Fresenius Annual Exam with verified solutions

Bleach :100. 60 All dialysis surfaces(machines, chairs) bleach 1:10. 80 Large blood spill of blood greater 10 ml Personal protective equipment (PPE) Full shield or mask, gowns , gloves Hepatitis B Patients infected dialyze isolation, have own equipment such as BP cuff and stethoscope , torniquete. etc. Blood test indicate infection with Hepatitis B HbsAg is the test for the hepatitis B antigen this indicates actual viral presence " aggressive " Blood test indicates the presence of immunity against hepatitis B HbsAb "bore" is the test for antibodies indicates presence of immunity against hepatitis B Factors affect the rate of diffusion Concentración gradients,temperature, membrane permeability Hand wash with soap 40-60 seconds Hands be sanitizer Alcohol 20-30 seconds Kidney anatomy 2 kidneys, 2 ureters, 1 bladder, 1 urethra Kidney some functions Producción of Renin to help regulate or control blood pressure Erythropoietin hormone Stimulates the bone marrow to produce red blood cells Three common causes of renal failure Diabetes nephropaty, or glomerulosclerosis, hipertensión and glomerulonephritid. Uremia Kidney failure; Waste product build up in blood Uremia symptoms Yellow gray skin, edema, high BP, itching, loss of appetite, fatigue, nausea, restless, metals change. Electrolytes in uremia patients Potassium, calcium, phosphates, magnesium and bicarbonate Symptoms of uremia Yellow gray skin, peripheral edema, high blood pressure, itching, loss appetite, fatigue, nausea, restlessness Why are renal failure patients aciditic Kidney control acid/base balances of the blood by excreting hydrogen by produce a buffers know as bicarbonate Dialysate contains... Sodium, bicarbonate "buffer", pure water Electrolytes found in the dialysate Na,k,calcium, magnesium and chloride. Glucose" Dextrose" a non electrolyte is also to dialysate for Dr Rx Phosphate binders take with meals Tums, amphojel, renagel Hemoglobin levels for hemodialysis patients According to FMS 10-11 g/dL What is diabetes? Body either doesn't produce or does not properly use insulin End stage renal disease modalities Vascular access to draw blood from the access to the dialyzer into semipermeable membrane where process of diffusion removes the waste and ultrafiltration removes fluid Peritoneal Dialysis Permanently catheter, surrounding the abdominals organs allowed to dwell on the cavity Electrolytes to consider in the uremic patients Sodium, potassium, calcium, phosphate, magnesium and bicarbonate Blood pH maintain by Buffer and normal pH of blood is 7.35 to 7.45 Metabolic acidosis is A state of too much acid in blood Dehydration Thirst, dry mucous membranes, sunken eyes, poor skin turbot, decreased urine output, cramping Symptoms of hemolysis Light translucent cranberry or cherry, back pain, chest pain access pain Crenation symptoms Shortness of breath, thirst, chest, suddenly fall in bp, flushed face and dark opaque blood Embolism symptoms Chest pain, shortness of breath and coughing Fluid overload Edema, productive cough shortness breath, increasing BP, retlessness, confusing Fluid removed during hemodialysis Removed from the intravascular fluid compartment or bloodstream Diffusion Movement of solutes through a semipermeable membrane from an area of higher concentration to an area of lower concentration. Osmosis Movement of fluid through semi-permeable from area of lesser solute concentration to an greater concentration until equilibrium reach What is a dialysate alarm Temp, conductivity only Good access flow reading for a fistula is? 400 What is ultrafiltration Pressure to remove fluid from the blood using positive and negative pressure Dialysate Non- sterile solution, function to remove waste products from blood and balance electrolytes DiaSafe filter Ultra pure dialysate Normal saline is used to rinse and primer the tubing of the extra corporal circuit to remove Sterilants and air Conductivity alarm Machine enter bypass mode What direction does blood flow through the dialyzer as compared to dialysate flow Blood and dialysate flow in a countercurrent Dialysate composed Purified water, acid solutions, and bicarbonate solutions Electrolytes are found in the dialysate Sodium, potassium, calcium, magnesium, chloride, glucose Why checking dialysate Compatible with human pH, conductivity and temperatures to prevent hemolysis or crenation to prevent harm to patients Way to check Dialysate Check for residual chloride( bleach), PH, conductivity (weekly) , machine temperature , disinformation before first treatment after disinfection When check conductivity and pH Prior to the to initiation of every treatment with Phoenix meter before Hanson connectors are attached to the dialyzer from venous/ blue dialysate line Normal ranges Temperatures 35-39 Celsius set by Dr order PH neutral 7, blood has a pH of 7:35-7:45 pH range approved AAMI 6.9 -7.6 Conductivity 12.6-15.9 varies composition of the acid Conductivity and pH be check Every TX before the Hanson connectors are attached to the dialyzer from venous line Carbon tanks remove Chlorine and chloramine Chlorine/chloramine max levels 0.09 ppm Breakthrough After the first carbon filter are at or above the action level of 0.10 ppm Who is the person to call when is breakthrough Medical Director (doctor) How do I know the water quality is bad The alarm How many times I should rinse the small continent when I'm checking the water for chlorine 3 times How many cc is The small container for checking the water has 100 cc Bleach for large blood spill 1:10 Heparin is a short Acting and large molecular