CHT BONENT EXAM SCRIPT QUESTIONS AND ANSWERS
GRADED A+
✔✔regular respiration rate - ✔✔12-16 breaths per minute
✔✔In dialysis patients water may enter the lungs due to water weight gains this can
cause - ✔✔Sob or trouble breathing
✔✔Payment for dialysis - ✔✔Medicare pays for 80% of dialysis
Medicare makes rules a clinic must follow to provide coverage of tax.
Pt who don't have Medicare before CKD a pt must wait 3 months for it to cover in center
but it will cover home-hemo right away.
2011 change how they pay for dialysis and created a "bundle" (composite rate,
labs,drugs and home training)
✔✔Quality Incentive Program - ✔✔Pay for performance, Cuts pay by 2% if measures
aren't met. (Kt/v and hemoglobin)
✔✔ESRD networks - ✔✔Oversees quality of care, 18 mostly nonprofit organizations.
✔✔Renal physicians association(RPA) - ✔✔1993 nephrologist made first clinical
practice guidelines, including minimum dose of HD , when to start and stop HD and care
for kidney disease for pt not on HD
✔✔National Kidney Foundation (NKF) - ✔✔1995, experts set guidelines for anemia,
adequacy, and vascular access
✔✔KDOQI - ✔✔Kidney Disease Outcomes Quality Initiative, improves care and
outcomes of all people with kidney disease
✔✔Dialysis Outcomes and Practice Pattern Study - DOPPS - ✔✔Help pts love longer
by finding patterns incenter that can be changed to improve outcome
✔✔state survey - ✔✔An inspection of the facility by state surveyors for compliance with
rules and regulations of Medicare. If clinics don't follow they must make a plan of
correction.
✔✔Continuous Quality Improvement (CQI) - ✔✔Finding problems and fixing them. 4
step process
✔✔4 steps of continuous quality improvement - ✔✔1.identify the problem- collect data
and figure out how to fix
2.analyze problem-see if there is a standard or guideline to fix it, look at patterns or
trends
,3.cause of problem?
4.Plan,do,check,act- make a plan to fix, try plan, check results and make changes if
needed
✔✔Professionalism - ✔✔The quality of performing at a high level and conducting
oneself with purpose and pride
✔✔Boundaries - ✔✔Never share personal life or concerns with patients, never date pts,
never borrow money, never invite to home or events, never except tips or money, do not
sexually harass
✔✔How big are the kidneys? - ✔✔size of fist, 5oz a piece
✔✔What protect the kidneys - ✔✔Pads of fat and the bones of the rib cage
✔✔What makes up the outside of the kidney - ✔✔Tough fibrous capsule, inside the
capsule is the cortex which is made of layers of cells
✔✔Medulla - ✔✔Inner part of kidney which is made up of pie shaped wedges called
pyramids
✔✔In the medulla the points of the pyramid are called - ✔✔Papillae
✔✔calyx - ✔✔Cup shaped opening at the end of the papillae, which sends drops of
Urine to the renal pelvis. The renal pelvis links to ureters (tube to bladder)
✔✔nephron - ✔✔filtering unit of the kidney, In the renal cortex and ends into medulla,
gets rid of excess water and waster keeps what the body needs. Made up of glomeruli
and tubules
✔✔glomeruli - ✔✔Ball of capillaries in a sac called Bowman's capsule.
Filtration system
Capillary wall are semipermeable
Blood enters the glomeruli through an afferent (towards organ) arteriole, with each heart
beat blood pressure forces water out of blood through tiny slits and into Bowman's
capsule.
Small wast that passes through the pores is called glomerular filtrate
✔✔Glomerular filtrate - ✔✔Substances that filter out of the blood through the thin walls
of the glomeruli, adults make 125ml each minute. And 180 liters a day.
Nearly all filtrate is reabsorbed in the tubules
✔✔Healthy glomeruli walls keep - ✔✔Large cells like blood cells and protein
, ✔✔If a nephron is damaged - ✔✔Large cells can leak through the membrane like RBC
and protein
✔✔tubular system - ✔✔proximal convoluted tubule, loop of henle, distal convoluted
tubule, is shaped like an "s", receives filtrate from the glomeruli
✔✔What happens in the tubules of the nephron - ✔✔Chemicals and water that the body
needs pad back into the blood. Waste and extra water empties into the calyces and
become urine
✔✔Jobs of the Kidney - ✔✔Homeostasis, removal of waste, fluid and electrolyte
balance, blood pressure control and horomones
✔✔Removal of waste in kidneys - ✔✔Excess water becomes urine, urine has high
levels of waste from metabolized food, break down of muscles, drugs, toxins and acid
✔✔fluid and electrolyte balance in kidney - ✔✔1% of glomerular filtrate become urine
the rest goes back into the bloodstream, most substance that go through kidney go
back into blood or are metabolized, this helps keep the right balances in the blood
✔✔Blood pressure control in kidney - ✔✔Kidney controls water and electrolytes,
electrolytes form ions which conducts electricity that dissolve in water. Balance of these
electrolytes help control bP
✔✔Horomones of the kidney - ✔✔Erythropoietin and calcitriol
✔✔Erythropoietin - ✔✔Tells bone marrow to make RBCs
✔✔Calcitriol - ✔✔(Vitamin d) let's the gut absorb calcium from food
✔✔acute kidney failure - ✔✔sudden loss of kidney function due to illness/injury/toxin.
Could last a few day/weeks/months
More than half of pts with AK die
✔✔chronic kidney failure - ✔✔A long-standing disease resulting in scarring in the
kidney, permanently altering function. Nephron function is lost
✔✔uremia - ✔✔Toxins in the blood
✔✔Symptoms of uremia - ✔✔Edema
Trouble breathing
Making more or less urine or nocturia
Foamy/bubbly urine
Severe itching from calcium phosphate
GRADED A+
✔✔regular respiration rate - ✔✔12-16 breaths per minute
✔✔In dialysis patients water may enter the lungs due to water weight gains this can
cause - ✔✔Sob or trouble breathing
✔✔Payment for dialysis - ✔✔Medicare pays for 80% of dialysis
Medicare makes rules a clinic must follow to provide coverage of tax.
Pt who don't have Medicare before CKD a pt must wait 3 months for it to cover in center
but it will cover home-hemo right away.
2011 change how they pay for dialysis and created a "bundle" (composite rate,
labs,drugs and home training)
✔✔Quality Incentive Program - ✔✔Pay for performance, Cuts pay by 2% if measures
aren't met. (Kt/v and hemoglobin)
✔✔ESRD networks - ✔✔Oversees quality of care, 18 mostly nonprofit organizations.
✔✔Renal physicians association(RPA) - ✔✔1993 nephrologist made first clinical
practice guidelines, including minimum dose of HD , when to start and stop HD and care
for kidney disease for pt not on HD
✔✔National Kidney Foundation (NKF) - ✔✔1995, experts set guidelines for anemia,
adequacy, and vascular access
✔✔KDOQI - ✔✔Kidney Disease Outcomes Quality Initiative, improves care and
outcomes of all people with kidney disease
✔✔Dialysis Outcomes and Practice Pattern Study - DOPPS - ✔✔Help pts love longer
by finding patterns incenter that can be changed to improve outcome
✔✔state survey - ✔✔An inspection of the facility by state surveyors for compliance with
rules and regulations of Medicare. If clinics don't follow they must make a plan of
correction.
✔✔Continuous Quality Improvement (CQI) - ✔✔Finding problems and fixing them. 4
step process
✔✔4 steps of continuous quality improvement - ✔✔1.identify the problem- collect data
and figure out how to fix
2.analyze problem-see if there is a standard or guideline to fix it, look at patterns or
trends
,3.cause of problem?
4.Plan,do,check,act- make a plan to fix, try plan, check results and make changes if
needed
✔✔Professionalism - ✔✔The quality of performing at a high level and conducting
oneself with purpose and pride
✔✔Boundaries - ✔✔Never share personal life or concerns with patients, never date pts,
never borrow money, never invite to home or events, never except tips or money, do not
sexually harass
✔✔How big are the kidneys? - ✔✔size of fist, 5oz a piece
✔✔What protect the kidneys - ✔✔Pads of fat and the bones of the rib cage
✔✔What makes up the outside of the kidney - ✔✔Tough fibrous capsule, inside the
capsule is the cortex which is made of layers of cells
✔✔Medulla - ✔✔Inner part of kidney which is made up of pie shaped wedges called
pyramids
✔✔In the medulla the points of the pyramid are called - ✔✔Papillae
✔✔calyx - ✔✔Cup shaped opening at the end of the papillae, which sends drops of
Urine to the renal pelvis. The renal pelvis links to ureters (tube to bladder)
✔✔nephron - ✔✔filtering unit of the kidney, In the renal cortex and ends into medulla,
gets rid of excess water and waster keeps what the body needs. Made up of glomeruli
and tubules
✔✔glomeruli - ✔✔Ball of capillaries in a sac called Bowman's capsule.
Filtration system
Capillary wall are semipermeable
Blood enters the glomeruli through an afferent (towards organ) arteriole, with each heart
beat blood pressure forces water out of blood through tiny slits and into Bowman's
capsule.
Small wast that passes through the pores is called glomerular filtrate
✔✔Glomerular filtrate - ✔✔Substances that filter out of the blood through the thin walls
of the glomeruli, adults make 125ml each minute. And 180 liters a day.
Nearly all filtrate is reabsorbed in the tubules
✔✔Healthy glomeruli walls keep - ✔✔Large cells like blood cells and protein
, ✔✔If a nephron is damaged - ✔✔Large cells can leak through the membrane like RBC
and protein
✔✔tubular system - ✔✔proximal convoluted tubule, loop of henle, distal convoluted
tubule, is shaped like an "s", receives filtrate from the glomeruli
✔✔What happens in the tubules of the nephron - ✔✔Chemicals and water that the body
needs pad back into the blood. Waste and extra water empties into the calyces and
become urine
✔✔Jobs of the Kidney - ✔✔Homeostasis, removal of waste, fluid and electrolyte
balance, blood pressure control and horomones
✔✔Removal of waste in kidneys - ✔✔Excess water becomes urine, urine has high
levels of waste from metabolized food, break down of muscles, drugs, toxins and acid
✔✔fluid and electrolyte balance in kidney - ✔✔1% of glomerular filtrate become urine
the rest goes back into the bloodstream, most substance that go through kidney go
back into blood or are metabolized, this helps keep the right balances in the blood
✔✔Blood pressure control in kidney - ✔✔Kidney controls water and electrolytes,
electrolytes form ions which conducts electricity that dissolve in water. Balance of these
electrolytes help control bP
✔✔Horomones of the kidney - ✔✔Erythropoietin and calcitriol
✔✔Erythropoietin - ✔✔Tells bone marrow to make RBCs
✔✔Calcitriol - ✔✔(Vitamin d) let's the gut absorb calcium from food
✔✔acute kidney failure - ✔✔sudden loss of kidney function due to illness/injury/toxin.
Could last a few day/weeks/months
More than half of pts with AK die
✔✔chronic kidney failure - ✔✔A long-standing disease resulting in scarring in the
kidney, permanently altering function. Nephron function is lost
✔✔uremia - ✔✔Toxins in the blood
✔✔Symptoms of uremia - ✔✔Edema
Trouble breathing
Making more or less urine or nocturia
Foamy/bubbly urine
Severe itching from calcium phosphate
