PCT Fresenius Kidney Care Questions Answered 100% correct

PCT Fresenius Kidney Care Questions Answered 100% correct Which vein do you put Heprin in? Venous How do you find the arterial vein in a AVF? Press in the middle of the fistula and whichever side has more of a vibration/is pulsating more is the arterial vein How do you find the arterial vein in a AVG? Press in the middle of the horseshoe and whichever has more vibration or pulse is the arterial What percentage of kidney does dialysis provide? Replaces 15% of Kidney function What are the functions of the kidneys? hormone regulation, regulate BP, filter blood/excess water/waste through the renal vein What is the the order of operations of the renal system? Kidney to Ureter to Bladder to Urethra and out through urine AWETBED Functions of the kidneys: Acid/base balance Water balance maintenance Electrolyte balance Toxin removal Blood pressure Erythropoietin production D vit. D metabolism Dialyzer works as a ___? Nephron Osmosis Diffusion of water through a semi-permeable membrane from a high to low concentration fluid motion Hypotonic Lower concentration of solvents: not enough concentration; swollen RBC, hemolysis can be cause by this type of solution Hypertonic higher concentration of solvents; can lead to crenated RBC Isotonic Same concentration as blood Through what means do we dialyze? Where do we take and replace the blood from? We only have access to the Plasma fluid by needle in the extracellular fluid TMP Trans-Membrane Pressure, measurement of pressure across dialyzers membrane, monitors blood and fluid coming from the patient, pressure needed during dialysis to squeeze off fluid In the Tea Bag experiment what represents Osmosis? Water in the tea bag In the Tea Bag experiment what represents Convection? the tea that comes out of the bag when you remove it from the water In the Tea Bag experiment what represents Diffusion? Tea leaves in the hot water What are the parts of the ECC? fistula needles, dialyzer, arterial and venous blood lines, pressure monitors, pump, anti-coagulant, air trap, and detector ECC extra corporeal circuit What are the functions of the dialysis machine? mix and monitor dialysate, pump and monitor patients blood, and monitor patient safety AVF arterial venous fistula How is an AVF made? Surgically connecting a vein to an artery How is a AVG made? Surgically adhering a piece of biological or semi biological material to the artery and vein. One side is arterial and one side is venous AVG Arterial Venous Graft How does a dialyzer work? hollow fibers in the dialyzer act as a semi permeable membrane and through counter current flow the blood gets taken out and filtered Diffusion High concentration of the thing being diffused aka solvent. The tea in the Tea Bag Experiment particle motion, how waste products and excess electrolytes are removed What is dialysate made up of? Acid + Bicarb + Treated water Solvent fluid into which something is dissolved Solutes substance that is dissoved Solvent the solution Goals of dialysis remove waste (diffusion), remove excess (osmosis and ultra filtration), regulate electrolytes How does dialysis work? Through the arterial and venous accesses. From the arterial access through the blood pump, heparin, dialyzer, return through venous access Mechanically, how does dialysis work? Through counter current flow dialysate goes from bottom to the top of the dialyzer which filters it, we can add electrolytes such as calcium and potassium to the dialysate if the patient needs it. The semi permeable membrane keeps blood and dialysate from mixing but keeps waste out Conductivity how well fluid will transfer an electrical charge; measure of ions of a solution pH hydrogen ion concentration of a solution. 6.9-7.6 Hemolysis bursting of the RBC What is the temperature range of dialysate? 35-37 Crenation shrinking of the blood cells can occur with exposure to hyper tonic dialysate that is more concentrated than the blood Acidosis Alkaosis pH range? 6.9-7.6 What is the affect of too high of a temp? hemoylsis 40+ degrees What is the affect of too low of a temp? decreased diffusion What is the range the conductivity test can withstand? +/- .3 Stenosis narrowing of the blood vessels Anastomosis connection between the artery and the vein BFR of 17g needle 30ml/min smallest needle BFR of 16g needle 300-355ml/min BFR of 15g needle 350-450ml/min BFR of 14g needle __ 450ml/min biggest needle Which vein do you take labs from? Arterial What angle is preferred when cannulating an AVG? 45 degress What angle is preferred when cannulating an AVF? 20-35 degress At what weight would the nurse need to be notified if the patient is above? +4kg of EDW Filtration movement of a fluid through a filter as a result of hydraulic pressure Ultra Filtration movement of water as the result of pressure across a membrane: Removing fluid from blood higher pressure What waste products does the dialyzer take out? urea and creatinine CVC central venous cathether How is a CVC made? A large dual lumen catheter is placed in a large central vein and allows for the removal and return of blood to the patient What leads to hypotension? excessive or too rapid fluid removal What leads to the patient cramping? too rapid removal or electrolyte shifts If the patient is vomiting or is nauseated what is that a result of? Hypotension What are the elements of the patients prescription in dialysis? dialysate formula, type of dialyzer, treatment time, flow rate, heparin, needle size and temperature At what temperature can crenation occur? -35 degrees Characteristics of a dialyzer biocompability, membrane surface area, molecular weight cut off, clearance Clearance amount of blood cleared of waste within a certain time Molecular Weight Cutoff How much can go through a semi permeable membrane, 15,000 Da weight limit, RBC 70,000 Da Describe how the blood and dialystae flow rate works within a dialyzer flow velocity, resistance:narrow tubing, flow rate:through tubing, auto flow (2.0) Heparin Anticoagulant that prevent the clotting of blood cells and is used to seal damaged blood vessels, prevents clots within the dialyzer which reduces surface area, 100 units per cc:10,000 units=100 cc How does needle size pertain to the dialyzer? based on blood flow rate and maturity of the access, the larger the gauge the higher the blood pressure can be Adequacy in blood tests urea reduction ratio Clearance in blood tests blood urea nitrogen: waste production of protein metabolism, urervic toxin found in patients with kidney failure, Creatinine: how well its going. BFR limits clearance, higher dialysis rate flow improves clearance CMS Regulation Center for medicare service Medicare 65+, disabled citizens -65y/o, ESRD, ESRD end-stage renal disease Part A Medicare Coverage hospital care Part B: Medical Coverage Medical insurance Part C of Medicare Coverage medicare advantage Part D of Medicare Coverage Prescription drug benefit CMS Survey conditions for coverage, state department of wealth or state facility licensing program, how well a dialysis facility complies with conditions for coverage