Fresenius Exam With Complete Solution ( A + Latest 2023)

FRESENIUS EXAM WITH COMPLETE SOLUTION ( A + LATEST 2023) What is a pre-dialysis evaluation? - 1) Review of the patient's health. 2) Compares current health status to previous evaluations. Why is pre-dialysis evaluations needed? - 1) To determine if the patient is stable to receive treatment. 2) Determine if there has been a change in health status. 3) Provides a baseline date to plan for a safe treatment. Describe Universal precautions - Steps we take with all patient contact to decrease the risk of spreading infection to protect our patient and ourselves. What are the 3 C's? - 1) Condition (objective) 2) Complaints (subjective) 3) Changes (objective) What should you look for with: Ambulation - Gait changes, use of assistive devices, ROM, energy level. What should you look for with: Mental status and mood - A&O x 3, any changes in usual mood (Alert and orientation) Person, place, time (situation) A&Ox4 What should you look for with: Skin - Color, integrity, temperature, edema What should you look for with: Vital signs - Weight, BP, HR, respiration's, temperature What is EDW? Estimated Dry weight - A patient's wt with excess fluid removed When is a RN required to assess a pre-treatment wt? - If the patient pre-treatment wt is 4 kg above EDW. What does a blood pressure measure? - Measurement of the pressure of force of blood against the walls of the arteries. When do you report a blood pressure to the RN? - SBP 100 or 180 DBP 100 When do you report a heart rate to a RN? - New onset of HR 60 or 100 or a irregular beat When do you report a respiratory rate to the Rn? - A respiratory rate of 24 breaths per minute True or False Does a dialysis patient maintain an average temperature? - False! When do you report a temperature to the RN? - Temperature 96 & or = to 100 degrees Name some important complaints you need to report to the RN? (10) - 1) Dizziness 2) Chest pain 3) SOB (shortness of breath) 4) Any new complaints 5) A visit to the ER or a hospital stay 6) Weakness 7) Numbness or tinglinng 8) Fever or chills 9) Depression/sadness 10) Pain What changes do you report to the RN? - New medications or visit to ER or hospital stay. What are the ABC's of the patients assessment? - A) Access B) Breathing C) Cardiac What to look for with: Access - Bruises, redness, drainage, swelling, bruit, thrill, pain, bleeding What to look for with: Breathing - Rate, rhythm, quality, SOB, breath sounds What to look for with: Cardiac - Skin color and turgor, heart sounds, pulse rate, rhythm & quality, edema, pain, SOB Why do patients expreience crackles (rales) breath sounds? - Indicates fluid or congestion in lungs Name some reasons for an abnormal heart rate? - Can indicate chemical imbalances or adverse effects from medications. Names some places fluid can get trapped? (Edema) - Abdomen, lungs, feet, legs, hands,and face What are the ranges for pitting edema? - 1-4 cm What do you do when you have a red light as a complaint? - Do not start the treatment until the RN has done a full assessment on the patient. Dialysis Prescription and Pre-treatment safety checks: Name what verifies the correct patient's dialysis prescription? (11) - 1) patient Identity 2) prescribed dialyzer 3) prescribed dialysate 4) special attention orders 5) SVS or UF profiling 6) prescribed heparin dose 7) OLC volume/test entered 8) prescribed dialysate rate 9) prescribed base sodium 10) prescribed bicarbonate 11) prescribed needle size Name important information programmed into the machine. (6) - 1) Prescribed treatment time 2) UF goal entered correctly 3) Prescribed BFR 4) Prescribed DFR 5) OLC volume 6) Na modeling or UF profile Name the final dialysis machine safety checks. (5) - 1) Dialysate temperature 2) Dialysate pH & conductivity 3) NS doubled clamped 4) Alarm & pressure holding test passed 5) Final check on blood circuit What is a priority and major reason why we monitor our patients? - Patient safety As fluid shifts during dialysis what changes can occur? - Blood pressure, fluid and electrolyte shifts. Who is responsible for monitoring patients? - Everyone! The PCT must take what action when he or she identifies a potential problem? - Immeddiate The RN must respond to what from patients and the PCT? - Complaints or PCT notifications to assess the patient Why does a pateint's face and vascular access need to be visible at all times? (3) - 1) It is a CMS requirement 2) Identify any changes in the patient's awareness 3) A covered access can result in major blood loss What are "Red Flags" to report to the RN? (5) - 1) Severe hypertesnion (SBP 200) 2) Severe hypotension (SBP 80) 3) New onset of pulse 60 or 100 4) Irregular heart rate 5) Temperature or = to 100 degress What should the RN do when notified about "red Flags" - 1) Assess the patient 2) Provide intervention 3) Report to the physician based on clinical judgment Name 4 non-verbal behaviors that may indicate a change in the patient status or discomfort: - 1) Restlessness 2) Grimacing 3) Excessive yawning 4) Is patient alert, drowsy,sleepy Name 5 changes you should educate your patient to report immediately? - 1) Discomfort at needle site 2) Muscle cramps 3) Headaches, dizziness, blurred vision 4) Nausea, vomiting 5) Fever, chills, chest pain, and SOB Name 4 machine reading we verify at every safety check? - 1) BFR 2) DFR 3) AP (not more than-250) 4) VP (not more that 1/2 the bfr rate) Describe what the arterial pressure reading reflect? - Refers to the pressure in the system from the patient;s vascular access to the blood pump. What are the potential compliactions of a high arterial pressure? (2) - Inadequate dialysis and hemolysis Name 5 reasons for a high arterial pressure? - 1) A kink in the arterial line 2) Poor cardiac status 3) Blood pump speed to much for vascular access 4) High hematocrit / increase blood viscosity 5) High BFR through a small needle gauge What can a low arterial pressure indicate? - 1) A line separation 2) Air 3) A decrease blood pump speed 4) A wet transducer Describe what the venous pressure reading reflects? - The pressure in the circuit after the dialyzer and before it re-enter the patient. Name 5 causes for low venous pressure? - 1) Blood line separation 2) Needle dislodgement 3) Decrease BFR 4) Clotting before the monitoring site 5) Wet transducer What can cause high venous pressure? (5) - 1) occlusion in the lines between the monitoring site and venous needle, 2) poor position 3) an infiltration of venous needle 4) poor CVC function 5) clotting in the access or dialyzer