Fresenius Nurse Final Exam Part 2 with 100%correct Answers

What must be evaluated and documented pre-tx? - ANSWER-Ambulation status, mental status, pre-weight, bp sitting and standing if patient is able, temperature, heart rate and rhythm, respirations, edema, GI status, skin color, access evaluation, hospitalizations since last tx, any new complaints or life changes What must be evaluated and documented during tx? - ANSWER-Current time of evaluation, bp, BFR, DFR, safety checks, arterial/venous pressures, fluid removed/administered, access check-hemosafe device attached, patient's overall status, interventions, changes in dialysis presecription What must be evaluated and documented post-tx? - ANSWER-Ambulation status, mental status, changes in condition, post weight, bp sitting and standing, temperature, heart rate and rhythm, respirations, edema, new complaints, evaluation of access including presence of thrill, condition of dressing Recommended body temperature range - ANSWER-96.4-98.9 What is the recommended interdialytic weight gain? - ANSWER-1.5-2.0 kg/day Signs and symptoms that EDW is too low (Too much fluid is being removed): - ANSWER-Dizziness, nausea, vomiting, hypotension, cramps, fatigue that sometimes persist until the next tx Signs and symptoms that EDW is too high (Not enough fluid is being removed): - ANSWER-Htn, headaches, SOB, edema, distended neck veins What is AW and how is it calculated? - ANSWER-In the weight loss plan, AW means "available weight", this is calculated by subtracting the EDW from the patient's pre-tx weight What makes up the goal for fluid removal? - ANSWER-The AW (available weight), priming and rinseback saline, and any other fluid the patient will receive during the tx (oral fluids, saline rinses, packed cells, IDPN, IVPB medications etc. ) ____________ is the measurement of how well we are cleaning wastes from our patients' blood - ANSWER-Adequacy of Dialysis How can we measure how well we clean our patients' blood? - ANSWER-By measuring the amount of wastes in the patient's blood before and after dialysis, we can calculate the amount of clearance we achieve. The following interventions improve the clearance of urea during hemodialysis: 1.Well functioning ___________ 2.Proper ____ of the circuit 3.Optimal _________ (autoflow 1.5 or 2 as ordered and ________ flow 4.Larger _______ and _______ 5.Ensuring needle tips are at _______ inches aprt 6. longer _______ - ANSWER-1. access 2. priming 3. dialysate & blood 4. dialyzer membrane and needle gauges 5. 1.5 to 2 inches 6. tx times What are 2 consequences of improperly primed dialyzer? - ANSWER-1. When the # of fibers available to affect clearance is greatly reduced, the result is a less effective tx for the patient. 2. Clotted fibers/ dialyzer will also result in a certain amount of blood loss for the patient, resulting in a potential for reduced hgb level. What is considered the best method currently available for determining tx effectiveness and is mandatory in all FMC clinics? - ANSWER-UKM (Urea Kinetic Modeling) In addition to UKM, these are two other methods of determining adequacy. - ANSWER-kt/V and URR Why is measuring the adequacy of the dialysis tx so important? - ANSWER-When the tx is more effective, patients live longer and have fewer health problems. What does Kt/v stand for? - ANSWER-K stands for the clearance (think k sound) of urea, t is the time in minutes, and v is the total volume of waste (urea) that exist in the patient What is the difference between spKt/v and eKt/v and how is it determined? - ANSWER-~single pool or spKt/v is the amount of dialysis having been delivered upon completion of the HD tx, it's the reduction from one pool of fluid (vascular space) ~double pool or eKt/v is the measured amount of dialysis accounting for the volume of urea distribution in both intracellular and extracellular compartments representing the amount of urea distribution of the entire body. What is FMCNA's goal for spKt/v and eKt/v? - ANSWER-Minimum 1.4 L for spKt/v and 1.2 L for eKt/v OLC stands for - ANSWER-On Line Clearance T machines are equipped with technology that that can measure single pool Kt/v. OLC test measure _____ transfer across the dialysis membrane which serves as a substitute for urea, so it's removal reflects how urea is removed. - ANSWER-Sodium These lights on the HD machines provide a visual indicator for tx adequacy. - ANSWER-AMP KECN is the acronym for ________ and refers to the clearance of sodium as measured by the conductivity changes during the OLC test. - ANSWER-clearance effective by conductivity sodium KECN normal range is - ANSWER-200-300 KCEN should be less than - ANSWER-The BFR Less than ____KECN is poor clearance and will not be used by Proton to generate and OLC Volume - ANSWER-150 Greater than ____ KECN indicates that the machine may potentially need temp and conductivity calibrated - ANSWER-350 How many KECN tests can be programmed into OLC? - ANSWER-Between 3-6 test/ If a tx is 3-4 hours in length, 6 tests should be programmed. How long should blood tubes spin? - ANSWER-Spin blood specimens for 10 minutes What lab tubes should not be spun in the centrifuge? - ANSWER-Collection tubes containing anticoagulants Mechanical injury during drawing, extreme hot/cold temps, vigorous shaking, centrifuging bf clot forms, unbalanced centrifuge and fragile cell can all lead to - ANSWER-Hemolysis of laboratory specimen Tubes not inverted enough to allow anticoagulant to mix, cold temps, outdated blood tubes, overfilled blood tubes, patient being clamped too long post cannulation can all lead to - ANSWER-Clotting of blood specimens When is lab work drawn and which port would you draw the sample from? - ANSWER-prior to administering heparin; arterial port What is the procedure for drawing post tx lab work? - ANSWER-The UF is turned off, DFR turned off and BFR decreased to 100 for 15 seconds, Blood pump stopped, arterial and venous clamped; vacutainer to arterial bloodline port; invent sample 5-10 times How are infiltrations treated and where should venous/arterial be stuck post infiltration? - ANSWER-Intermittent ice for 24 hours followed by intermittent heat as needed. Venous needle is place above site/ arterial is placed above or below What four things should be taught to patients in regards to preventing access from clotting? - ANSWER-1. Not to wear tight fitting clothing or jewelry 2. Not to sleep on arm 3. Not to let anyone draw labs or check BP 4. Not to carry heavy objects What is VAM? - ANSWER-Vascular Access Monitoring is an assessment tool to help determine the rate of blood flow through an AV fistula or graft in ml/min What blood pump speed is required for a VAM access flow test? - ANSWER-200-300 ml/min When should an access flow test be conducted and why? - ANSWER-It should be performed at the beginning of tx because patients are more hemodynamically stable and the access is not affected by UF What should be documented when conducting an access flow test? - ANSWER-KECN 1 reading, KECN 2 reading, Access Flow reading What is a good access flow reading? ____ ml/min for grafts ____ ml/min for fistulas less than _____% from baseline - ANSWER- What factors could produce a negative access flow value? - ANSWER-reversal of lines, flow of access is opposite of what was initially believed; large amount of movement Access Flow Results 2000 with less than 20 point difference between access 1 and 2 indicates - ANSWER-Possible recirculation or subclavian stenosis Access Flow Results 2000 greater than 20 point difference between access 1 and 2 indicates - ANSWER-Indicates high flow access and could indicate high output cardiac failure To distinguish the arterial side from the venous side on a horseshoe graft, depress the midpoint of the graft partially obstructing flow, feel from the strongest thrill, and listen for the strongest bruit. The strongest thrill or bruit is on the _________ side. - ANSWER-Arterial To distinguish the arterial side from the venous side on a horseshoe graft, insert both needs and secure with tape; open the cap of fistula needle to bleed halfway down, the needle with the strongest flashback is the ______ side - ANSWER-Arterial How should the skin be prepped for needle insertion? - ANSWER-Betadine/alcohol pad in a circular motion from the insertion site to cover 2-3 inch area for 30 seconds/ if using betadine, allow to dry for 3-5 minutes What insertion angle should be used for cannulation? fistula v/s graft - ANSWER-fistula 20-30/ graft 45 Rule of thumb, in terms of needle place, stay _____ away from the anastomosis as this distance is also how far needle tips should be - ANSWER-1.5 - 2 inches This is caused by excess arterial blood being shunted into the venous circulation through anastomosis which can lead to a reduction of blood flow (ischemia) to the extremity. Symptoms associated are pain, tingling and numbness, cold, cyanotic or blue digits or nail beds - ANSWER-Steal Syndrome In treating cramps do not ______ but use ______. - ANSWER-massage; pressure How do you test for a small blood leak? - ANSWER-Dip a FMS approved blood leak strip into dialysate obtain from the outflow (arterial/red) The following are signs and symptoms of what? light translucent/cranberry or cherry colored blood, back/flank pain, chest pain, access pain, sob, n/v, hypotension, seizures - ANSWER-hemolysis What test can be done to rule out hemolysis and where is it drawn from? - ANSWER-A blood specimen is drawn from venous bloodline sampling port; the specimen is spun down in the centrifuge; if the resulting serum is pink or red in color, a + diagnosis for hemolysis can be made Dark opaque blood along with sob, thirst, chest pain, flushed faced and sudden fall in bp are signs of ____ - ANSWER-crenation What is the tx steps for an air embolism - ANSWER-COLT!!! C-Clamp venous line O-Off the pump L-Left Side T-Trendelenburg **Admin oxygen FMS safe total chlorine levels are: - ANSWER-0.00-0.09 Prior to testing chlorine levels, the RO must run for - ANSWER-15 minutes When is water hardness checked? - ANSWER-Twice a day, at the start of the day and after the last tx of the day has been terminated Total water hardness should not exceed - ANSWER-10ppm How long can bicarbonate be used after it is mixed? - ANSWER-Within 24 hours Who is ultimately responsible for proper maintenance of water room, accuracy of water logs, and every other occurrence in the dialysis unit? - ANSWER-Medical Director What do the colors blue, red, yellow and white represent on the HMIS label? - ANSWER-Blue--health hazard Red-Flammable Yellow-Reaction to other chemicals White-PPE What is tx initiated BFR? - ANSWER-100-150 ml/min What is termination BFR? - ANSWER-150-200 ml/min What do you do if you make a written mistake in the patients chart or flow sheet? - ANSWER-Draw a single line through the incorrect material, write error or mistaken entry above. Then initial and date the entry. State the reason for error in the margin or above the note. Any time there is a failure to follow established clinical procedure or a tx prescription or when a serious or unexpected equipment event occurs, this occurs - ANSWER-Adverse event When should blood loss be reported? - ANSWER-100 ml These 3 options are utilized for used equipment - ANSWER-disinfected, discarded, dedicated