QUESTIONS AND VERIFIED SOLUTIONS
◉ regular respiration rate. Answer: 12-16 breaths per minute
◉ In dialysis patients water may enter the lungs due to water weight
gains this can cause. Answer: Sob or trouble breathing
◉ Payment for dialysis. Answer: 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. Answer: Pay for performance, Cuts pay
by 2% if measures aren't met. (Kt/v and hemoglobin)
◉ ESRD networks. Answer: Oversees quality of care, 18 mostly
nonprofit organizations.
◉ Renal physicians association(RPA). Answer: 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). Answer: 1995, experts set
guidelines for anemia, adequacy, and vascular access
◉ KDOQI. Answer: Kidney Disease Outcomes Quality Initiative,
improves care and outcomes of all people with kidney disease
◉ Dialysis Outcomes and Practice Pattern Study - DOPPS. Answer:
Help pts love longer by finding patterns incenter that can be
changed to improve outcome
◉ state survey. Answer: 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). Answer: Finding
problems and fixing them. 4 step process
◉ 4 steps of continuous quality improvement. Answer: 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. Answer: The quality of performing at a high level
and conducting oneself with purpose and pride
◉ Boundaries. Answer: 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?. Answer: size of fist, 5oz a piece
◉ What protect the kidneys. Answer: Pads of fat and the bones of the
rib cage
◉ What makes up the outside of the kidney. Answer: Tough fibrous
capsule, inside the capsule is the cortex which is made of layers of
cells
◉ Medulla. Answer: Inner part of kidney which is made up of pie
shaped wedges called pyramids
, ◉ In the medulla the points of the pyramid are called. Answer:
Papillae
◉ calyx. Answer: 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. Answer: 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. Answer: 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. Answer: 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