DaVita Final Exam Questions and Answers Accurate Solution A level Based

DaVita Final Exam Questions and Answers Accurate Solution A level Based AKI - acute kidney injury (Was once called 'Acute Renal Failure') Encompasses wide spectrum of kidney issues Includes acute kidney failure and kidney function changes May dialyze in out-patient facility until kidney function recovers Examples of pre-renal causes of AKI - Burns, hemorrhage, heart failure, obstruction of renal artery, hypotension, stenosis of renal artery Examples of intra-renal causes of AKI - nephritis, tubular necrosis, glomerular nephritis, chemo, some antibiotics, anti inflammatory, poisons Examples of post-renal causes of AKI - kidney stones, tumor in bladder, problem with ureter, anything preventing urine from leaving kidney When outlining the treatment foals for a patient with AKI dialyzing in the out-patient facility, How do you help in restoring kidney function? - treat problem causing AKI When outlining the treatment foals for a patient with AKI dialyzing in the out-patient facility, How do you protect kidneys from further injury? - Do not pull too much fluid!! It is better to leave patient a little wet than too dry, DO NOT CAUSE HYPOTENSION, keep CVC infection free When outlining the treatment foals for a patient with AKI dialyzing in the out-patient facility, What is important when monitoring weight and BP? - Educate patient on and promote adequate diet When outlining the treatment foals for a patient with AKI dialyzing in the out-patient facility, AKI patients are at increased risk for which complications? - hypovolemia, hypotension When outlining the treatment foals for a patient with AKI dialyzing in the out-patient facility, What do you need to consider in regards to their vascular access? - Will only have CVC which will be open to infection What is the difference between AKI and CKD? - AKI is temporary and reversible CKD is permanent and not reversible Treatment goals for patients with CKD - -slow the progression of CKD -manage comorbidities and complications -controlling symptoms -minimizing the effects of CKD on patients' lifestyle -kidney replacement therapy modality education -encouraging patients to actively participate in their healthcare What are the most common causes for CKD in the USA? - Diabetes & Hypertension account for 70% of CKD. Polycystic Kidney Disease is another cause Kt/V -- goal is - >= 1.2, for 3x/week frequency Kt/V --- "K" stands for - clearance of urea Kt/V --- "t" stands for - the time of the dialysis session Kt/V --- "V" stands for - total volume of the patient's body water in which urea is distributed Kt/V --- What treatment factors decrease K? - dialyzer too small, inadequate heparin dose, not an adequate BFR Kt/V --- What treatment factors increase 'K'? - increase in BVP, solute drag (convection - adding more clearance with diffusion), proper heparin dose, dialysate temperature Kt/V --- What treatment factors influence 't'? - longer blood/dialysate contact time; more frequent or extra treatment Kt/V --- What treatment factors influence 'V'? - patient's height, weight, sex, age, amputations. Basically, anything affecting the body's composition Needle gauge suggested BFR ---- 17 gauge - BFR 200-250 Needle gauge suggested BFR ---- 16 gauge - BFR 250-350 Needle gauge suggested BFR ---- 15 gauge - BFR 350-450 Needle gauge suggested BFR ---- 14 gauge - BFR >450 Procedure for Post BUN lab draw: - -Turn off or decrease UF to 50 -decrease DFR to 300 or place machine in bypass -decrease BFR to 100 -wait 15 seconds for all types of access -obtain from arterial line Accidentally diluting the pre-treatment arterial BUN blood sample with saline would cause the Kt/V reading to be falsely....... - Too low Drawing the post-BUN sample while the blood pump remained at the patient's prescribed blood flow rate could cause the Kt/V reading to be falsely....... - Too high Waiting only five seconds between lowering the blood pump speed and drawing the post treatment blood sample could cause the Kt/V reading to be falsely....... - Too high Drawing the post-BUN sample from the venous bloodline would cause the Kt/V reading to be falsely...... - Too high Waiting longer than 15 seconds between lowering the blood pump speed and drawing the post treatment blood sample would cause the Kt/V reading to be falsely......... - Too low When is a pre-treatment assessment by the licensed nurse required? - -when it is state mandated -PCT reports abnormal findings in data collection -patient complains of something AKI When is post-treatment assessment by the licensed nurse required? - -when it is state mandated -if an unusual finding has been observed -if patient is +/- 1 kg from target weight -SBP >140 or <90; DBP >90 or <50 -s/sx of hypotension -irregular HR or <60, >100 What is the purpose of DQI (DaVita Quality Index) - provides a powerful tool for assessing facility performance and improving the lives of patients DQI success is achieved by.... - Managing individual patients first - DQI scores will follow. -THE FOCUS IS ON GREAT PATIENT OUTCOMES The Clinical Pyramid includes: - -The Fundamentals -Complex Programs -Measures of Effectiveness -What Matters Most The Clinical Pyramid - The Fundamentals: - -immunizations -iron -dialysis access -calcium -phosphorus -Hb -Kt/V -target weight -PTH The Clinical Pyramid - Complex Programs: - -Fluid Management -Infection Management - DM Management -Meds Management -CVC Management -Palliative / EOL Care -Infection Surveillance -Transition of Care -CKD Education -Depression -Missed Treatments The Clinical Pyramid - Measures of Effectiveness: - -Mortality -Hospitalization / Re-hospitalization -Patient Experience of Care The Clinical Pyramid - What Matters Most: - Our patients' Health-related Quality of Life What can be done to prevent DQI 'dips' related to lab draws? - -know lab draw schedule -anticipate holidays and FedEx closures -reschedule holiday lab draws proactively -follow tube draw order -confirm all labels have printed clearly before putting on lab container -remind TMs of importance of proper tube processing -correct draw dates before shipping -don't borrow boxes for shipping -freeze ice packs flat & solid -record FedEx tracking numbers List some occurrences when to chart: - -Any time BP has to be rechecked -When UF is turned off -Early termination of treatment -Any s/sx of complications during treatment -BFR changed up or down -Emotional change -Any change from baseline -Unusual occurrences -Observations every 30 minutes -Meds and response to meds -Change in condition -Patient teaching -Procedure , treatment What is the appropriate time for documenting Pre-treatment safety checks? - Prior to treatment initiation What is the appropriate time for documenting Pre-treatment patient data collection? - Before treatment is initiated What is the appropriate time for documenting observations during treatment? - As observation occurs (every 30 minutes or as it occurs) What is the appropriate time for documenting Post-treatment data collection/assessment? - After treatment is completed, after rinse back What are possible consequences of poor or incomplete documentationi? - -Liability to me and DaVita -Lawyers will attack my care and ability (easy target) -Reputational injury -Potential threat to career