Final CCHT Exam 580 Questions with Verified Answers,100% CORRECT

Final CCHT Exam 580 Questions with Verified Answers Abscess - CORRECT ANSWER An abscess is an infection under the skin. It looks lika blister or pimple filled with fluid or pus. If needles are inserted into or near an abscess, infection of a dialysis access or other tissues may occur. Access - CORRECT ANSWER An access -vascular access- is a route into the bloodstream that allows enough blood flow for hemodialysis. For permanent access, a surgeon connects a vein to an artery. This can be done directly - fistula- or with a piece of synthetic tubing - graft. For short term access, a catheter may be placed in a large central vein. - CORRECT ANSWER Acid - CORRECT ANSWER An acid is substance with a pH below 7.0 that can donate a hydrogen ion -H+. In the human body, acids form when protein and other foods are broken down by cell metabolism. Acquired Immunodeficiency Syndrome - AIDS - CORRECT ANSWER Acute Kidney Failure - CORRECT ANSWER Acute kidney failure has a sudden onset. It is most often caused by an illness, injury, or toxin that stresses the kidneys. Some patients who survive acute kidney failure can recover kidney function. Others die or go on to develop chronic kidney failure. Alum - CORRECT ANSWER Alum is an aluminum compound. It is often added to city water supplies to remove sediment and make the water clearer. Aluminum can build up in the bodies and brains of dialysis patients. Aluminum in dialysis water must be kept at low levels with water treatment. - CORRECT ANSWER Aluminum-Related Bone Disease - ARBD - CORRECT ANSWER ARBD is cause by long-term exposure to aluminum. Aluminum builds up in the tissues at the point where new bone forms and be seen on X-ray. Sources of aluminum include dialysis water, medications, and cookware. Phosphate binders with aluminum are also a source, but these are rarely used today. Symptoms of ARBD can include deep bone pain, muscle weakness, and fractures. - CORRECT ANSWER Amyloidosis - CORRECT ANSWER Amyloidosis occurs when aproteingcalled beta-2-microglobulin -B2M- builds up in soft tissues, bones, and joints. The deposits can cause joint and or bone pain. High-flux membranes and or noctournal hemodialysis remove more B2M, which may help prevent or treat this problem. Anaphylaxis - CORRECT ANSWER Anaphylaxis is a fast severe immune response to an allergen. Hives, itching, or wheezing may occur. Anaphylactic shock may cause blood pressure drop; change in heart rhythms or arrest; and swelling of the lips, tongue, and throat. This problem can be fatal. Anastomosis - CORRECT ANSWER An anastomosis is a surgical connection beteen two blood vessels. Dialysis needles should not be inserted into the area of the anastomosis in a fistual or graft. Adsorb - CORRECT ANSWER Adsorb means to attract and hold. The dialyzer membrane adsorbs blood proteins to the walls of the hollow fibers during a treatment. This can make reused dialyzers more biocompatible than new ones - if bleach is not used to remove the protein coating. - CORRECT ANSWER Advance Directives - CORRECT ANSWER Advance directives outline a patient's wishes for medical treatment in case he or she becomes too ill to make such choices. A living will is one type of advance directive. The patient's family and other members of the care team should be told of the patient's wishes when an advance directive is done and given a copy to keep. - CORRECT ANSWER Afferent - CORRECT ANSWER means toward an organ. Air Detector - CORRECT ANSWER The air - or foam detector checks blood in the venous line of the extracorporeal circuit for air. Air in a patient's bloodstream can stop the blood flow or heartbeat, causing death. If the detector finds air, an alarm will sound, the blood pump will stop, and the venous bloodline will clamp to keep air from reaching the patient. - CORRECT ANSWER Air Embolism - CORRECT ANSWER An air embolism occurs when air bubbles enter the bloodstream and flow into a vessel small enough to be blocked by the air. The air in the vessel acts like a clot, blocking the flow of blood. Dialysis machines have an air detector on the venous bloodline to help prevent this problem, which can be fatal. - CORRECT ANSWER Albumin - CORRECT ANSWER Albumin is a blood protein. Lo serum albumin levels -<3.5 g/dL- may mean a patient is undernourished. Malnutrition is a common in dialysis patients and raises their risk of death. Anemia - CORRECT ANSWER Anemia is a shortage of oxygen-carrying red blood cells. It causes sever fatigue, trouble with metal focus, reduced immune function, and many other problems. Anemia is common in kidney failure due to less erythropoietin, iron deficiency, and loss of blood through tests and dialysis itself. - CORRECT ANSWER Anesthetic - CORRECT ANSWER An anesthetic is a drug that numbs the body to reduce pain. Local anesthetics can be injected into a spot, such as the skin around a puncture site, before needle placement. Or, gels or creams can be put on the skin to prevent pain at that site. Aneurysm - CORRECT ANSWER An aneurysm is a ballooning or bulging of a weak spot in a blood vessel. Severe bleeding can occur if an anerurysm ruptures, so great care must be taken with a patient who has one. Aneurysms can occur if needles are placed too often into the small area of a fistula. Angioplasty - CORRECT ANSWER Angioplasty is a procedure to open a narrowed blood vessel - stenosis. It may be used for vascular access repair. A small balloon is threaded through the vessel into the access and gently inflated to push the walls of the vessel open. Anion - CORRECT ANSWER An anion is a negatively-charged ion. Antegrade - CORRECT ANSWER Antegrade means forward-moving. In dialysis, it means in the direction of blood flow. The venous needle should always be placed antegrade. The arterial needle is placed antegrade or retrograde, though there is some evidenc that antegrade is better. . Anticoagulant - CORRECT ANSWER An anticoagulant is a blood-thinning drug used to keep clots from forming. Anticoagulants, such as heperain, are used to prevent clotting in the extracorporeal circuit during hemodialysis. Antidiuretic Hormone- ADH - CORRECT ANSWER Antidiuretic hormone - ADH or vasopressin- is released by the pituitary gland in the brain. ADH helps prevent excess fluid loss by telling healthy kidneys to reabsorb water. ADH also tells the blood vessels to constrict - tighten. Apical Pulse - CORRECT ANSWER The apical pulse is felt on the chest wall over the heart. Apnea - CORRECT ANSWER Apnea is a period when breathing stops. Arterial Pressure - CORRECT ANSWER In hemodialysis, arterial pressure is measured in the extracorporeal circuit between the arterial needle and the dialyzer. Pre-pump arterial pressure is measured from the patient's access to the blood pump. Post-pump arterial pressure is measured after the blood pump, but before the dialyzer. - CORRECT ANSWER Arrhythmia - CORRECT ANSWER An arrhythmia is an irregular heartbeat. It may be felt as an extra pulse or heard over the heart. Arterial pressure Monitor - CORRECT ANSWER A pressure sensor monitors pre-pump arterial pressure in the extracorporeal circuit between the patient's access and the blood pump. A post-pump arterial pressure monitor measures pressure beten the blood pump and the dialyzer. If the pressure reading is outside of set limits, an alarm will sound and the blood pump will stop. - CORRECT ANSWER Arterialize - CORRECT ANSWER When a fistual is made, strong arterial blood flow causes the vein to arterialize - it dilates - widens, thickens and becomes more muscular, like an artery. Arteriovenous -AV-Fistula - CORRECT ANSWER In dialysis, an arteriovenous fistula is a link beteen an artery and a vein under the skin of an arm or leg to provide access to the blood. The force of blood from the artery makes the vein larger and thicker. After a fistual matures, it can be punctured with dialysis needles and will allo the blood flow rates needed for dialysis. - CORRECT ANSWER Arteriole - CORRECT ANSWER An arteriole is a small artery. Artery - CORRECT ANSWER A blood vessel that carries blood away from the heart at high pressure. Arteries bring oxygenated blood to each part of the body. Artificial - CORRECT ANSWER Artificial means man-made. The dialyzer is called an artificial kidney. A piece of artificial vein is used to create a dialysis graft. Ascites - CORRECT ANSWER Ascites is a build - up of fluid inthe abdomen caused by liver damage, heart failure, malnutrition, or infection. Special ultrafiltration and other methods - i.e. drainage may be needed to remove it. Asepsis - CORRECT ANSWER Asepsis is the absence of pathogens. Aseptic - CORRECT ANSWER Aseptic means sterile or germ-free. Aseptic technique - CORRECT ANSWER Aseptic technique is a series of steps used to maintain a germ-free environment. The steps include washing hands before touching things in sterile packages, touching sterile objects only to other sterile objects, cleaning blood ports or the patient's skin with disinfectant before placing a needle, and throwing out any sterile supplies in we, damaged, or torn packages. Peritoneal dialysis exchanges must be done using aseptic technique to prevent infection. - CORRECT ANSWER Association for the Advancement of Medical Instrumentation - AAMI - CORRECT ANSWER AAMI develops voluntary standards for dialysis water treatment and dialyzer reprocessing. TheAAMI guidelines have been adopted by CMS. Auscultate - CORRECT ANSWER Auscultate means to listen with a stethoscope. Auscultation is used to diagnose access problems like stenosis or thromboisis that can change the normal sound of the bruit. Backfiltration - CORRECT ANSWER Backfiltration occurs when dialysate crosses the dialyzer membrane into the patient's blood. It can be caused by a change in the presure or concentration gradient between the dialysate and blood. Back filtration may be more likely with high-flux dialyzer membranes, which have larger pores. Backfiltration can harm patients because endotoxin in the nonsterile dialysate can enter the bloodstream, causing infection and fever. - CORRECT ANSWER Backwashing - CORRECT ANSWER Backwashing means forcing water backwards through a filter. It can used to remove particles from clogged sediment filters in a water treatment system. Bacteria - CORRECT ANSWER Bacteria are microscopic, single-celled organisms that can cause disease. Bacteria are classified as Gram-positive or Gram-negative by the color they turn on a test called Gram's stain. Base - CORRECT ANSWER Bases are chemicals that can accept a hydrogen ion-H+. A ubstance with a pH of greater than 7.0 is a base, or alkaline. In the body, bicarbonate is a base. Bicarbonate - CORRECT ANSWER Bicarbonate is a buffer. It helpsneutralize acids that form when the body breaks down protein and other foods, and is reabsorbed by healthy kidneys. Dialysis patients often have low levels of bicarbonate because their kidneys do not reabsorb enough. Thus, they can't neutralize acids well. Bicarbonate is used in dialysate to help restore levels in the body, but it has two main drawbacks; it supports bacterial growth, and it needs two concentrates - acid and bicarbonate to keep scale from forming and harming equipment. - CORRECT ANSWER Biocompatible - CORRECT ANSWER Biocompatible means like the human body. A biocompatible membrane is less likely to cause patient symptoms or trigger immune responses caused by a foreign "invader." Blood leak - CORRECT ANSWER A blood leak occurs when the delicate semipermeable membrane of the dialyzer tears, letting blood leak into the dialysate. Severe blood leaks can cause major blood loss during treatment. Any blood leak will expose patients directly to the dialysate. Blood Leak Detector - CORRECT ANSWER The blood leak detector is an alarm system on the hemodialysis delivery system. It checks used dialysate for blood that would mean a leak in the membrane. The dector shines a beam of light through the dialysate and into a photocell. A break in the light beam caused by blood cells triggers and alarm that stops the blood pump and clamps the venous line. This prevents further blood loss and contamination of the patient's blood with dialysate. - CORRECT ANSWER Blood pump - CORRECT ANSWER The blood pump is part of the hemodialysis delivery system. It pushes the patient's blood through the extracorporeal circuit at a fixed rate of speed. During a treatment, the blood tubing is threaded beteen the pump head and rollers. the rollers move blood through the circuit and back to the patient. Blood Pump Segment - CORRECT ANSWER The blood pump segment is a durable, larger diameter section of the arterial blood tubing. It is a threaded through the roller mechanism of the blood pump. Blood tubing - CORRECT ANSWER Blood tubing is the part of the extracorporeal circuit that carries blood from the patient;s access, through the arterial needle, to the dialyzer, and back to the patient through the venous needle. There are two segments of blood tubing. The arterial segment is often color-coded red. The venous segment is often color - coded blue. Parts of the blood tubing include patient conncetors, dialyzer conncetors, drip chamber/bubble trap, blood pump segment, and heparin and saline infusion lines. - CORRECT ANSWER Blood Urea Nitrogen - BUN - CORRECT ANSWER Urea is a waste product of protein metabolism. It is measured as blood urea nitrogen - BUN. Failed kidneys cannot remove urea, which builds up in the body between treatments. BUN is easy and low cost to measure , so it is used as a stand - in for other wastes that are harder to identify or measure. BUN levels are the basis of the urea reduction ratio and urea kinetic modeling-methods used to assess the adequacy of dialysis. - CORRECT ANSWER Bolus - CORRECT ANSWER A bolus is a single, large amount of something. In dialysis, heparin can be given by bolus. The full prescribed dose is given all at once. Brachial pulse - CORRECT ANSWER The brachial pulse is the pulse felt in the crease of the elbow at the brachial artery. Brachiocephalic Fistula - CORRECT ANSWER A brachiocephalic fistula is the most common type of AV fistula of the upper arm. It is created by surgically joining the brachial artery to the cephalic vein. Brine - CORRECT ANSWER Brine is a concentrated saline solution. In dialysis water treatment, brine is used to flush the resinbed of a water softener. This recharges the softener with sodium chloride ions. These ions are then exchanged with calcium and magnesium to soften the water. Bruit - CORRECT ANSWER A Bruit is a buzzing or swooshing sound caused by the high-pressure flow of blood through a patient's fistula or graft. The bruit can be heard through a stethoscope at the anastomosis, and for some length along the access. A high-pitched bruit may mean there is stenosis of the access. Buffer - CORRECT ANSWER A buffer is a substance that keeps the pH of a solution at a constant level, even when an acid or base is added. Bicarbonate is the buffer used in dialysis to maintain the pH for dialysate. Buttonhole Technique - CORRECT ANSWER In the buttonhole technique, dialysis needles are placed in a fistula - not a graft- into the same holes at the same angle. Over 3 - 4 weeks, this creates pierced earring -like tracts that guide the needles to the right spots. The patient or the same staff person should place the needles. Once the tracts are formed, special blunt needles are used to avoid cutting new tracts. Buttonhole cannulation is quick to do, less likely to infiltrate, and largely painless for the patient. - CORRECT ANSWER Bypass - CORRECT ANSWER Bypass is a safety feature of the hemodialysis delivery system. It cuts off the flow of fresh dialysate to the dialyzer and shunts it to the drain. Bypass keeps unsafe dialysate -wrong conductivity, temperature, or pH- from reaching the patient and causing harm. Calcium - CORRECT ANSWER Calcium is an element that exists as a cation - positively-charge ion. In the body, calcium is an electrolyte needed for nerves and muscles to form normal bone. It is partly bound to protein in the blood. Too much or too little calcium in dialysate can cause sever health problems or death for patients. Patient blood levels of calcium are checked once a month. - CORRECT ANSWER Calcium in a dialysis feed water supply can combine with other substances to form scale that can clog equipment. Cannulate - CORRECT ANSWER Cannulate means to put dialysis needles into a fistual or graft. Capillaries - CORRECT ANSWER Capillaries are tiny blood vessels, where oxygenated blood crosses from arteries into veins. They are smaller than a human hair; blood cells must line up single file to pass through. Unlike arteries and veins, capillary walls are semipermeable. The walls let oxygen, nutrients, and waste products pass through. In the kidneys, each glomerulus is a ball of capillaries that filters out wastes from the blood. - CORRECT ANSWER Carbon tank - CORRECT ANSWER Carbon tanks are water treament devices. They contain granular, activated carbon that adsorbs low molecular weight particles from water. Carbon tanks are mainly used to remove chlorine, chloramines, pesticides, solvents, and some trace organic substances from water used for dialysis . Cardiac Arrest - CORRECT ANSWER Cardiac arrest occurs when the heart stops beating. Cardiac arrest can be a deadly side effect of some dialysiss problems, such as too-warm dialysate, wrong dialysate concentration, hemolysis, severe blood loss, or a large amount of air in the blood-stream. Hyperkalmia - high potassium levels- can also cause cardiac arrest. Cardiac Output - CORRECT ANSWER Cardiac output is the amount of blood passing through the heart in a certain period of time. Having an AV fistual or graft causes a 10% increase in cardiac output. This causes a 10% increase in the size of the heart. Patients who can't tolerate this increase in cardiac output cant's have AV fistulae or grafts. Catabolism - CORRECT ANSWER Catabolism is a chemical process that occurs in the body. Substances, such as proteins, are broken down, forming wastes. These wastes -e.g., urea- are removed by healthy kidneys. In dialysis patients, the wastes must be removed by the treatment. Catheter - CORRECT ANSWER A catheter is a plastic tube. In hemodialysis, a catheter can be placed in a large, central vein for short-term or long term access. In peritoneal dialysis, a catheter is placed in the abdoman or chest. It is used to infuse fresh dialysate into the periotoneum and drain used dialysate. Cation - CORRECT ANSWER A cation is a positively-charged ion. In water treatment, cations can be removed by ion exchange or reverse osmosis to ensure safe water for dialysate and dialyzer repr0cessing. Cellulose - CORRECT ANSWER Cellulose is a fiber that forms the cell walls of plants. Cellulose acetate was used as the first dialyzer membrane by Dr. Willem Kolff in 1942. It was also the first substance used to make reverse osmosis membranes for water treatment. To form a membrane, cellulose can be dissolved in a solution ith copper salts and ammonium, then spun into sheets or hollow fibers. Cellulose dialyzer membranes are the most likely to cause first - use syndrome, because they are not biocompatible. - CORRECT ANSWER Central Venous Stenosis - CORRECT ANSWER Central venous stenosis is narrowing of a central vein. It can damage vessels in the arm on the of affected side so a patient can't have a fistula or a graft. With only 10 access sites in the body, it is vital to preserve as many as possible. Due to the risk of stenosis, the KDOQI guidelines say the subclavian vein should not be used for a hemodialysis catheter site The internal jugular -IJ- vein should be used instead. - CORRECT ANSWER Certified Clinical Hemodialysis Technician - CCHT - CORRECT ANSWER The 2yr CCHT certification is offered by the Nephrology Nursing Certification Committee. Certified in Biomedical Nephrology Technology -CBNT - CORRECT ANSWER The CBNT certification is offered by the National Nephrology Certification Organization Inc. - NNCO. Certified in Clinical Nephrology Technology - CCNT - CORRECT ANSWER The CCNT certification is offered by the Natonal Nephrology Certification Organization, Inc - NNCO Chloramine - CORRECT ANSWER Chloramine is a mix of chlorine an ammonia. Ammonia may be added to city water to boost the germ-killing power of chlorine. Chloramine is an oxidant. It destroys microbes by breaking down their cell walls. Chloramines in dialysis water can cause a deadly health problem called hemolysis - rupture of red blood celles. Carbon tanks are used to remove chloramines from water used for dialysis. - CORRECT ANSWER Chloride - CORRECT ANSWER Chloride is a salt concentrate needed in dialystate and in the human body. Chloride combines with other elements to form sodium chloride, potassium chloride, magnesium chloride, and calcium chloride. Chlorine - CORRECT ANSWER The element chlorine is greenish yellow gas. It can cause severe lung irritation if inhaled. Chlorine is blended with other substances to disinfect surfaces. Chlorine may be added to city water to destroy micorbes. Carbon tanks are used to remove chlorine and chloramines from water used for hemodialysis and dialyzer reuse. - CORRECT ANSWER Chronic - CORRECT ANSWER means long-term Chronic Kidney Disease - CKD - CORRECT ANSWER CKD is a long , slow loss of nephrons - and thus kidney function. CKD can take many years to progress. It is divided into stages based on the glomerular filtration rate -GFR. Stage 1 CKD is mild kidney dysfunction. Stage 5 CKD is the most severe forms. Clearance - K - CORRECT ANSWER Clearance is the amount of blood - in mL- that is completely cleared of a solute in one minute of dialysis at a given blood and dialysate flow rate. Dialyzer clearance affects how much treatment a patient receives. Dialyzer makers test their products with fluids other than blood - in vitro. This means that clearance of a dialyzer during treatment - in vivio - can vary from the maker's stated clearance. - CORRECT ANSWER Clinical Practice Guidelines - CORRECT ANSWER Clinical practice guidelines are the suggestions of experst to improve patient outcomes. The National Kidney Foundation - NKF - DOQITM giudelines were written by expert panels who reviewed many research studies. CMS often adopts guidelines and turns them into rules that clinics must follow or benchmarks for good care. Coefficient of Ultrafiltration - CORRECT ANSWER T Kuf is the amount of water a dialyzer will remove from the patient's blood per hour at a certain pressure. Kuf is also called the ultrafiltraion factor -UFF or UR rate - UFR. It is stated in milliliters - mL per hour - hr of water removed for each millimeter - mm of mercury - Hg - of transmembrane pressure - TMP, or mL/hr/mmHg TMP. The higher the Kuf the more water per mL of pressure will be removed. High-flux and high-efficiency dialyzers has a higher Kuf than conventional dialyzers. Any Kuf above 8 requires volumetric control hemodialysis system to precisely control how much water is removed. - CORRECT ANSWER Colony-Forming Unit - CFU - CORRECT ANSWER The number of CFUs in a water or dialysate sample is a measure of the number of living bacteria. Complement Activation - CORRECT ANSWER Complement is a group of proteins in the blood serum that work to remove pathogens from the body. Complement activation occurs when this system is exposed to a pathogen. Concentrate - CORRECT ANSWER In dialysis, concentrate is one of two salt solutions - acid and bicarbonate - that are mixed together to form dialysate. Concentration - CORRECT ANSWER Concentration is the level of solute dissoved in a measure of fluid. A highly-concentrated solution has more solutes. A less -concentrated - more dilute solution has less solutes. One task of healthy kidneys is to control the concentration of urine so the right amounts of fluid and other substances stay in the body. In dialysis, the concentration of each of substance in dialysate must be correct to ensure a safe and effective treatment. - CORRECT ANSWER Conditions for Coverage - CORRECT ANSWER The Conditions for Coverage for ESRD facilities are Medicare rules for dialysis clinics to follow to receive federal dollars. In 2008, the conditions were updated for the first time in 29yrs. Medicare surveyors visit dialysis clinics to ensure that they are following the rules. Conductivity - CORRECT ANSWER Conductivity is how well a fluid will transfer an electrical charge. It is a measure of ions in solution. A conductivity meter measures the electrolyte level of dialysate to be sure it is within safe limits. Conductivity Monitor - CORRECT ANSWER This monitor checks the conductivity of dialysate to be sure it is correct. If the level is wrong, an alarm goes off and the machine goes into bypass mode so dialysate is sent to the drain. Congestive Heart Failure - CHF - CORRECT ANSWER CHF occurs when the heart can't pump out enough of the blood it receives. Excess fluid backs up into the lungs. Fluid overload from too much fluid intake or not enough fluid removal at dialysis may lead to CHF in dialysis patients. Contamination - CORRECT ANSWER means that something is impure due to the presence of dirt, blood, or micorbes. Continuous Ambulatory Peritoneal Dialysis -CAPD - CORRECT ANSWER CAPD is peritoneal dialysis with manual exchanges done four or five times each day. The exchanges can be done at home or ork while the patient goes about his or her day. Each one takes about 30 minutes. CAPD is continous, so large amounts of wastes do not build up beteen treatments. This means the diet and fluids tend to ble less restricted for CAPD than for standard in-center hemodialysis. Because the patient can dialyze on his or her own schedule, this treatment is work-friendly. - CORRECT ANSWER Continuous Cycling Peritoneal Dialysis - CCPD - CORRECT ANSWER CCPD, or automated peritoneal dialysis - APD, is PD using a cycler machine to do exchanges at night while the patient sleeps. Because the patients days are free, this treatment is work friendly. Some patients may use a cycler at night and do one exchange by hand at mid-day. Continuous Quality Improvement -CQI - CORRECT ANSWER CQI is a way to improve care by choosing an area that needs to be improved, analyzing the process of care, finding root causes of problems, and then making and using a plan of change. Continuous Renal Replacement Therapy - CRRT - CORRECT ANSWER CRRT is slow, ongoing form of dialysis. It uses the patient's heart or blood pump to move blood through an extracorporeal circuit. CRRT is most often done for may hours to gently remove extra fluid and some wastes in patients who are too ill or unstable for standard hemodialysis. A cartridge with a semipermeable membrane - like a dialyzer - is used. - CORRECT ANSWER Countercurrent flow - CORRECT ANSWER Countercurrent flow in a dialyzer occurs when blood moves one ay and dialysate flows the other way. This type of flow allows for the most efficient dialysis because it keeps the blood in constant contact with fresh dialysate. Creatinine - CORRECT ANSWER is a waste product of muscle use that healthy kidneys remove from the blood. Larger people with more muscle tend to have higher creatine levels in their blood. Higher-than-normal creatinine levels may be a sign of kidney disease. Creatinine Clearance - CORRECT ANSWER Creatinine clearance is a urine test that measures how well the kidneys remove creatinine from the blood in a certain amount of time . As kidney disease worsens, creatinine clearance will fall to 10% of normal or less. Crenation - CORRECT ANSWER Crenation is the shriveling of blood cells. This can occur if blood cells are exposed to dialysate that is more concentrated than blood - hypertonic. If crenation is present, the blood will look dark red. Crenation can be fatal. CROWNWeb - CORRECT ANSWER is Consolidated Renal Operations in a Web-enabled Network. It is a computer program that allows clinics to send their required data to the ESRD networks. Cuffed Tunneled Catheters - CORRECT ANSWER are placed into a large central blood vessel through a tunnel formed under the skin. Inside the tunnel, tissue grows into an attached cuff. The cuff makes the catheter more stable and is a physical barrier against bacteria. Cyanosis - CORRECT ANSWER is bluish-colored skin, lips, gums, and fingernil beds from lack of oxygen. It may be present in patients with methemoglobinemia, caused by exposure to dialysate made form water that contains high levels of nitrates. Dehydration - CORRECT ANSWER means the body does not have enough water. It may be caused by diarrhea, vomiting, heavy seating, or removingtoo much water at dialysis. A dehydrated patient may have low blood pressure, sunken eyes, be listless, and have poor skin tone. Deionization - DI - Tank - CORRECT ANSWER Part of a water treament systems, a DI tank uses beds of resin beads to remove unwatned ions from water used for dialysis. The unwanted ions are exchanged for hydrogen - H+ and Hydroxide -OH - ions to form pure water. Diabetes - CORRECT ANSWER There are 2 main types of diabetes, and both can harm the kidneys. In type 1, the immune system kills the pa ncreas cells that make insulin. In type 2 the pancreas does not make enough insulin, or the body can't use what it does make. Diabetic Nephropathy - CORRECT ANSWER is kidney disease that results from diabetes. Type 2 diabetes, a shortagle of or resistance to insulin, is the number one cause of kidney failure in the US. In type 1 diabetes, the immune system destroys the pancreas cells that make insulin. Diabetes is a disease of the blood vessels. It causes heart disease and nerve damage. Diabetes is also the leading cause of blindness and loss of limb in the US. - CORRECT ANSWER Dialysate - CORRECT ANSWER is a precise mixture of treated water and chemicals. It is used in dialysis to create a concentration gradient ot remove wastes from the blood. Sodium, calcium, magnesium, chloride, potassium, glucose, and bicarbonate are most often included, at levels like those ofnormal blood. Dialysate must be mixed properly or patients can be harmed. Dialysis - CORRECT ANSWER is a process of removing wastes and excess water from the blood of people whose kidneys have failed. It may be done using a dialyzer - hemodialysis - or the patient's own peritoneum - peritoneal dialysis - as a filter. Dialysis Outcomes and Practice Pattern Study - DOPPS - CORRECT ANSWER The DOPPS is a long-term study of patients in Australia, Belgium, Canada, France, Germany, Italy, Japan, Ne Zealand, Spain, Sweden, the United Kingdom, and the US> The goal of DOPPS is to help patients live longer by looking at practice patterns in centers. The data are used to help find practices that can be changed to improve patient outcomes. - CORRECT ANSWER Dialyzer - CORRECT ANSWER is a semipermeable membrane in a plastic cylinder. Dialyzers are used in hemodialysis to filter wastes and water out of the blood of patients with kidney failure. Ports on the cylinder let blood and dialysate flow in and out. The membrane keeps blood and dialysate apart, but allows an exchange of water and some solutes to occur. Diastolic - CORRECT ANSWER Diastolic blood pressure is the pressure of blood against the arteries when the heart rate is at rest - between beats. It is the bottom number of a blood pressure reading. Diffusion - CORRECT ANSWER is the principle on which dialysis is based. Dissolved particles will move across a semipermeable membrane for ma higher solute level to a lower one. The process will go on unitl both sides of the membrane have the same solute level. In dialysis, diffusion removes wastes form the blood. Dialsate has no wastes, so wastes in the blood diffuse across the dialyzer membrane into the dialysate. The rate of diffusion depends on the concentration gradient, temperature, and size of the wastes and the membrane pores. Diffusion is also called conductive solute transfer. - CORRECT ANSWER Disinfectant - CORRECT ANSWER A disinfectant is a chemical or process - e.g., heat - that destroys or slows the groth of harmful microbes. To work, disinfectants need time. They must stay moist and in contact with a surface. Some common equipment disinfectants are heat, bleach, formaldehyde, gluteraldehyde, renalin, citric acid, and amuchina. Disinfectnats are also used to clean water treatment ports before taking a water sample and to wipe off surfaces in the center. - CORRECT ANSWER Distal - CORRECT ANSWER Distal means far. In anatomy, distal is far from the center of the body. The hands and feet are distal extremities. Diuretic - CORRECT ANSWER is a drug that causes someone to make more urine. Some diuretics can cause hypokalemia because they promote the loss of potassium in the urine. Diuretics are the first line of treatment for high blood pressure. They may be used for kidney patients before they start dialysis. Once the kidneys stop making urine, diuretics no longer ork. Documentation - CORRECT ANSWER is information about a patients care entered in the permanent medical record or chart. It is vital to track the patient's progress, to provide a way to follow up on each patients response to treatment, and to ensure continuity of care. A patient's chart is legal evidence of the care he or she received. If a task wasn't charted, it wasn't done - CORRECT ANSWER Drip Chamber - CORRECT ANSWER An arterial or venous drip chamber checks arterial or venous pressure in the extracorporeal circuit. A bubble trap in the drip chamber collects any air that enters the blood tubing Dry weight - CORRECT ANSWER is the Patient's weight without excess fluid. When dry weight is reached, there are not signs of fluid overload or dehydration. Breathing is normal, with no signs of fluid in the lungs. And, blood pressure is normal for the patient - not too high or too low. "Target weight" is the goal wight for a given dialysis treatment and is most often determined by the dry weight. - CORRECT ANSWER Dwell Time - CORRECT ANSWER In hemodialysis, dwell time is the length of time a disinfectant must stay in a dialyzer while reprocessing. If a disinfectant is used on the hemodialysis delivery system, it must dwell in the fluid pathways long enough to kill microbes. Then, it is rinsed out. In peritoneal dialysis, dwell time is the length of time dialysate stays in the patient's abdomen before it is drained. - CORRECT ANSWER Dyspnea - CORRECT ANSWER Means trouble breathing or shortness of breath. It can be a symptom of fluid overload, anemia, or heart or lung disease. Dyspnea can also occur at dialysis due to problems such as an air embolism. Ecchymosis - CORRECT ANSWER is a bruise or bleeding under the skin. In dialysis patients, an ecchymosis can be a sign that too much heparin has been given. Or, it can mean that not enough pressure was placed on the needle sites after the needles were removed. Edema - CORRECT ANSWER is water retention with swelling in body tissues. It occurs as a result of fluid overload or other health problems, such as congestive heart failure. This swelling may be seen in the patient's eyelids, ankles, feet, hands, abdomen, or lower back area. "Pitting" edema is present when a finger pushed against the skin of the ankle leaves a dent. Report this to the nurse if you see it. - CORRECT ANSWER Efferent - CORRECT ANSWER means away from an organ Electrolyte - CORRECT ANSWER is a compound that breaks apart into ions when dissolved in water. Electrolytes send electrical signals along the nerves to the muscles, including the heart. In the body, healthy kidneys keep electrolytes in balance. Sodium, Potassium, magnesium, chloride, and calcium are electrolytes. Each is added to dialysate in precise amounts. - CORRECT ANSWER Empty Bed Contact Time - EBCT - CORRECT ANSWER is the amount of time that feed water must stay in contact with the charcoal bed in a carbon tank during water treatment to remove chlorine and chloramines. Encephalopathy - CORRECT ANSWER is a change in brain function that can be fatal. Patients may seem confused or may lose short-term memory. You may see a change in personality or speech. Muscle spasms, hallucinations, and seizures can also occur. Chronic exposure to high levels of aluminum can cause the problem. Aluminum can come from dialysate water, some antacids, and cookware. - CORRECT ANSWER Endocrine Function - CORRECT ANSWER - making hormones is one of the tasks of healthy kidneys. Kidneys maker hormones that control blood pressure and tell the bone marrow to make red blood cells. They also convert Vitamin D into an active form the body can use to absorb calcium. Endotoxin - CORRECT ANSWER -Lipopolysaccaride is a toxic part of the cell walls of some bacteria. Live bacteria can shed endotoxin, and it is released when they die. Wndotoxin is not alive, so it cant be killed. If endotoxin enters a patients body, it can cause pyrogenic reactions. Endotoxin is a concern in water treatment and dialyzer reprocessing. To control it, we reduce bacteria count of the water or remove it with an ultrafilter. - CORRECT ANSWER End-Stage Renal Disease - ERSD - CORRECT ANSWER is a legal term for complete and permanent loss of kidney funtion. This occurs during the last state - stage 5- of chronic kidney disease, when dialysis or a transplant is needed for the patient to live. Patients have ERSD when their glomerular filtration rate has dropped less that 15. Equilibrium - CORRECT ANSWER is a state of balance. Diffusion and osmosis both go on until equilibrium has been reached the levels of solutes or fluid are equal on both sides of a semipermeable membrane. Erythropoietin - EPO - CORRECT ANSWER is a hormone made by healthy kidneys that tell the bone marrow to make red blood cells. ERSD Networks - CORRECT ANSWER were formed by the US Congress in 1978. Their job is to oversee dialysis centers and make sure patients receive high-quality care. The Networks collect data, take steps to improve quality, and promote rehabilitation. They also handle patient grievances and give resources to ESRD staff and patients. There are 18 regional ERSD Networks in the US. - CORRECT ANSWER Ethylene Oxide - ETO - CORRECT ANSWER is a gas used by some manufacturers to sterilize new dialyzers. Patients who are hypersensitive to ETO may have first-use syndrome if a new dialyzer is properly rinsed. Exchange - CORRECT ANSWER In peritoneal dialysis, an exchange occurs each time used dialysate is drained and replaced with fresh after a dwell time. Exchanges may be done by hand or with a cycler machine. Excretory Function - CORRECT ANSWER To excrete means to eliminate from the body. The excretory function of healthy kidneys is to remove wastes and excess water as urine. Exsanguination - CORRECT ANSWER is a severe loss of blood that can be fatal. At dialysis, this can occur if a needle is dislodged, a bloodline seperates, an access ruptures, or there is a crack in a dialyzer casing. All of these problems can be prevented. Extracellular - CORRECT ANSWER means outside the cells. About one-third of the water in the body is extracellur, between the cells and in the blood vessels. Water must move into the blood vessels for dialysis to remove it. The sodium in dialysate helps draw water into the blood vessels so it can be removed. - CORRECT ANSWER Extracorporeal - CORRECT ANSWER means outside the body. Hemodialysis is an extracorporeal therapy; it takes place outside the body Extracorporeal Circuit - CORRECT ANSWER Is the arterial bloodline, dilyzer, venous blooline and extracorporeal circuit monitors. It is an extension of the patients blood vessels outside of the body, bringing blood from the access to the dialyzer and then back to the patient. Extracorporeal Circuit Monitors - CORRECT ANSWER include a blood flow monitor, arterial or venous pressure monitors - measured at drip chambers-, an air dectector, and a blood leak detector. Each will shut off the blood pump and clamp the venous bloodline if the pressure is too high, aire gets in the venous blooline, or there is blood in the used dialysate. Extraskeletal Calcification - CORRECT ANSWER occurs when calcium phosphate crystals form in blood vessels or soft tissues. Though rate, it can cause gangrene, loss of limb, and death. Patients with high blood -serum-levels of calcium and phosphorus are at a higher risk for the problem. If you see that a patient has mottled, painful, purplish skin - often in the same place on both sides of the body - tell the nurse or nephrologist right away. - CORRECT ANSWER Feed water - CORRECT ANSWER is untreated tap water before it passes through a water treatment system. Feed water must pass through all of the parts of a water treatment system before it is used for dialysis. Femoral Catheter - CORRECT ANSWER is a short-term vascular access placed in the femoral vein in the groin. This vein is easy to reach and leaves blood vessels in the upper body to be used for a fistula or graft. But, the groin is quite prone to infection. It is most often used for critically ill or bedridden patients. Ferritin - CORRECT ANSWER is an iron storage protein. It is measured with a blood test. Ferritin stores are needed as a building block for red blood cells. KDOQI anemia guidelines say dialysis patients ferritin levels should be greater than 200ng/mL. Most patients need intravenous iron to keep their ferritin levels at this level. Fiber Bundle Volume -FBV - CORRECT ANSWER or total cell volume - TCV s a measure of the volume of fluid the hollow fibers in a dialyzer can hold. FBV is checked before a dialyzer is used again after each reprocessing. Reprocessing a dialyzer can reduce its FBV. Fibrin Sheath - CORRECT ANSWER is a cluster of blood clotting fibers that build up on the outside of a catheter lumen. The fibers can form a cap that blocks the end of a catheter and reduces blood flow. Fibrosis - CORRECT ANSWER is overgrowth of scar tissue. Fibrosis can develop in a fistula due to needle punctures for dialysis. Scar tissue builds up, narrowing the lumen of the vessel and reducing blood flow. Filters - CORRECT ANSWER are devices that remove particles, solutes, and other substances by passing solutions that contain them through membranes that have holes of various sizes. Filtration - CORRECT ANSWER is the process of passing a fluid through a filter. In dialysis, filtration forces water out of the patient's blood and across the dialyzer membrane by using pressure. First-Use Syndrome - CORRECT ANSWER is a reaction to a new dialyzer. Shortly after a treatment starts, patients may feel nervous, have itching, chest or back pain, or palpitations - skipped or missed heartbeats. First-use syndrome may be caused by ethylene oxide gas or manufacturing residues. Preprocessing a dialyzer may help remove some of these substances. - CORRECT ANSWER Flocculant - CORRECT ANSWER is a chemical added to drinking water to remove solid particles from the water to make it clearer. Flow - CORRECT ANSWER is a stream. Blood flow to each organ in the body is based on the amount and pressure of blood delivered by the heart, and the resistance the blood meets in the blood vessels. Blood flow in the extracorporeal circuit is based on the blood pump setting, resistance in the extracorporeal circuit, and the access. - CORRECT ANSWER Flow rate - CORRECT ANSWER is the amount of fluid that flows through the tubing in a given period of time. Flow velocity - CORRECT ANSWER is the speed at which the fluid moves through a give length of tubing. FDA - CORRECT ANSWER is a federal agency. It makes rules that cover the release and marketing of drugs and medical devices, such as dialyzers and repr0cessing machines. Formalin - CORRECT ANSWER is the trademark name for a 37% solution of formaldehyde. Formaldehyde - CORRECT ANSWER is a poisonous, clear, strong-smelling gas. Formalin is a germicide used to disinfect dialysate delivery systems or reprocess dialyzers. The liquid form is volatile. It changes into a vapor that can penetrate and disinfect even small spaces. Formaldehyde is a known cancer-causing agent. Centers must follow OSHA safety rues to keep patients and staff safe. - CORRECT ANSWER Free Chlorine - CORRECT ANSWER is chlorine that is not chemically bound to other substances. Gauge - CORRECT ANSWER is a standard of measurement for needle sizes. Glomerular Filtration Rate -GFR - CORRECT ANSWER is the volume of blood filtered by the glomeruli each minute, in mL/min. A normal GFR is about 120 to 130 mL/min. Chronic kidney diseae is divided into stages based on the level of GFR. Glomerulonephritis - CORRECT ANSWER is an inflammation that damages the glomeruli. It can be slow and progressive or rapid in onset. It may occur as an immune response to a strep infection. Hypertension often occurs with it. Glomerulosclerosis - CORRECT ANSWER is hardening of the glomeruli Glomerulus - CORRECT ANSWER is a tangled ball of capillaries in each nephron. It is held together by a membrane called a Bowman's capsule. Water and small solutes are forced through filtration slits in each glomerulus by the presure of the beating heart. The fluid that results is called glomerular filtrate. Hemodialysis Adequacy - CORRECT ANSWER is the least amount of treatment patients need to live. It is measured with urea kinetic modeling - Kt/V or the urea reduction ratio - URR. KDOQI guidelines say the delivered Kt/V must be at least 1.2 - with a prescribed Kt/V of 1.4. A minimum delivered URR must be about 65% - with a prescribed URR of about 70%. - CORRECT ANSWER Gradient - CORRECT ANSWER is a difference. A concentration gradient is a difference in the level of solutes between to fluids kept apart by a semipermeable membrane. In dialysis, the fluids are blood and dialysate. Graft - CORRECT ANSWER is to join one thing surgically to another. In hemodialysis, a graft is a piece of man-made vessel that is used to create a vascular access. One end of the graft is connected to the patients artery, the other to the vein. Gram-Negative - CORRECT ANSWER Gram-negative bacteria live in water and form an electrically charged biofile - slime- that lets them cling to surfaces like dialysate jugs or hoses. Biofilm protects the bacteria from disinfectants, and is very hard to remove. For example, Achromobacter is a Gram-negative bacteria that can contaminate dialysis water or dialysate. Acinetobacter, Aeromaonas, Alcaigenes, Flavobacterium, Moraxella, Pseudomonas, and Serratia are toerh types of Gram-Negative Bacteria. - CORRECT ANSWER Gram-Positive - CORRECT ANSWER bacteria turn purple with a Gram's stain. Staphylococcia are Gram-Positive bacteria that cause most access infections. Heat Disinfection - CORRECT ANSWER Heat can be used instead of chemicals to disinfect some types of dialyzers and equipment. The use of heat prevents patient and staff exposure to chemicals. Cellulose dialyzer membranes degrade in heat and cannot be disinfected in this way. Hemastix - CORRECT ANSWER is a regent strip that reacts to blood. When the blood leak dector shows that there is blood in the used dialysate - but the blood cant be seen - a Hemastix strip is used to check the extent of the leak. Hematocrit - CORRECT ANSWER Hct - is a measure of red cells in the blood. It is stated as percentage of red blood cells per total blood volume. Routing checks of Hct levels were used to assess anemia in the past. Hematoma - CORRECT ANSWER is a painful, hard, black and blue mass of blood under the skin. It caused by blood leaking out of a vessel into the tissues. Hematomas can form when dialysis needles are placed, infiltrated, or taken out. A hematoma can compress the access, making a clot more likely. Hemoconcentration - CORRECT ANSWER is dehydration of the blood. This can occur in the extracorporeal circuit if ultrafiltration goes on after the blood pump is turned off. Recirculation can also lead to this problem. Hemoconcentration can lead to blood clotting, which can harm the patients access. Hemodialysis - CORRECT ANSWER removes excess water and wastes from the blood by passing it through a dialyzer. Blood goes to the dialyzer and back to the patients body through tubing connected to needles that are placed in a cascular access. Water and wastes pass through the semipermeable dialyzer membrane and into the dialysate. Alarms and monitors help ensure a safe treatment. Treatments can be done in a center or at home,during the day or at night while the patient sleeps. - CORRECT ANSWER Hemoglobin - Hgb - CORRECT ANSWER is the red, oxygen-carrying pigment of red blood cells. Routinely checking Hgb levels lets the care team follow the patients response to anemia treatment and alerts them to any chronic blood loss. Hemodialysis Delivery System - CORRECT ANSWER The delivery system is a machine hat has a blood pump, dialysate delivery system, and safety monitors. The blood pump moves blood from the patients access through the dialyzer and back to the patient. The machine makes dialsate by mixing treated water with two types of concentrate. Safety alarms check blood and dialysate flow, dialysate temperature, conductivity, venous and arterial pressure, blood in dialysate leaks, and often, the patients blood pressure. - CORRECT ANSWER Hemodialysis Reliable Outflow - HeRO - CORRECT ANSWER is a type of dialysis graft. It can be used ofr patients whos only access choice was a catheter due to central venous stenosis and blockages. The HeRO is a 6mm ePTFE graft with an arterial anastomosis on one side. Onthe other side, it has a 5 mm silicone outflow into a central vein, with the tip placed in the right atrium of the heart. The HeRO is completely under the skin. It has continuous flow from the graft into the outflow component. It is FDA-approved as a graft, and needles are placed in it just like any other graft. - CORRECT ANSWER Hemolysis - CORRECT ANSWER is red blood cell rupture. It is a life threatening problem that needs urgent care from a doctor. Hemolysis may be caused by hyponatremia - low blood sodium; dialysate that is too hot or too dilute - hypotonic; chloramines, copper, or nitrates in dialysate water; formaldehyde or bleach in the dialysate; low dialysate conductivity; too-high pre-pump arterial pressure; transfusions with the wrong blood type; kinked blood tubing; some drugs; ande certain diseases. - CORRECT ANSWER Hemolytic Anemia - CORRECT ANSWER is a shortage of red blood cells due to hemolysis Hemothorax - CORRECT ANSWER is a collection of blood in the chest that keeps the lungs from fully expanding. This causes trouble breathing. The problem can occur if a blood vessel is punctured when a hemodialysis catheter is placed. High-Output Cardiac Failure - CORRECT ANSWER occurs when the patients heart cannot work hard enough to pump out the extra blood sent to it by an AV fistual or graft. Heparin - CORRECT ANSWER is a blood thinner used during dialysis so blood will flow freely through the extracorporeal circuit. It can be given as a bolus - single does, intermittently - on and off, or continuously. Continuous infusion uses a pump to slowly inject heparin onto the circuit at a prescribed rate during a treatment. Heparin Infusion Line - CORRECT ANSWER The heparin infusion line is a small tube that extends from the blood tubing. It allows heparin to be given during dialysis. The line is most often found on the arterial blood tubing segment just before the dialzyer. Heparin Infusion Pump - CORRECT ANSWER consists of a syring holder, a piston, and an electric motor. It is used to deliver precise amounts of heparin during dialysis. The heparin pump is connected to the heparin infusion line, which is part of the extracorporeal blood tubing. Most dialysis machines have a heparin delivery system, although stand-alone heparin pumps are still used in some settings. - CORRECT ANSWER Hepatitis - CORRECT ANSWER inflammation of the liver. It can be caused by one of three viruses - A, B, or C. Hepatitis B and C are spread through contact with infected blood or other body fluids, and a concern for dialysis patients and staff. Hepatitis can cause permanent liver damage or death. Vaccination against the hep B virus should be offered to all staff and patients - CORRECT ANSWER Infection control is used to prevent the spread of hepatitis and other diseases. High-Efficiency Dialysis - CORRECT ANSWER uses dialyzers that can remove more small solutes- e. g. urea than conventional ones. Larger-guage needles and blood flow rates from 300-500 mL/min are most often used. The US government requires ultrafiltration control when a dialyzer with a Kur above 8 is used. High-Flux Dialysis - CORRECT ANSWER uses a dialyzer with a Kuf value higher than 8. Ultrafiltration control must be used. High-flux dialyzers can remove more fluid and large wastes, such as beta-2microglobulin. HIPAA - CORRECT ANSWER is the Health Insurance Portability and Accountability Act. This Act requires that patients personal health information be kept confidential. Hydrophobic - CORRECT ANSWER means water-repellent. Hollow Fiber Dialyzer - CORRECT ANSWER Thousands of tiny hollow fibers form the membrane of this dialyzer. The fibers are held in place at each end by a plastic potting material. Both the fibers and the potting material are encased in a hard plastic cylinder. During dialysis, blood flows through the hollow tubes, while dialysate flows around them. This type of dialyzer allows for well-controlled and predictable diffusion and ultrafiltration. It is the only type of dialyzer on the market in the US. - CORRECT ANSWER Homeostasis - CORRECT ANSWER is a constant internal balance in the body. Healthy kidneys help maintain fluid balance, acid/base balance, hormone balance, and electrolyte balance. All of these are key aspects of homeostasis. Hormones - CORRECT ANSWER are chemical messages made in one organ or gland that act on another part of the body. Healthy kidneys make a hormone - erythropoietin - that tells the bone marrow to make red blood cells and other hormones that control blood pressure and use of calcium in the body. Human Immunodeficiency Virus - HIV - CORRECT ANSWER is a virus that attacks the immune system. It destroys the white blood cells that fight disease - T-lymphocytes. HIV is spread through blood, semen, vaginal secretions, peritoneal fluids, and breast mile. Over time people who have HIV can develop AIDS. Damage to the immune system caused by AIDs leaves the body open to infections and cancers that rarely occur in people with healthy immune systems. There are treatments, but it is best to prevent the spread of HIV with infection control. - CORRECT ANSWER Hydraulic Pressure - CORRECT ANSWER is water pressure. It can be created naturally - such as form gravity - or artificially - such as from a pump. Hydraulic pressure affects the amount of water that is removed from the patient during dialysis. Hyper- - CORRECT ANSWER The prefix "Hyper" means beyond, above, more, or too much. For example, hyperactivity is an above normal activity level. Hyperplasia - CORRECT ANSWER is overgrowth of cells. Clotting in the middle of vascular access graft is often caused by clumps of platelets that build up on areas of hyperplasia. Hypercalcemia - CORRECT ANSWER means toos much calcium - electrolyte in the blood. Patients with this problem may have muscle weakness, fatigue, constipation, loss of appetite, abdominal cramps, nausea and vomiting, and coma. Hyperglycemia - CORRECT ANSWER means high blood sugar levels. Thirst may be a symptom of hyperglycemia in a patient who has diabetes. Hyperkalemia - CORRECT ANSWER means too much potassium - an electrolyte - in the blood. Patients with this problem may have muscle weakness, heart arrhythmia, cardiac arrest, or may die. Hyperkalemia can occur if a patient eats too may high-potassium foods or if dialysate with too much potassium is used. Bleeding, hemolysis, surgery, or fever can also cause this problem because as tissue breaks down potassium is released from cells into the blood stream. - CORRECT ANSWER Hypermagnesemia - CORRECT ANSWER means too much magnesium - an electrolyte in the blood. Magnesium is needed for muscle and nerve funciton. patients with hypermagnesemia may feel sleepy or have nerve problems, low blood pressure, and slower breathing. In sever cases, cardiac arrest may occur. Hypernatremia - CORRECT ANSWER means too much sodium - an electrolyte- in the blood. Excess sodium in the blood causes water to move out of the cells - including red blood cells. It can cause headaches, high blood pressure, and crenation. Hyperphoshatemia - CORRECT ANSWER means too much phosphorus in the blood. It is most often found in patients wh0 eat a lot of protein or dairy foods and dont take enough phosphate binders. Phosphorus is a component of bones. It is key to energy transfer between cells. Hyperphospatemia can cause sever itching in the short term and bone damage in the long term. When it occurs with hypercalcemia, hypercalcemia can cause fractures, bone pain, and sharp calcium phosphate crystals in the soft tissues. - CORRECT ANSWER Infection - CORRECT ANSWER is an invasion of the body by a pathogen. Hypersensitivity - CORRECT ANSWER is above-normal sensitivity or allergy. Hypersensitivity reactiosn occur most often with cellulose dialyzers. This can cause anaphylaxis in some patients. Hypertension - CORRECT ANSWER is high blood pressure. It can be a cause or result of kidney failure and is the second most common cause of kidney disease in the US. High blood pressure can raise the risk of a stroke and damage the kidneys, heart, blood vessels, eyes, and other organs. Patients on standard in-center hemodialysis often take more than one blood pressure drug to control hypertension. Hypertonic - CORRECT ANSWER A hypertonic solution has a higher osmotic concentration than another solution. Use of hypertonic saline - more concentrated than the blood - can draw more water into the blood if a patient feels dizzy or faint. Since its use leaves cause excess sodium in the blood, this practice has fallen out of favor. Hypo - CORRECT ANSWER - means below, beneath, or too little. Fox example, a hypodermic needle is a needle that is inserted beneath the skin. Hypocalcemia - CORRECT ANSWER means not enough calcium in the blood. Hypocalcemia can cause tetany-spasms and twitching of the muscles - or seizures. Low blood calcium can occur in kidney disease due to the loss of calcitriol production by the failing kidneys. Calcitriol lets the body absorb calcium from the diet. Hypoglycemia - CORRECT ANSWER means below-normal levels of sugar in the blood. In a patient with diabetes, this can cause hunger, nervousness, shaking, weakness, sweating, dizziness, sleepiness, confusion, or trouble speaking. The treatment is a fast-acting carbohydrate, like juice. Hypokalemia - CORRECT ANSWER means below-normal levels of potassium in the blood. This is rare in dialysis patients. It can occur if there is too little potassium in the diet or in the dialysate. Hypokalemia can also be caused by a loss of potassium due to vomiting, diarrhea, use of potassium exhange resins, and use of diuretics that increase the loss of potassium in the urine - if the Patient makes urine. Hyponatremia - CORRECT ANSWER means below-normal levels of sodium in the blood. Without enough sodium, water moves out of the extracellular space and into the cells. This can cause low blood pressure and hemolysis. Symptoms can include muscle cramping, restlessness, anxiety, access pain, headaches, and nausea. Hypophosphatemia - CORRECT ANSWER means below-normal levels of phosphorus in the blood. This is rare in dialysis patients, as phosphorus is found in most foods. It may occur if a patient has a poor diet and takes too many phosphate binders, or in patients who do nocturnal HD. Low levels of phosphorus can suggest malnutrition. Hypophosphatemia can cause heart arrhythmias or muscle weakness - CORRECT ANSWER Hypotension - CORRECT ANSWER is low blood pressure. In dialysis patients, low blood pressure occurs most often when too much fluid is removed during dialysis or when patients take too many blood pressure drugs. Symptoms include sever muscle cramps; headaches; feeling warm, restless, dizzy, faint, or nauseated; or having visual disturbances. The trendelenburg position - raising the feet higher than the heart - and giving fluids help return blood pressure to normal. - CORRECT ANSWER Hypotonic - CORRECT ANSWER A hypotonic solution has a lower osmotic concentration than another solution. Use of hypotonic dialysate - more dilute than the blood - can lead to hemolysis - bursting of red blood cells. Interdialytic - CORRECT ANSWER means between dialysis treatments. Infection Conctrol - CORRECT ANSWER is a series of steps taken to prevent the spread of infection. The steps include washing hands, using aseptic technique for invasive procedures, disinfecting and cleaning, and wearing protective gear. Infiltration - CORRECT ANSWER is a leakage of a substance into body tissues. In dialysis patients, infiltration of blood into the tissues around the access can occur if the needle punctures the back of the vessel wall. To prevent infiltration, place needles with great care. Use of the buttonhole for cannulation can reduce the risk of infiltration. - CORRECT ANSWER Instill - CORRECT ANSWER To instill is to place into or cause to enter. Heparin is instilled into each lumen of a dialysis catheter to prevent clotting in a catheter between treatments. Dialysate is instilled into the peritoneum for peritoneal dialysis. Interstitial Space - CORRECT ANSWER is between the cells or organ tissues. Intermittent - CORRECT ANSWER means periodically or not continuously. Heparin can be given intermittently during dialysis. Internal Jugular - IJ - Catheter - CORRECT ANSWER Dialysis catheters may be placed in the internal jugular vein in the neck. This site is less likely to cause central venous stenosis than placement in the subclavian vein. Intima - CORRECT ANSWER is the smooth lining of the inner surfaces of arteries and veins. The intima is covered with a thin, fragile layer of cells that allows blood to flow through the vessel easily. In a fistual or graft, hyperplasia of the intima cells at the anastomosis can cause stenosis - narrowing, which makes blood clots more likely. - CORRECT ANSWER Intracellular - CORRECT ANSWER means within the cells. Two-thirds of fluid in the body is inside the cells. Sodium causes fluid to move accross cell membranes between the intracellular and extracellular spaces. Intradermal - CORRECT ANSWER means within the skin. Local anesthetics may be injected intradermally. Intramuscular - CORRECT ANSWER means within a muscle Intravacular - CORRECT ANSWER means within a blood vessel. Intravenous - IV - CORRECT ANSWER means within a vein. Many medications are injected intravenously. Ion - CORRECT ANSWER is an electrically-charged particle. Ions can carry a positive charge - cation - or a negative charge - anion. Ion Exchange - CORRECT ANSWER Occurs inside a deionizer for water treatment. Unwanted ions are traded for hydrogen and hydroxyl ions to create pure water. Isotonic - CORRECT ANSWER An is0tonic solution has the same osmotic concentration as another solution. Normal saline is isotonic; it has the same level of sodium as the blood. Iron Deficiency - CORRECT ANSWER is a lack of iron in the body to make red blood cells. Without iron, the bone marrow cant make red blood cells, even if erythropoietin is present. Low levels of iron can cause a form of anemia. Ischemia - CORRECT ANSWER is a lack of oxygen in the tissues due to reduced blood flow. It can be painful. Ischemia of the heart can cause angina pain. Steal syndrome - ischemia of the hand - may cause hand pain; a cold, clammy feeling; and, in extreme cases, painful, non-healing skin ulcers. Isolated Ultrafiltration - IU - CORRECT ANSWER IU removes water, but not solutes. It uses the extracorporeal circuit and dialyzer - without dialysate. IU is also called dry ultrafiltration, sequential ultrafiltration, or pure ultrafiltration. IU can be done before, after, or without dialysis. Its main advantage is that fluid removal is better tolerated than with standard dialysis. . - CORRECT ANSWER Kidney Transplant - CORRECT ANSWER replaces the failed kidneys with a healthy kidney from a donor. It is possible to receive