Davita PCT Final Exam Study Guide Questions and Answers (2022/2023) (Verified Answers)

Davita PCT Final Exam Study Guide Questions and Answers (2022/2023) (Verified Answers) 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 Edema 2) 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 loss What 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 AKI 1. 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 hemodialysis 2) 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 contamination Why 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 Pre-treatment safety checks Pre-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? Simple Meaningful Actual Read Teach What are the 5 W's? Who When What Where Why 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 time Four 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? Bleeding Erosion Stenosis Thrombosis Infection Pseudo aneursym Steel 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?