DaVita ICHD Nurse/PCT Test questions and answers with verified content

DaVita ICHD Nurse/PCT Test questions and answers with verified content Cardiac Arrest: Definition: Cessation of heart beat. Signs/Symptoms: Absence of pulse, lack of respiration, unresponsiveness Interventions:Assess ABC's, get help, CPR, return blood, keep access open, call EMS, maintain patency of needles or CVC ports with NS Angina Definition: Chest pain or discomfort due to Coronary Heart Disease. Occurs when heart muscle doesn't get as much blood as it needs. May also feel discomfort in neck, jaw, shoulder, back or arm. Uncomfortable pressure, fullness, squeezing pain in center of chest. S/S: Chest pain, difficulty breathing, nausea Interventions: Reduce BFR to 150, reduce UFR, give O2, monitor cardiac rhythm/VS Dialysis Disequilibrium Syndrome (DDS) Definition: A condition in which rapid or drastic changes in the patient's extracellular fluid affect the brain S/S: Headache, hypertension, nausea, restlessness, convulsions/seizures, confusion, blurred vision Intervention: decrease BFR and DFR, shorter initial treatments, Hypertension Definition: high blood pressure (Pre-Dialysis: >140/90; Post> 130/80) S/S: No symptoms, headache, dizziness, Irritability, Blurred vision, nervousness, edema secondary to fluid retention Intervention:Determine cause, maintain fluid balance take medications as prescribed, notify MD hypotension Definition: low blood pressure (Systolic: <90, Diastolic: <60 or drop in systolic more than 20 mm/hg S/S: flushing, yawning, dizziness, ear ringing, tachycardia, anxiousness, nausea/vomiting, cold clammy skin, seizures, cardiac arrest Interventions: place pt in supine position, decrease UFR to minimum, provide drinking water for less severe hypotension, give 100-200 mL saline for severe hypotension, monitor BP, notify RN Muscle Cramps Definition: painful muscle contractions in extremities or abdomen typically occurring due to rapid/excessive fluid removal. S/S: painful cramps usually occuring later in dialysis Intervention: massage or apply opposing force, give normal saline bolus, reduce UFR, assess dry weight Fever & Chills Definition: Any temp greater than 100° F or increase over baseline of 2° F with symptoms S/S: Temp >100°F, involuntary shaking, chills, hypotension, nausea, vomiting, headache, hypotension, tachycardia, hot flushed skin, dry mucous membranes Interventions: nurse must assess pt for possible cause of fever, notify treating nephrologist and obtain cultures per protocol, administer antibiotics as ordered Pyrogen Reaction Definitions: elevated temp- usually occurs 45-75 min into treatment as a result of pyrogens (endotoxins) S/S: chills, shaking, fever, hypotension, vomiting, muscle pain Intervention: Provide support, report pt s/s to RN, stop tx, do not return blood, notify MD. Seizures Definition: involuntary muscle spasms and loss of consciousness S/S: change in level of consciousness, twitching/jerking movements of the extremities Intervention: protect pt and access arm from harm, protect airway, administer O2, d/c dialysis Blood Loss Definition: loss of blood typically due to dislodged needle, bleeding at access site, disconnection of lines, system clotted and unable to return blood. S/S: hypotension, loss of consciousness, blood on floor, chair or clothing, blood lead detector alarm, VP alarm if needle dislodged or line separate, TMP alarm, visible clots in chamber Interventions: Manage symptoms, give saline replacement if needed, give O2, fix cause Clotted Dialyzer Definition: Dialyzer membrane clotted S/S: decrease in VP with no change in BFR, visible clots in the venous drip chamber or line, dark blood, unable to rinse back pt's blood Intervention: ensure proper use of heparin, monitoring pressures, maintain proper BFR. Change set up, determine cause Hemolysis Definition: rupture of red blood cells S/S: cherry red blood,anxiety, restlessness, abdominal cramping, back pain, chest tightness/dyspnea, seizures, thready pulse, hyper/hypotension Intervention: Stop blood pump, clamp lines, do not return blood, RN assess pt, administer O2, monitor VS and cadiac rhythm, check hemoglobin and K+ First Use Syndrom Definition: a group of symptoms that occur shortly after starting a treatment with a new dialyzer; may be caused by manufacturing residues in dialyzer S/S: Nervousness, chest pain, back pain, palpitations, itching, funny taste in mouth Intervention: notify RN, manage symptoms, d/c tx, notify MD Disinfectant Infusion Definition: disinfectant being infused into pt's blood stream as a result in a breach in protocol S/S: pain at venous needle site, itching, restlessness, respiratory distress/SOB, flushing, chest pain, tingling around lips, back pain, hemolysis Interventions: discard bicarb and rinse mixer according to policy, do not initiate treatments until residual tests are negative Dysrhythmias Definition: irregular heart beat S/S: irregular HR, palpitations Interventions: treat cause Air Embolism Definition: Air bubbles enter blood stream and are carried to a vessel small enough to be blocked by air S/S: visible air in venous line, chest tightness or reports of pain, Dyspnea and coughing, cyanosis, restlessness & confusion, visual disturbances, convulsions/ seizures, cardiac arrest Interventions: stop pump, clamp CVC limb, place pt in trendelenburg position on left side, contact EMS and MD, aspirate air from arterial line, attach saline bag with administration line to arterial access, give O2 Anaphylaxis Definition: rapid, severe immune response to an allergen, may be caused by ETO allergy, rxn to germicide left in blood lines, or medication allergy S/S: difficulty breathing, wheezing, tachycardia, hives, itching, periorbital edema, hypotension, anxiety, restlessness, chest tightness, cardiac arrest Intervention: stop the medication, stop blood pump. d/c treatment, do not return blood, notify MD, call EMS Crenation Definition: shrinking of red blood cells S/S: dark red blood, nausea/vomiting, headache Interventions: stop pump, clamp lines, do not return blood, asses pt, dialysate sample for hypertonic dialysate Heparin Overdose S/S: bleeding around needles, bruising, prolonged bleeding post dialysis, GI blooding, retinal bleeding Intervention: evaluate heparin dose and clotting time, notify MD Decrease in blood pH results in increased resp. rate & depth of breathing increase in unloading of CO2 in lungs Increase in blood pH results in repressed respiratory center. CO2 accumulates and lowers pH as a result Conductivity reading that measures the transmission of en electrical charge within dialysate solution Electrolytes increase conductivity Arterio-venous Fistula (AVF) gold standard due to lasting the longest with fewest complications surgically connected artery and vein can be created on arm or leg Arterio-venous graft used if pt doesnt have adequate vessels to create fistula, does not require time to mature. higher rate of complications ( i.e. clotting) created by tunneling synthetic or biologic tubing underneath skin Central Venous Catheter (CVC) intravenous access device inserted into large veins such as the subclavian, jugular, or femoral veins in the center of the body. Highest occurrence of complications (i.e. blood flow and infections) Advantageous b/c it can be used immediately Rule of 6's <0.6 cm deep: new fistula should be no deeper than 0.6 cm below skin >0.6 cm wide: width should exceed 0.6 cm >600 mL/min: minimum blood flow should be 600 mL/min Outflow Stenosis identified by high pitched whistle (whistle=blowing air out= OUTflow stenosis). pt may req continuously lowered BFR, high VP, excessive bleeding post treatment Aneurysms an excessive localized baloon like enlargement of an artery caused by a weakening of the vessel wall. can occur when old insertion sites are not given sufficient time to heal & needles are repeatedly placed Pseudoaneurysm false aneurysm that results from leakage of blood into soft tissues abutting the punctured artery with fibrous encapsulation and failure of the vessel wall to heal. indicates graft damage due to repeated needle sticks to same area without sufficient healing time Beginner Cannulator TM with less than 6 mo of dialysis experience & less than 10 successful cannulations on established fistulae Intermediate Cannulator TM with less than 6 mo of dialysis experience & at least 10 successful cannulations on established fistulae Advanced Cannulator TM who has completed all competencies listed on NFACT skills checklist and who also has expert assessment and cannulation skills Newly Mature Fistula new fistula that has received post op exam by surgeon and meets criteria listed in the KDOQI Rule of 6's. Must be performed by NFACT advanced cannulator Mature fistula fistula that has successfully tolerated its prescribed maximum needle gauge and blood flow rate for at least 6 treatments. NFACT intermediate cannulator may begin cannulating access Established Fistula fistua that has been cunnulated with both arterial and venous needles for at least 2 months without S/S of dysfunction. May be cannulated by beginner cannulator Needle Gauge: 17 G Suggested blood flow range: 200-250 mL/min Needle Gauge: 16 G Suggested blood flow range: 250-350 mL/min Needle Gauge: 15 G Suggested blood flow range: 350-450 mL/min Needle Gauge: 14 G Suggested blood flow range: >450 mL/min Interventions for venous needle infiltration (localized & not increasing in size) -if cannulation above is possible, clamp & secure infiltrated needle -if not possible, remove infiltrated needle and apply direct pressure -Apply cold pack to infiltration -remove cold pack and check every 15 min Interventions for venous needle infiltration (increasing in size/severity) Remove infiltrated needle and apply direct pressure Intervention for arterial needle infiltration (localized & not increasing in size -if possible, reposition and continue use -if not possible, clamp & secure infiltrated needle and recannulate away from infiltrated needle -apply cold pack -remove and check cold pack every 15 min Heparin Anticoagulant used to prevent clotting adequacy of dialysis monitored with Kt/V K=clearance t=time of session V=Volume what factors decrease K value? inadequate coagulation, lowering BFR, poor priming what factors increase K value? increase BFR, correct DFR, using correct dialyzer, correct target weight What would falsely increase Kt/V value? BFR not reduced, waiting only 5 seconds to draw lab, Drawing post BUN from venous line What would falsely decrease Kt/V value? Diluting pre-tx BUN sample with saline, waiting longer than 15 seconds to draw blood sample Protocol for post BUN lab draw 1. turn off UFR or decrease to 50 2. decrease DFR to 300 or put in Bypass 3. decrease BFR to 100 4. wait 15 seconds and draw post when is the pretreatment assessment by the licensed nurse required Required to be done within 1 hour of treatment initiation unless state law specify otherwise (WI requires prior to tx initiation) Using a BP cuff that's too small results in a falsely high BP reading Using a BP cuff that's too large results in a falsely low BP reading what are consequences of sodium loading? increased thirst, large fluid gains, increased hypotension and ischemic events during treatment what are consequences of Hypovolemia? increased mortality, Ischemia & damage to vital organs, loss of residual kidney function What is the purpose of DQI? To encourage continuous improvement across a broad range of disease management processes What is DQI? Davita Quality Index Consequences of Hypervolemia (fluid overload) LVH, increased CVP, Hypertension, increased mortality, pulmonery edema, increased rate of hospitalization rate Types of PD CAPD: Continuous ambulatory peritoneal dialysis CCPD: Continuous cycling peritoneal dialysis What are the phases of PD exchange? Drain, flush, fill, dwell Differences between OSHA and CMS OSHA: concerned with employee safety CMS: concerned with pt care and safety Most common transmission route for HAI? Contact Most appropriate intervention to prevent HAIs Hand Hygiene What is the most common infection complication in Dialysis patients? Vascular access infection What germ causes most infections among Dialysis patients MRSA What is the normal pH of blood? 7.35-7.45 How much of normal kidney function is replaced by Hemodialysis? 15%