DaVita PCT Training Exam ( Final Exam for STAR Program) with Complete Solutions What is adequacy? - ANSWER--How well dialysis tx is working
-measured by green post BUN lab
- Kt/V goal is 1.2 or 65%
What affects Kt/V? - ANSWER-- time of tx -frequency of tx
-increasing BFR and DFR increase Kt/V
Needle gauge sizes vs. BFR - ANSWER-- 17g=200-250
- 16g = 250-350
- 15g = 350-450
- 14g = 450 and ^
procedure for post BUN lab draw - ANSWER-turn off UF DFR to 300
decrease BFR to 100 ml/pm
WAIT 15 SEC.
draw from arterial line port
What causes Kt/V to be falsely high? - ANSWER-if you take it before waiting the full 15 secs
what causes kt/v to be falsely low? - ANSWER-if you wait longer than 15 sec to take it
Consideration for pt with AKI - ANSWER-don't want them too dry; better to leave them with a little extra fluid than to take too much off
CKD vs AKI - ANSWER-CKD = longstanding disease to the kidneys leading to renal failure
AKI = abrupt decrease in renal function; kidney function can return but not at 100%...can also lead to CKD
why is it important to know each pt primary dx? - ANSWER-so you know how to monitor
and treat each pt specifically
what is a fever? - ANSWER-anything above 100 F or 2 degrees above baseline temp What can cramping cause? - ANSWER-low bp (hypotension)
normal chlorine check result - ANSWER-< 0.1 ppm
what does chlorine in blood cause? - ANSWER-hemolysis
how can you tell that hemolysis is occurring? what do you do? - ANSWER--blood is bright red (cherry kool-aid colored)
- you would stop tx and NOT return pt blood
What do you do if a pt starts seizing? - ANSWER-
why do we recirc machines? - ANSWER-to get rid of any air in lines
what do you do if a pt has an air embolism? - ANSWER-left side trendelenburg position
What can possibly happen if its a pts first time receiving dialysis tx? - ANSWER-they can have an allergic rx to dialyzer; may go into anaphylaxis
what do you do if a pt has angina during tx? - ANSWER-call the nurse - they will give fluid, slow BFR, turn off UF
what causes angina during dialysis? - ANSWER-dehydration and electrolyte imbalance
what is disinfectant infusion? + s/s - ANSWER-when there is leftover disinfectant in the machine
- s/s is pain at venous needle site at beginning of tx
When must RN pre-assessment be done? - ANSWER-PRIOR to tx initiation (state of CA)
when must RN post assessment be done? - ANSWER-before the pt is aloud to leave
Why is it important to document? - ANSWER-- if you don't document it did not happen
- continuity of care
When must machine safety checks be done and documented? - ANSWER-before putting pt on the machine
when can you start post tx vitals and assessment? - ANSWER-AFTER tx is done and stopped; cannot start till tx is completely done
what do you have to do if if you give saline? - ANSWER-notify RN and document under medication
-measured by green post BUN lab
- Kt/V goal is 1.2 or 65%
What affects Kt/V? - ANSWER-- time of tx -frequency of tx
-increasing BFR and DFR increase Kt/V
Needle gauge sizes vs. BFR - ANSWER-- 17g=200-250
- 16g = 250-350
- 15g = 350-450
- 14g = 450 and ^
procedure for post BUN lab draw - ANSWER-turn off UF DFR to 300
decrease BFR to 100 ml/pm
WAIT 15 SEC.
draw from arterial line port
What causes Kt/V to be falsely high? - ANSWER-if you take it before waiting the full 15 secs
what causes kt/v to be falsely low? - ANSWER-if you wait longer than 15 sec to take it
Consideration for pt with AKI - ANSWER-don't want them too dry; better to leave them with a little extra fluid than to take too much off
CKD vs AKI - ANSWER-CKD = longstanding disease to the kidneys leading to renal failure
AKI = abrupt decrease in renal function; kidney function can return but not at 100%...can also lead to CKD
why is it important to know each pt primary dx? - ANSWER-so you know how to monitor
and treat each pt specifically
what is a fever? - ANSWER-anything above 100 F or 2 degrees above baseline temp What can cramping cause? - ANSWER-low bp (hypotension)
normal chlorine check result - ANSWER-< 0.1 ppm
what does chlorine in blood cause? - ANSWER-hemolysis
how can you tell that hemolysis is occurring? what do you do? - ANSWER--blood is bright red (cherry kool-aid colored)
- you would stop tx and NOT return pt blood
What do you do if a pt starts seizing? - ANSWER-
why do we recirc machines? - ANSWER-to get rid of any air in lines
what do you do if a pt has an air embolism? - ANSWER-left side trendelenburg position
What can possibly happen if its a pts first time receiving dialysis tx? - ANSWER-they can have an allergic rx to dialyzer; may go into anaphylaxis
what do you do if a pt has angina during tx? - ANSWER-call the nurse - they will give fluid, slow BFR, turn off UF
what causes angina during dialysis? - ANSWER-dehydration and electrolyte imbalance
what is disinfectant infusion? + s/s - ANSWER-when there is leftover disinfectant in the machine
- s/s is pain at venous needle site at beginning of tx
When must RN pre-assessment be done? - ANSWER-PRIOR to tx initiation (state of CA)
when must RN post assessment be done? - ANSWER-before the pt is aloud to leave
Why is it important to document? - ANSWER-- if you don't document it did not happen
- continuity of care
When must machine safety checks be done and documented? - ANSWER-before putting pt on the machine
when can you start post tx vitals and assessment? - ANSWER-AFTER tx is done and stopped; cannot start till tx is completely done
what do you have to do if if you give saline? - ANSWER-notify RN and document under medication
