Davita Final Exam (Study Guide) 195 Questions and Answers(A+ Solution guide)

Fluid pushed thru a semipermeable membrane - Ultrafiltration Known as solute drag, solute move w/ water across the semipermeable membrane. *kidneys remove waste this way* - Convection Movement of dissolved particles across a semipermeable membrane from *high* to *low* concentration - Diffusion Fluid move from *low* to *high* solute concentration - Osmosis 1) Fluid Balance (ultrafiltration) 2) Electrolyte balance (diffusion) 3) Acid/Base balance - Kidneys excretory functions 1) Renin (angiotensin aldosterone system) 2) Erythropoiesis 3) Vitamin D & Calcium regulation - Kidneys endocrine functions Function of Bicarbonate - Maintains acid-base balance and help clean blood by functioning as the primary buffer in the body How do we replace *excretory* functions? - Hemodialysis removes urea, salt, excess water from blood which normalizes electrolytes and metabolic acidosis Hormones replaced by medications such as Epogen, Iron, Antihypertensive (ACE inhibitors), Phosphate binders, Vitamins D, Calcimetric agents - How we replace *endocrine* functions? 1) Edema & Pulmonary Edema2) Hypertension 3) Chronic Heart Failure 4) Shortness of breath 5) Headaches - Signs & symptoms of fluid imbalance Hypertension leads to - Left Ventricular Hypertrophy (LVH) Why is sodium balance important? - Sodium holds onto water, thirst and blood pressure control 1) Extreme muscle weakness 2) Irregular heart rhythm (Brady) 3) Wide QRS 4) Cardia arrest - Signs and symptoms of Hyperkalemia 1. Fatigue 2. Muscle weakness 3. Respiratory failure 4. Irritable heart muscle 4. Dysrhythmias (irregular heartbeat) 6. Cardia arrest - Signs and symptoms of Hypokalemia Lack of Erythropoeitin - Primary cause of anemia Secondary Cause of anemia? - blood loss 1) Heparin lines are clamped 2) Wait 3-5 min after Heparin dose 3) Proper priming - How to prevent blood lossWhat is the sac inflammation of the heart that is indicated by fever, hearing rub, low blood pressure, and chest pain? - Pericarditis 1) Lower heparin 2) More dialysis 3)* More antibiotics & anti-inflammatory meds* - Treatment of Pericarditis Recommend fatty lotions, lukewarm water, antihistamine (allergy relievers), pat not rub skin dry and checking phosphorus levels - If patient is complaining of dry, itchy skin What would you do if patient complaints of Peripheral Neuropathy (nerve pain)? - Check water temperature, wear good shoes, no barefeet, and observe/inspect feet 1) Calcium 2) Phosphorus 3) PTH (Parathyroid Hormone) 4) Calcium/Vitamin D - Four key elements affected in CKD-MBD What is AKI? - Acute Renal Injury (Failure), Kidneys can't filter waste from blood on their own. 1) Blood loss (Hemorrhaging) 2) Blood clots 3) Burns *Not getting blood flow to kidneys* - Examples of Pre- renal causes of AKI 1) Medications 2) Dyes * Not getting blood inside the kidneys* - Examples of Intra- renal causes of AKI1. Kidney stones 2. Neurogenic bladder 3. Vesicoureteral reflux (reflux from bladder ureter) *Blockage to kidneys* - Examples of Post-renal causes of AKI 1) Removing blockages 2) Managing blood loss 3) Dialysis till kidneys functions - How to help in restoring kidney function How do you protect kidneys from further injury? - Keeping a patient more "wet" than dry stimulates the kidneys to keep working and make urine. Be aware of dyes What is important when monitoring weight and BP? - Hypovolemia and hypotension episodes can cause renal/schiema and further damage to kidneys AKI patients are risk of ? - Kidney infections 1) Risk at infections 2) Access may not run well - Things to consider with vascular access (CVC) Difference between AKI & CKD - Acute: some urine production/kidney function ( Temporary Chronic: no urine & kidney function (permeant) 1) Immunocompromised because of kidney failure 2) Technicians going from patient to patient - Are what makes dialysis patients more susceptible to HAIs (Healthcare Associated Infections) 1) Prolonged access to patient's blood during hemodialysis2) Bacterial infections especially w/ CVC's - Reasons why dialysis patients have an increase risk for acquiring a HAI at the facility What is the difference between OSHA and CMS infection control requirements? - OSHA (employers providing a safe workplace) CMS (patient care & safety) What are v-tags and why are they important - CMS/State regulations to be met to state guidelines important for infection control Which V-tags are relative for patient care and safety? - 110-148 1) Surgical masks 2) Sterile gloves/gown 3) Avoid touching exposed surfaces - Three strategies recommended by KDOQI to decrease risk of infection when working w/ CVC's Hepatitis B surface Antigen (HBsAg) are performed...? - Monthly Anti-HBs - Hepatitis B surface antibody Anti-HBclgm - Hepatitis B Core antibody The manual conductive value must match +/-______ on the Fresenius (FMC) dialysis delivery system displayed conductivity. - 0.4 What is the safe dialysate pH range? - 6.9 to 7.6 What is "strikethrough" of an external pressure transducer? - blood contaminationWhy is strikethrough important? - Fluid could have enter the machine and contaminated the internal pressure and transducer protector provider a revivor for microorganisms which can lead to blood infections Why is it important for patient care teammates to know when the water treatment system disinfection was performed? - It will introduce disinfectant solution in the dialysis delivery systems thru water inlet lines 1) Following standard care makes the care given defensible and avoids negligence's part of the ... - Reasonable & Prudent Standard Care for Nephrology Nursing Key Concept When supervising non -licensed techs it is the responsibility of the ______ _______ to ensure these teammates also meet standard of care - licensed nurse 1) Davita provides standard of care 2) Acting accordingly to Davita ____ & _____ is "prima facie" (first sight) evidence to compliance 3) Davita _____ & ______ serves "best demonstrated practice" - P & P (Policy and Procedure) What are risks of doing it your way? - civil liability Six occurrences when to chart: - 1) change from assessment 2) change of patient condition 3) change of procedure/tx 4) change of medication/patient response 5) patient education/teaching 6) care plan review and interventions These are done prior to initaition for treatment and must be documented within an hour - Pretreatment safety checksPre-treatment data collection - are done prior to treatment, 10 second access listen, feel, and raise arm to see flatten open for questions or attack on care - possible consequences of poor or incomplete documentation (leaving a blank space or N/A) What does SMART communication stand for? - *S*imple *M*eaningful *A*ctual *R*ead *T*each What are the 5 W's? - *W*ho *W*hen *W*hat *W*here *W*hy Three things to not include in a REM (Risk Event Mangement) - personal opinions, speculations, rendattas When is post-treatment assessment by the licensed nurse required? - Required by state; or if data collection includes abnormal findings How to calculate Interdialytic Weight Gain (IDWG)? -pre weight - last post weight How to calculate UF goal? - pre weight - target weight + rinse back + oral intake How to calculate UFR? - UF goal divided by tx timeFour consequences of sodium loading - 1) *Increased sodium* in post tx weight 2) *Increased thirst* 3) *Increased fluid* weight gain 4) *Hypertension* Three ways to contribute to sodium loading - 1) Diffusion from dialysate 2) Normal saline administration 3) Dietary intake 1) *Hypertension* 2) *LVH (left ventricular hypertrophy)* 3) CVD (cardiovascular disease) are consequences of ... - Hypervolemia (Fluid overload) 1) *Ischemia & damage* to initial vital organs 2) Loss of residual renal function 3) *Increase mortality rate* - Hypovolemia Tunneled Central Venous Catheter - *Long-term* use Implanted into the *internal or external jugular or subclavian vein* Length of catheter is 8 cm depending on patient size Tunneled in subcutaneous tissue *under the skin* for 3 to 6 inches to its exit site Non-tunneled catheter - A catheter that is inserted through the skin directly into a central vessel (chest or neck) Four AVF evaluations: *HINT* *DPBD* - 1) Depth (below skin 1cm/.6cm) 2) Post op (6-8 weeks)3) Blood flow 600 mL/min 4) Diameter .6cm Describe a beginner cannulator - 6 months experience 10 successful cannulations Describe intermediate cannulator - 6 months experience 10 successful cannulations When evaluating an an access: *Look* at the entire access, look for signs of steal syndrome _______ for bruit, whistle sound indicates stenosis _______ for thrill, should be soft, compressible, and warm - Listen, Feel 1) Meets KDOQI rule of 6's 2) Nephrologist ordered to be cannulated 3) Only advanced cannulators can cannulate - Newly matured AVF 1) Tolerates maximum needle size & BFR for at least 6 tx's 2) Intermediate cannulator can cannulate - Mature AVF 1) Access has been cannulated w/ 2 needles for 2 months w/o complications 2) Beginner cannulator can cannulate - Established AVF The ____ needle gauge for initial cannulation. - 17 What does BESTIPS stand for? - *B*leeding *E*rosion*S*tenosis *T*hrombosis *I*nfection *P*seudo aneursym *S*teel syndrome What is the distance should be from a anastomosis ? - 1.5 inches same as for needle tips What is K in Kt/V? - clearance of urea Treatment factors that increase K - DFR, *BVP*, UF goal, adequate anticoagulation (heparin) *Decrease* in *BFR and DVP * Inadequate heparin - Can decrease K in Kt/V T in Kt/V stands for time of dialysis session What factors influence T? - Longer blood/dialysate contact time Frequent/extra tx's V stands for volume for patient's body water, which urea is distributed What factors influence V? - sex, body weight, height, age, and amputations What is the suggested BFR for the following needle gauges? 17: 16: 15: 14: *Note the smaller the needle size the larger the BFR* - 17: : 250-350 15: 350-450 14: 450 What should you do for a post BUN lab draw? - 1) Turn off/decrease UF to 50 mL/hr 2) Decrease DFR to 300 or place in bypass 3) Reduce BFR to 100 and wait for 15 seconds 1) Drawing from venous line 2) Not waiting for the full 15 seconds *HINT* Opposite of negative - Lab draw mistakes that would falsely increase Kt/V What are lab draw mistakes that would decrease Kt/V? *HINT* Opposite of positive - 1) Accidentally diluting arterial line with saline 2) Waiting longer than 15 seconds At what time are medications containing a preservative discarded? - 28 days What is the time frame during which a single use medications should be prepared and administered? - 4 hours How do you verify your needle is not in the access when administering Lidocaine? - By aspirating (pulling back on the plunger of a syringe) 1) *Wash* arm 2) *Clean* according to P&P guidelines 3) Spray *4-10 seconds 3-7 inches away* 4) Try to not frost skin - How to administer topical anesthetic sprayWhat does TRAMP stand for? - *T*ime *R*oute *A*mount *M*edication *P*atient 1) patient safety 2) prevent equipment malfunction - Two reasons for water treatment What does aluminum in waster used for dialysis causes? - *Anemia, *bone disease*, *nausea*, and vomiting Chlorine in water used for treatment causes *RBC RUPTURE* - Hemolysis Excess calcium & sodium in water used for treatment causes - hypertension Excess calcium & magnesium in water used for treatment causes - muscle weakness What removes chlorine/chloramines? - carbon tanks When should chlorine/chloramine testing should be done? Where? and acceptable result? - After RO runs for 15 mins before 1st shift, every 4 hours. In the Primary carbon tank Result should be 0.1 mg/L What should be done if test for primary carbon tank is too high? - Repeat it and if still too high test the secondary carbon tank. If secondary tank is within limits contact BIOMED and test every 30 minWhat if secondary tank results are too high? - stop dialysis, contact BIOMED and FA In hardness testing what is being removed? and why is it important - 1) Calcium and magnesium (these also causes muscle weakness). 2) Important for RO protection When does water hardness testing occur? - at the end of treatment day What does RO remove? - organic and inorganic materials bacteria and endotoxins 1) Exhausts quickly 2) Highly dangerous when exhausted - Two concerns of using DI tanks How to respond to a Final Water Quality Alarm? - 1) Place all machines on Bypass 2) Notify BIOMED 3) If not restored, terminate all treatments 1) *Excessive UF* 2) *Too much removal/too rapid removal of fluid* 3) Antihypertensive meds 4) *Dehydration (Vomiting/Diarrhea)* 5) OTC drugs (herbs) 6) Foods 7) *Inappropriate TW* - Causes of hypotension 1) Flushing 2) Yawning 3) Dizziness4) *Cold, clammy skin* 5) *Ringing in the ears* 6) Anxiety 7) Seizures & cardiac arrest - Symptoms of hypotension Hypotension is a BP less than 90/60 or a drop by 20 mmHg. What to do in a hypotensive episode? - 1) Place patient in *flat supine position* 2) give normal saline per nephrologist order 3) pct's may provide or equal to *200 mL saline* before notifying nurse 4) monitor vitals, if severe give oral fluids (water) Acute stress, can lead to heart failure - Consequences of organ stunning of the heart Release of endotoxins into circulation, and causes inflammation - Consequences of organ stunning of the Gut Loss of RRF (residual renal failure) - Consequences of organ stunning of the Kidneys White matter injury - Consequences of organ stunning of the Brain 1) Frequent assessment of *TW* 2) Limit UFR to ,13 mL/hr 3) *UF profiling* 4) *Extend tx time* 5) Pure ultrafiltration - How to prevent Hypotension Hypertension is a pre-dialysis BP higher than 140/90 & a post BP higher than 130/80. What can cause hypertension? - *Fluid overload*, *non taking meds*, *renin* response (damaged kidneys producing too much renin), anxiety and *DDS*1) Headache 2) *Dizziness* 3) *Blurred Vision* 4) *Edema* 5) Asymptomatic - Symptoms of Hypertension What to do in a hypertensive episode? Promoting fluid and medication adherence can prevent hypertension - Provide assurance to patient if due to anxiety Administer meds 1) Disconnected CVC/arterial/blood lines 2) Unarmed /defective air detector 3) Careless administration of saline 4) Empty saline bag - Causes of Air Embolism 1) *SOB* 2) *Chest pain* 3) *Dyspnea/coughing* 4) *Cyanosis* (blue-purple tint of skin) 5) Paralysis on one side of the body 6) *Visible air* in venous line 7) Restlessness/confusion 8) Seizures & Cardiac arrest - Symptoms of Air Embolism Verifying all connections are secure at all times can prevent air embolism What to if there is an air embolism? *DO NOT RETRUN BLOOD OR CONTINUE TX* - 1) Clamp all blood lines, DO NOT RETURN BLOOD2) Place patient in a Trendelenburg position 3) Notify EMS 4) Disconnect pt from tx and draw labs if needed 5)Attach 10 ml syringe to arterial 6) Aspirate venous line with new syringes and attach new syringe 1) *Rapid/excessive* shifts in patient *fluid volume* and *removal* 2) *Exceeding maximum of UFR* of 13 mL/hr 3) *Fluid/electrolyte imbalance* 4) Hypovolemia *(low potassium)* 5) Hypoxemia (*low oxygen* in tissues) - Causes of Muscle cramps With appropriate dietary control of fluid, electrolytes, UFR of 13mL/hr, *decrease sodium loading, increasing TX time and UF profiling* can help prevent muscle cramps What to do if patient is experiencing muscle cramps? - 1) Assist patient to stretch muscle 2) Apply comfort measures (massage, applications of opposing force) 3) Reduce UFR or turn off UF *Must notify nurse before doing it* 4) PCT may give saline up to 200 mL Heating pad, heated saline bags, gloves filled with heated liquid, electric blankets, *any items w/ water* - Should *NOT* be used for muscle cramps Seizures are involuntary muscle spasms and loss of consciousness. Seizures are caused by - dialysis side effects, adverse reaction to a problem, improper prepared dialysate of severe hypotension 1) Twitching 2) Foaming 3) Confusion 4) Change in level of consciousness - Symptoms of SeizuresWhat are the interventions of seizures according to state regulations? - 1) Contact EMS 2) Protect airway 3) Protect patient access to avoid line separation/needle dislodgment 4) Protect patient from harming themselves 5) If possible place pt on floor, note the duration 6) Administer 200 ml saline if hypotensive following nurse orders If patient is responsive after having seizure can treatment continue? - Yes if patient does not respond to tx do not continue 1) *Pain in chest* 2) *Difficulty breathing* 3)* Nausea (GI distress)* 4) *Discomfort in jaw, neck, shoulder, back, or arms* 5) Dyspnea 6) Pale/ashen color - Symptoms of chest pain Chest symptoms are usually relieved by rest/meds and lasts 5 min or less. What should be done if patient is experiencing chest pain? - 1) PCT's notify nurse 2) *Decrease BFR & UFR to 150* 3) If pt *is hypotensive administer saline* and monitor vitals *Preventing hypovolemia and hypotension*, monitoring hemoglobin, Identifying and treating with medication may - Help prevent chest pain 1) Underlying heart disease (in older pt's) 2) Change in electrolytes (potassium) 3) Volume excess4) Myocardial infarction (artery blockage of heart) - Causes of Dysrhythmia (Arrhythmia) (irregular heart beat) *Lack of oxygen to the heart muscle*, CVD, Hypotension, Anemia, hemoglobin and anxiety can cause - Chest pain 1) PCT's notify nurse of pt complaints or manually have to take HR 2) Monitor vitals closely and notify nurse for further direction - Interventions for Dysrhythmias 1) Irregular heart rate 2) Skipped or extra beats 3) Slow (less than 60) 4) Rapid (more than 100) - Symptoms of Dysrhythmias Cardiac arrest in adult most often happens due to - 1) Cardiac arrhythmia 2) Loss of all blood volume 3) Hyperthermia (high temp.) 4) Cardiac Tamponade (fluid build up in pericardial sac surrounding heart preventing heart from beating properly) What is a cause of Angina? - Anemia Pyrogen reaction is an exposure to endotoxins and likely to occur in first 45-75 min What are symptoms of a pyrogen reaction? - chills, shaking fever, hypotension, vomiting, muscle pain 1. Call for help. 2. Check for pt's DNR status, if no DNR start CPR till EMS arrives 3. Discontinue dialysis 4. Maintain access/CVC ports w/ saline5. Secure needles/ports and prepare for transport 6. Complete the CAS (Cardiopulmonary Arrest Sheet) does not need to be signed off by nurse. 7. Dialyzer materials are to sequestered for investigation - Interventions of cardiac arrest 1) Notify nurse 2) Discontinue dialysis 3) *DO NOT RETURN BLOOD* 4) Provide comfort measures 4) Monitor symptoms and vitals 5) *Place blood lines and dialyzer in bag w/ "Not for pt use" for testing* 6) *Remove dialysis system* from tx area and *sequester* it 7) *Collect cultures and endotoxin levels* - Interventions for pyrogen reaction 1) Proper water treatment and disinfection of equipment 2) Proper preparation of dialysate 3) Proper machine set up and priming - Preventions of pyrogen reaction First Use Syndrome is a group of symptoms that occur shortly after starting a tx w/ a new dialyzer. What is the cause of first use syndrome? - *Ethylene oxide gas (ETD)* used a sterilant in dialyzer Manufacturing residues in dialyzer or patient adverse reaction to dialyzer fiber 1) Nervousness 2) *Chest & back pain* 3) *Palpitations* 4) *Funny taste* in mouth 5) *Itching* - Symptoms of First Use Syndrome 1) *STOP* DIALYSIS 2) Clamp lines*DO NOT RETURN BLOOD* 3) Support vascular status by administering saline as needed - Intervention for First Use Syndrome Rinsing the dialyzer well before treatment, and discussing alternative dialyzer w/ physician may - Prevent First Use Syndrome 1) Immune response caused by dialyzer fibers/membranes 2) Allergies to meds 3) Allergy to ETO 4) Reaction to germicide left in dialysis machine/blood lines - Causes of Anaphylactic shock 1) Difficulty breathing 2) Hives/itching 3) Periorbital edema (eye swelling) 4) Wheezing 5) Numbness/tingling around mouth 6) Tachycardia - Symptoms of Anaphylactic shock The plasma solute level is lowered rapidly during tx. The plasma becomes hypotonic w/ respect to the brain cells and water shifts from the plasma into brain tissues - Cause of DDS (Dialysis disequilibrium syndrome) 1) Missed treatment = BUN values are high (150 mg/dl)/ new acute renal failure 2) Transfer of urea from tissues to blood during dialysis is slower in the brain than the rest of the body. Fluid is moved to brain and causes brain to swell. - DDS causes What to do if patient is experiencing an Anaphylactic shock? *Similar to First Use intervention except for last step of saline administration* - 1) Discontinue therapy (meds, blood transfusion)2) *STOP* dialysis, *DO NOT RETURN BLOOD* 3) Monitor vitals 4) Perform CPR if needed 1) *Headache* * THINK OF FLUID IN BRAIN 2) Hypertension 3) Nausea 4) Restlessness 5) Blurred Vision 6) Seizures 7) Confusion - Symptoms of DDS 1) Mechanical destruction of RBC's 2) Chemicals 3) Thermal (overheated dialysate) 4) Mechanical issues (excessive pressure of bloodline, hypertonic dialysate, etc) - Causes of Hemolysis 1) *Back pain* 2) *Cherry red blood (Kool-aid)* 3) *Pain the venous access* 4) Chest pain 5) Dyspnea (SOB) - Symptoms of Hemolysis 1) *STOP* blood pump 2) Clamp all lines, *DO NOT RETURN BLOOD* 3) Draw 10 ml of blood from both arterial/venous lines then attach new syringe to arterial 4) Attach new saline bag to venous line 5) *Collect BLOOD specimens* from both lines6) Monitor vitals 7) *Investigate cause: check dialysate temp., test for chlorine /chloramine, conductivity, draw dialysate culture, and residual sterilant testing* - Interventions of Hemolysis Calciphylaxis is a consequence of which out of range labs? (3 OF THEM INVOLVED W/ CKD-MBD - Calcium, Phos, and PTH Disinfectant infusion occurs when disinfectant is infused into patient bloodstream. What are the causes? - 1) not performing disinfectant testing 2) sterilant rebound 3) inadequate rinse after loop disinfection with Renalin 1) *Burning/hot sensation at venous access site* 2) *Itching* 3) Respiratory distress 4) Back pain & severe chest pain 5) Tingling around lips 6) Swelling of eyes & lips 7) Hemolysis or foam and bubbles in blood 8) Flushing - Symptoms of Disinfectant Infusion 1) Clamp lines, *DO NOT RETURN BLOOD* 2) Monitor vitals till stable 3) Prime and attach new saline bag, add saline line to arterial to support BP 4) Maintain patency of access by aspirating 10 ml from venous access and attach new syringe 5) Treat symptoms and draw ordered labs 6) *Cap ports of dialysate and save for testing* 7) *Draw STAT labs* if ordered by nephrologist 8) If patient is stable, *set up new dialyzer and blood lines on a different system* - Interventions of Disinfectant infusionBlood loss should always be documented in the electronic health record. Blood loss is characterized by a "fist" which is ____ ml of blood - 20 Blood on floor, chair, clothing, visible clots in drip chamber, foamy pink to red tinged dialysate are symptoms of blood loss as well as... - *blood leak detector* alarm, *VP* alarm if needle is dislodged/separated, circuit clotting, *TMP* alarm 1) Separation of lines/Needle dislodgement 2) Clotted dialyzer 3) Rupture of access aneurysm 4) Dialyzer leak/rupture - Causes of blood loss A clotted dialyzer may be indicated when they are many dark fibers in the dialyzer. What are the causes of a clotted dialyzer? *Think of bloodthinner* - 1) Inadequate anticoagulation therapy 2) Incorrectly functioning heparin pump 3) Not allowing 3-5 minutes after heparinization 4) Clotting disorder 5) Low BFR or frequent extracorporeal alarms (leads to dehydrated dialyzer) 6) Air was not purged from lines during priming 1) Drop in venous pressure 2) *Increase in TMP ( low fluxed dialyzer)* and possible increase in arterial pressure 3) Darkening of blood line/dialyzer fibers 4) Rapid filling of tranduceer protector 5) Failure to clear dialyzer w/ saline infusion 6) Fibrin or clot in bloodlines & drip chambers 7) Blood turns dark and more thick (viscous) - Symptoms of clotted dialyzerArterial blood line clotting is indicated by a ________ in arterial pressure. Venous blood line clotting is indicated by a ________ in venous pressure. - decrease , increase 1) Identify cause, flush dialysis system using bolus/saline and resume treatment if able 2) Maintain patency of access 3) If flushing is unsuccessful restart treatment w/extracorporeal circuit 4) Obtain labs as ordered - Interventions for clotted dialyzer a. Stable desirable *target weight* b. Adequate *fat stores* and *muscle mass* c. Serum *Albumin /=4.0 gm/dl* d. Appropriate *appetite* and *intake* - Four indicators of optimal nutrition status Why is protein important? - maintains health, helps fight infections, prevents anemia, heals wounds and builds muscles a. Helps regulate body fluid volume and balance b. Sodium loading causes increased thirst c. Increased IDWG d. Increased blood pressure e. LVH f. Higher UF during Tx which causes more hypotension during Tx - Importance of sodium and negative effects of sodium loading Signs and symptoms of fluid excess - Edema, SOB, Hypertension, and CHG (congestive heart failure) Why is limiting potassium important? *Normal range is 3.5-5.5* - Prevents sudden deathHyperkalemia (muscle weakness, numbness/tingling in extremities, (Bradycardia) decreased HR and cardiac arrest) Hypokalemia (muscle weakness and arrhythmias) Importance of limiting phosphorus and when to take binders? - Itching, bone damage, soft tissue calcification and should be taken with meals a. *Increased risk of heart disease* b. Calcification of soft tissues c. Confusion d. Muscle spasms e. *Seizures (low levels of ________)* - Importance of keeping Calcium within normal limits Why are vitamins important? - Some are removed during treatment and renal diet restricts some vitamins. Five stages of grief - Denial, Anger, Bargaining, Depression, Acceptance What is the test used to evaluate barriers to successful adaptation to dialysis called? - KDQOL 36 At what temperature does hemolysis occur in the blood? - 42 What does DARN stand for? - Desire, Ability, Reason, Need What are three core communication skills to be used within the communication styles? - 1) Acting 2) Listening 3) Informing 1. Dealing with consequences of illness2. Focusing on problem solving, decision making and self confidence 3. Placing patient and care providers in partnership with specific responsibilities - what are the three basic principles of self management What is health literacy? - the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions What are the educational tips for visual learners? - surroundings, note taking, visual aids, short lectures, eye contact What are educational tips for auditory learners? - word associations, mnemonics, videos, repeat information, discuss or explain, give more time to read What are the educational tips for tactile learners? -short breaks, background music, encourage to write or highlight, short lectures, hands on activities. A patients blood pressure drops to 87/52 what do you do? - place patient in supine position, decrease UFR, 100-200ml of normal saline if severe What is the function of the acid concentrate? - provides the concentration gradient for diffusion What is the purpose of flash tour? - surveyours immediately disperse on floor What prompts a visit from a surveyor ? - 1) new facility 2) recertification 3) additional services 4) relocation 5) complaint 6) follow up safetyStandard (CMS) - failure to meet regulations Condition (CMS) - many citations in one area must be corrected in 30 -90 days Immediate Jeopardy - potential for actual harm to patient, only 23 days to correct What is the purpose of DQI? - How many CFCS are there? - 16 Culture of safety - the surveyor will look for evidence that we are providing safe care and that PTs and TM feel comfortable saying something when their may be a problem DQI success is achieved by - managing individual Patient First and allowing scores to follow knowing each team members role in improving dqi scores 1) The fundamentals 2) Complex programs 3) Measures of Effectiveness 4) What Matters Most - Clinical Pyramid How to prevent DQI dips relates to laboratory draws - 1. know facility lab draw schedule 2. anticipate holidays & FedEx closures 3. reschedule holiday lab draws proactively 4. follow tube draw order 5. confirm ll labels have printed clearly before adhering to lab container 6. remind teammates of the importance of proper tube processing 7. correct draw dates before shipping8. don't borrow boxes for shipping 9. freeze ice packs flat & solid 10. record FedEx tracking #s -