chlorine/Chloramines max level? - 0.09 ppm
Causes of Acute renal failure - Blood loss, shock, toxicity, injury, dehydration
Causes of Chronic renal failure - Diabetes, Hypertension, Lupus, Polycystic Kidney Disease, Glomerulonephritis, Goodpasture's syndrome
Water Hardness max level - 10 ppm
Steps on changing a contaminated transducer - ...
pH range: - 6.8-7.4
Conductivity range: - 13.5-14.5
What do Carbon tanks/GAC filters do? - Remove total chlorine
What is the R/O? - the reverse osmosis, Removes all dissolved solids
How does the R/O work? - by reverse osmosis, it relies on the application of pressure and the natural process of osmosis to remove contaminants from water
All of the following are possible causes of hypotension - Fluid loss, eating while on dialysis, blood loss, hemolysis, low albumin, temp too hot, Heart Failure, BP meds, disinfectants
All of the following are s/s of hypotension - Feeling of impending doom, N/V, feeling hot, dizziness, restlessness, fatigue, decreased LOC, yawning, seizures, cool clammy skin, feeling need to have BM, SOB, blurred vision
The following tasks are included in routine checks - Machine and ECC, safety, access and V/S every 30 minutes
According to the CDC, Hepatitis B positive patients should be dialized - in isolation
TB patients need to dialyze where? - in the clinic unless active TB then in the hospital in a negative pressure isolation room
1 kilogram = ________ pounds - 2.2
The two electrolytes in the acid bath to pay close attention to when checking the physicians orders are - Calcium and Potassium (Ca and K)
Renal bone disease is caused by - ↑ Phosphorus, ↓ Calcium, can not convert Vitamin D to Calcitriol, Secondary Hyperparathyroidism
Most foods contain - Phosphorus
What is peritoneal dialysis - uses lining of abdomen (peritoneal membrane) to filter blood, catheter in abdomen surgically placed, dialysate is instilled in the abdomen, it dwells and then is drained using gravity
Some factors that may contribute to delivering an adequate hemodialysis treatment - ...
Does Estimated Dry Weight ever change? - Yes, frequently
Does Heparin dissolve clots? - No, it prevents
Which direction do you place the venous needle? - antegrade - up, with the blood flow
Which direction do you place the arterial needle? - antegrade or retrograde
What vascular access is the access of choice? - AV Fistula
The tips of the arterial and venous fistula needles must be at least ________ inches apart - 2
How do you treat an air embolism in the correct order? - Clamp lines, off pump, left side, trendelenburg
What does COLT stand for and what is it used for? - Clamp lines, off pump, left side, trendelenberg, for treatment of an air embolism
What is the anastomosis? - where the vein and artery are connected
The angle an AV fistula needle should be inserted - 25-30 degrees
The following solutions are used to calibrate the TDS meter - 1500-150-15
What does the TDS meter measure? - the sum of all ions in the water or the total dissolved solids
What should you do if your post carbon chlorine test is positive? - Switch to the 2nd tank (never bypass) then test for chlorine every 2 hours, notify technical, the clinic manager and the MD
The angle an AV graft needle should be inserted - 45 degrees
After an infiltration of the venous needle the second venous needle should be stuck - above the infiltration
What technique should be used to prolong graft life? - Rope ladder technique
Symptoms of uremia may include - Confusion, uremic "frost", sleep problems, urine breath, itching
What do you do for a minor blood leak? - Use hemastick to test for blood, if blood present pull tubing, don't give blood back
What do you do for a major blood leak? - Stop treatment, pull tubing, don't give blood back
S/S of fluid overload - Edema, SOB, Hypertension, itchy, can't sleep
Dialyzing fluid is also known as - Dialysate or bath
The three components of dialysate are - Acid, bicarbonate, RO water
Correct way to correct charting errors - no white out, black pen, sign, time, date entry
Catheters are associated with increased risk of - infection
RN or LPN only: Adverse reactions of Venofer - dropping BP, clots system, allergy can develop over time (back pain, flushing, chest pain, SOB)
RN or LPN only: Why are we giving patients Hectoral/Zemplar? - The ESRD patient can not convert Vitamin D to Calcitriol, treatment for hyperparathyroidism
RN or LPN only: Why are we giving patients Epogen? - Treats anemia, mimics erythropoeitin
RN or LPN only: Antibiotics should be given via what chamber? - Venous
Major functional unit of the kidney is the - Nephron
Differences between Chronic and Acute Renal Failure - CRF worsens overtime, can only slow progression, permanent, requires transplant or dialysis for survival, has stages I-V. ARF is sudden (from blood loss, drug use, toxicity), may be reversed
Complications of Uremia - Pericardia, neuropathy, itching, carpal tunnel, , sleep problems, decreased libido
What does TMP stand for? - Transmembrane pressure
What does TMP or transmembrane pressure mean? - Total amount of pressure (positive and negative) exerted on the dialyzer to remove fluid from the patient
What should you think of when there are a lot of TMP alarms? - Too high of a UF goal, Kink in ECC, wet tranducers
Post BUN collection order - Turn off UF, Turn off DFR, ↓ BFR to 100 x 15 seconds, Turn off Blood pump, Clamp A & V needle tubing, Collect from Arterial side, Invert tube 5-6 times
Why do we use Heparin? - It is short acting, 2-4 hours is its action, effects are gone by the end of the treatment, large molecule so it isn't dialyzed
If patient falls, what should we think first? - Anticoagulant, bleeding
Which molecule is used as a "surrogate" marker for urea during OLC? - Sodium, Na
Define Clearance - how well blood is cleared of waste products, how well the filter is working, think dialyzer
If KECN is decreasing what is happening? - losing dialyzer space, clotting, look at dialyzer
If conductivity is 13.5 what is the sodium? - 135
What are AMPS? - Dialysis machine traffic lights, green light if spKT/V ≥ 1.4, if yellow spKT/V < 1.4
How many tests per treatment are done for OLC? - 6
What must be programmed for AMPs to work/run accurately? - OLC-V
Why does hypertension cause kidneys to fail? - pressure damages the small vessels, damaged vessels can't filter waste products from the blood as they should
What do kidneys do? - Maintain fluid, electrolyte, pH/base balance; remove waste, covert Vitamin D to calcitriol, excrete Phosporus, secrete epoeitin, regulate BP
Dialysate will never have? - Phosphorus
How does the kidney regulate BP? - ADH - regulates Renin Angiotensin system - regulates blood pressure
Dialysis does everything kidneys do besides - hormone stuff which is treated with medications
Correct fluid balance by - reducing fluid removal rate (↓ UF goal), administer meds, administer saline bolus, albumin
If EDW is too low - we are trying to remove fluid that isn't there, cramping, BP lowering, sick, pt. may have gained body weight, needs adjusted up
If EDW is too high - Not removing enough, leaving with crackles, SOB, swelling, pt. has lost body weight, needs adjusted down
↑ Na will do what with fluid? - pull it out of other compartments, water follows Na
↑ Na will make a person - thirsty
How to prevent hypotension - review EDW frequently, keep pt from eating on dialysis, keep feet elevated
Define exsanguination - bleeding out
Most severe infiltration - Venous
Why is venous inflitration the most severe? - blood is pushing through
What does hemolysized blood look like? - Cherry pop, bright red, don't give this blood back
Gain - pre - last
AW - pre - EDW
TW - avail + saline
Goal - TW x 1000
What happens naturally and at the same time across a semipermeable membrane? - osmosis and diffusion
If the conductivity is not in normal range what is wrong? - there is something wrong with the solutions
Why are the blood lines and dialyzer are primed before dialysis is initiated? - to remove air, wet the fibers and rinse the ECC to reduce adverse reactions to the tubing
What is a dialysate alarm? - Temp, conductivity ONLY
What is a blood alarm? - Patient, tubing, system. Blood is not moving, needs fixed quickly
Why is a visible access important? - Body has only 4-5 units of blood, the dialyzer pumps 400-500 mL or 1 unit of blood/minute. After 3 minutes of an access being dislodged, a person is dead.
Dislodgement - out of the body [Show Less]