Fresenius Water Treatment Exam, Fresenius Hemodialysis Study Guide

Fresenius Water Treatment Exam, Fresenius Hemodialysis Study Guide Types of water sources? Surface and Ground Examples of surface water? lakes, streams, rivers, reservoirs Examples of ground water? Wells, springs FMC follows water quality standards according to who's standards? AAMI Bone disease can be caused by ________ in product water? Aluminum Aluminum in product water put the patient at risk for ________? Anemia Aluminum, chloramphenicol, copper or zinc may cause _______ when present in water used for dialysis? Hemolysis The presence of bacteria in the bloodstream is? Sepsis Parts of a bacteria cell wall, released from dead bacteria is? Endotoxin What are characteristics of bacteria/viruses? 1. Grows rapidly 2. Too large to cross an intact dialysis membrane, but can cross a damaged/torn membrane 3. May produce endotoxins or biofilm Safe range for total chlorine is? Less than 0.1 ppm (0.00-0.09 ppm) A serious side effect if chlorine crosses the dialyzer membrane is? Hemolysis Chloramphenicol is a combination of ________ and _________ ? Chlorine and Ammonia Chlorine and chloramphenicol are added to city water for what reason? To reduce or eliminate bacteria A patient complication due to the exposure of blood to chlorine an chloramines is? Hemolysis Examples of the symptoms the patient might experience from Hemolysis. 1. Chest pain 2. Shortness of breath 3. Cherry pop red / translucent blood Where does the water pathway start in the dialysis facility? City Water Inlet The first piece of equipment that the water goes through in the dialysis facility is the? Backflow Preventer What is the function of the backflow preventer? Prevents water from flowing back into the city's water suppl. The recommended water temperature for ideal RO operation is? 77 degrees F What is the function of the water booster pump? Boosts incoming city water pressure What is the function of the Captive Air Tank (bladder tank)? Help maintain a minimum pressure What is the function of the Chemical Feed pump? Help adjust the pH level of the water What is the function of the Sediment Filters? Removes larger particles from the incoming water What is the function of the multimedia filter? Removes particles 10 microns in size or larger What is the size of particulate matter removed by the multimedia filter? 10 What is the function of the Carbon Filter/Tank? To remove chlorine and Chloramines and other organic materials. Carbon filters remove chlorine and chloramines by the process of? Adsorbtion What is the "Empty Bed Contact Time?" The length of time that the water is exposed to carbon AAMI requires a minimum EBCT of __ minutes, FMC requires a minimum EBCT of __ minutes for new water treatment systems. 10, 12 RPC Ultra-Low Total Chlorine test strips are used to test for? Total Chlorine in the water after GAC #1 and Post RO. When and at what frequency is routine total chlorine testing performed per FMS policy? Prior to the initiation of treatment and at least every 4 hours. The reverse osmosis (RO) machine runs for __ minutes before performing any total chlorine testing. 15 Total chlorine testing for a central water system must be performed and documented by __ qualified staff members. 2 A sample container is always rinsed __ times before a sample is collected for testing. 3 ___ ml is the correct amount of water to collect for total chlorine testing when using RPC Ultra-Low Total Chlorine test strips 100 How long is the RPC Ultra-Low Total Chlorine test stripe immersed in the sample? 60 seconds If a chlorine breakthrough occurs post GAC (Carbon) Filter #1, what are the several steps that are taken to ensure patients are safe from harm? 1. Place all machines in bypass 2. Repeat test (optional) 3. Immediately test after GAC#2/Carbon Tank#2 4. If results are less than 0.1, notify the CM, MD, and ATOM/BMT If total chlorine testing after the second carbon tank shows results above the action limit, what action is immediately taken? Immediately stop treatments _______ and _______ are removed from water by the softener by the process of ion exchange? Calcium and Magnesium Water hardness is measured in parts per million (PPM). The FMS acceptable limit for water hardness post softener is __ PPM. Normally, there are __ water hardness tests done daily. 10, 2 What do hardness strips test for? Calcium and magnesium The RO must run for how long prior to testing water? 15 minutes. What is "product water" ? Water exiting the RO that meets the AAMI standards for water to be used for dialysis. RO performance is measured by what? Percent rejection. The full calibration of the TDS meter is required how often? Weekly UV light is a form of? Invisible Radiation UV lights are effective when they have a wave length of ___ nanometers 254 The low level alarm on the holding tank must be set (or on) when? Always Where are the ultrafiltration located in the water treatment system? In the loop What method of water treatment component is used during RO failure and is part of the "Alternate Water Supply Plan"? Demonization Tanks Piping within the water treatment distribution lop is made of what material? PVC, Stainless Steel, PEX. Teflon What causes a progenitor reaction in patients? Exposure to bacteria and endotoxins Watch at are some of the symptoms of a pyrogens can reaction? 1. Fever and chills 2. Nausea and vomiting 3. Hypotension CFU is an abbreviation for? Colony Forming Unit The FMS action level for bacteria in product water exiting the RO is __ cfu/ml 20 The FMS action level for bacteria for water in the tank, piping and distribution loop is __ cfu/ml 20 The FMS action level for Endotoxin in product water exiting the RO is __ EU/ml 0.125 The FMS action level for Endotoxin for water in the tank, piping and distribution loop is __ EU/ml 0.125 Routine testing for bacteria and Endotoxin should take place how often? Monthly What is the frequency of routine holding tank and water distribution loop disinfections? Monthly What is the purpose of Residual Chlorine strips? Test for residual bleach What does a pHoenix meter measure? 1. Conductivity 2. pH 3. Temperature When is the pHoenix meter verified? Daily, before use. When is the pHoenix meter is calibrated? When daily verification indicates the meter is not within acceptable limits. Three pieces of personal protective equipment that are mandatory for use in the patient care area are: Gown, gloves, face shield The function of Erythropoietin is Stimulate production of RBC's, tells bone marrow to make RBC's Hepatitis is an inflammation of the liver caused by most commonly a viral infection Max Chlorine level in H2O room 0.09 ppm Albumin is a protein that helps fight infections and aids in healing and tissue formation. Gets fluid back into the blood, an osmotic agent. HD patient range for Albumin ≥ 4.0 Potassium is an electrolyte that regulates cardiac action HD patient range for Potassium 3.5-6.0 Hemoglobin is what carries oxygen and iron from the lungs to vital organs