DaVita Exam Module 1
Ultrafiltration definition - ANS(Fluid movement) Controlled fluid removal by manipulation of
hydrostatic pressure
Convection definition - ANS(Particle/solute movement) Solutes are dragged across the
semipermeable membrane along with fluid
Diffusion definition - ANS(Particle/solute movement) Particles move from an area of higher
solute concentration to lower solute concentration
Osmosis definition - ANS(Fluid movement) fluid moves from lower solute concentration to
higher solute concentration
What are the kidney's excretory functions? - ANSWater removal, electrolyte balance, toxin
removal and acid base balance
How do we replace normal excretory kidney functions? - ANSBy normalizing the electrolytes
and providing fluid balance through ultrafiltration
What is the function of the acid concentrate? - ANSIt provides the concentration gradient for
diffusion
What is the function of bicarbonate in the dialysate solution? - ANSIt buffers the acid
concentrate
What is the function of bicarbonate when it diffuses into the patient's blood? - ANSIt
normalizes the patients body temp pH in the blood stream (7.35-7.45)
Signs and symptoms of Hyperkalemia - ANSGreater than 6.5 EXTREME muscles weakness
and abnormal heart rhythm
Signs and symptoms of Hypokalemia - ANSLess than 3.5; fatigue, muscle weakness,
irregular heart rhythm and cardiac instability
What are the kidneys' endocrine functions? - ANSBlood pressure regulation (Renin),
Erythropoiesis (helps prevent anemia), and vitamin D activation (calcium/phosphorus)
How do we replace normal endocrine kidney functions? - ANSGive them their meds
How much of normal kidney function is replaced by hemodialysis? - ANS15%
What is uremia and what does it affect? - ANSIt's the build up of waste products in the blood
due to kidney failure and it affects all body symptoms
,What are the most common causes for CKD in the USA? - ANSDiabetes and hypertension
Outline the treatment goals for a patient with CKD - ANSAcid base balance, fluid removal,
electrolyte balance and toxin removal
Why is it important to know what caused your patients CKD - ANSSo the nurse and pct can
inquire about possible problems during data collection and assessment
Signs and symptoms of fluid balance - ANSHypertension (high BP), swelling or edema, and
shortness of breathe
Why is sodium balance important? - ANSSodium creates thirst which leads to volume
expansion, increases the bp, LVH, leads to higher mortality rate
Advice for a pt that complains of dry, itchy skin - ANSHyper fatty soaps and lotion, emotional
support
Peripheral neuropathy (nerve pain in the extremities) - ANSAdvise not to walk barefoot, bath
water temp
GI problems (nausea/vomiting) - ANSGet nurse involved
Psychological problems (anxiety/depression) - ANSGet it up to the social worker
What does hypertension lead to? - ANSLeft ventricular hypertrophy (LVH)
What is pericarditis? - ANSInflammation of the membrane (pericardiosack)
What is included in pericarditis treatment? - ANSDecrease or stop heparin or give more
dialysis
Why are dialysis patients anemic? (Primary cause) - ANSLack of Erythropoietin
Secondary causes of anemic pts - ANSInadequate dialysis and blood loss during treatment
How can you prevent contributing to lower hemoglobin levels and blood loss in dialysis
patients? - ANSGet the heparin into them, give good rinse back, and avoid repeated lab
draws
What are the four key elements affected in CKD-Mineral Bone Disorder (MBD)? -
ANSCalcium, phosphorus, calcitriol (Vitamin D) and parathyroid hormone (PTH)
What are symptoms of CKD-MBD in addition to bone disease? - ANSSoft tissue calcification
What is your role in CKD-MBD Management? - ANSGet meds in, take binders, get dietitian
in and encourage them to be compliant
, Define the term AKI - ANSencompasses wide spectrum of kidney issues, including kidney
failure and kidney function changes
3 examples of pre-renal causes of AKI - ANSVolume depletion (hemorrhage, burns),
decrease in cardiac output, renal vascular obstruction
3. examples of Intra-renal causes of AKI - ANSAcute interstitial nephritis, acute tubular
necrosis, chemotherapy
3 examples of post-renal causes of AKI - ANSBladder or ureteral malignancy, kidney stones,
benign prostatic hyperplasia
Explain the difference between AKI and CKD - ANSAKI- happens suddenly, hoping to
eliminate the cause and hope of recovery
CKD- slowly progressing and irreversible
How do you help in restoring kidney function with AKI pts? - ANSFind the cause of AKI and
try to get rid of it
What do you need to consider in regards to AKI pts vascular access - ANSMake sure to
follow policy and procedures to prepare the access sites so they don't get septic (infection)
How do you protect kidneys from further injury? - ANSAvoid substances that may be toxic to
the kidneys
What is important when monitoring weight and BP? - ANSAlways want to keep a little bit of
fluid on so the kidneys stay perfused
AKI pts are at increased risk for which complications? - ANShypovolemia (loss of fluid
volume in blood) which leads to hypotension
What makes dialysis patients more susceptible to HAIs? (Healthcare-Associated Infections) -
ANSWhen immune system is weakened
Why are dialysis patients at increased risk for acquiring a HAI at the facility? - ANSHD
procedure requires prolonged access to patient blood
What is the most common transmission route for HAIs? - ANSContact
What is the most important intervention you can do to prevent HAIs? - ANSHand hygiene
What is the most common infectious complication in hemodialysis patients? - ANSVascular
access infection
What germ causes the most common infections in hemodialysis patients? - ANSMRSA - can
remain on surfaces for days with plastic and vinyl
Why is wearing gloves so important? - ANSreduces the risk of hand contamination
Ultrafiltration definition - ANS(Fluid movement) Controlled fluid removal by manipulation of
hydrostatic pressure
Convection definition - ANS(Particle/solute movement) Solutes are dragged across the
semipermeable membrane along with fluid
Diffusion definition - ANS(Particle/solute movement) Particles move from an area of higher
solute concentration to lower solute concentration
Osmosis definition - ANS(Fluid movement) fluid moves from lower solute concentration to
higher solute concentration
What are the kidney's excretory functions? - ANSWater removal, electrolyte balance, toxin
removal and acid base balance
How do we replace normal excretory kidney functions? - ANSBy normalizing the electrolytes
and providing fluid balance through ultrafiltration
What is the function of the acid concentrate? - ANSIt provides the concentration gradient for
diffusion
What is the function of bicarbonate in the dialysate solution? - ANSIt buffers the acid
concentrate
What is the function of bicarbonate when it diffuses into the patient's blood? - ANSIt
normalizes the patients body temp pH in the blood stream (7.35-7.45)
Signs and symptoms of Hyperkalemia - ANSGreater than 6.5 EXTREME muscles weakness
and abnormal heart rhythm
Signs and symptoms of Hypokalemia - ANSLess than 3.5; fatigue, muscle weakness,
irregular heart rhythm and cardiac instability
What are the kidneys' endocrine functions? - ANSBlood pressure regulation (Renin),
Erythropoiesis (helps prevent anemia), and vitamin D activation (calcium/phosphorus)
How do we replace normal endocrine kidney functions? - ANSGive them their meds
How much of normal kidney function is replaced by hemodialysis? - ANS15%
What is uremia and what does it affect? - ANSIt's the build up of waste products in the blood
due to kidney failure and it affects all body symptoms
,What are the most common causes for CKD in the USA? - ANSDiabetes and hypertension
Outline the treatment goals for a patient with CKD - ANSAcid base balance, fluid removal,
electrolyte balance and toxin removal
Why is it important to know what caused your patients CKD - ANSSo the nurse and pct can
inquire about possible problems during data collection and assessment
Signs and symptoms of fluid balance - ANSHypertension (high BP), swelling or edema, and
shortness of breathe
Why is sodium balance important? - ANSSodium creates thirst which leads to volume
expansion, increases the bp, LVH, leads to higher mortality rate
Advice for a pt that complains of dry, itchy skin - ANSHyper fatty soaps and lotion, emotional
support
Peripheral neuropathy (nerve pain in the extremities) - ANSAdvise not to walk barefoot, bath
water temp
GI problems (nausea/vomiting) - ANSGet nurse involved
Psychological problems (anxiety/depression) - ANSGet it up to the social worker
What does hypertension lead to? - ANSLeft ventricular hypertrophy (LVH)
What is pericarditis? - ANSInflammation of the membrane (pericardiosack)
What is included in pericarditis treatment? - ANSDecrease or stop heparin or give more
dialysis
Why are dialysis patients anemic? (Primary cause) - ANSLack of Erythropoietin
Secondary causes of anemic pts - ANSInadequate dialysis and blood loss during treatment
How can you prevent contributing to lower hemoglobin levels and blood loss in dialysis
patients? - ANSGet the heparin into them, give good rinse back, and avoid repeated lab
draws
What are the four key elements affected in CKD-Mineral Bone Disorder (MBD)? -
ANSCalcium, phosphorus, calcitriol (Vitamin D) and parathyroid hormone (PTH)
What are symptoms of CKD-MBD in addition to bone disease? - ANSSoft tissue calcification
What is your role in CKD-MBD Management? - ANSGet meds in, take binders, get dietitian
in and encourage them to be compliant
, Define the term AKI - ANSencompasses wide spectrum of kidney issues, including kidney
failure and kidney function changes
3 examples of pre-renal causes of AKI - ANSVolume depletion (hemorrhage, burns),
decrease in cardiac output, renal vascular obstruction
3. examples of Intra-renal causes of AKI - ANSAcute interstitial nephritis, acute tubular
necrosis, chemotherapy
3 examples of post-renal causes of AKI - ANSBladder or ureteral malignancy, kidney stones,
benign prostatic hyperplasia
Explain the difference between AKI and CKD - ANSAKI- happens suddenly, hoping to
eliminate the cause and hope of recovery
CKD- slowly progressing and irreversible
How do you help in restoring kidney function with AKI pts? - ANSFind the cause of AKI and
try to get rid of it
What do you need to consider in regards to AKI pts vascular access - ANSMake sure to
follow policy and procedures to prepare the access sites so they don't get septic (infection)
How do you protect kidneys from further injury? - ANSAvoid substances that may be toxic to
the kidneys
What is important when monitoring weight and BP? - ANSAlways want to keep a little bit of
fluid on so the kidneys stay perfused
AKI pts are at increased risk for which complications? - ANShypovolemia (loss of fluid
volume in blood) which leads to hypotension
What makes dialysis patients more susceptible to HAIs? (Healthcare-Associated Infections) -
ANSWhen immune system is weakened
Why are dialysis patients at increased risk for acquiring a HAI at the facility? - ANSHD
procedure requires prolonged access to patient blood
What is the most common transmission route for HAIs? - ANSContact
What is the most important intervention you can do to prevent HAIs? - ANSHand hygiene
What is the most common infectious complication in hemodialysis patients? - ANSVascular
access infection
What germ causes the most common infections in hemodialysis patients? - ANSMRSA - can
remain on surfaces for days with plastic and vinyl
Why is wearing gloves so important? - ANSreduces the risk of hand contamination
