Fresenius Exam (End of Training) ALL SOLUTION AND ANSWERS CORRECT GUARANTEED GRADE A+

Fresenius Exam (End of Training) ALL SOLUTION AND ANSWERS CORRECT GUARANTEED GRADE A+ What are the anatomical structures in ORDER of urine flow? 2 Kidneys 2 Ureters 1 Urethra 1 Bladder What is a nephron? It is a tubular structure that filters blood to form urine. What is the functional unit of the Kidney? nephron What is the nephron composed of? glomerulus (tangled cluster of capillaries surrounded by the Bowmans Capsule) 7 Functions of the kidney A- acid/base balance maintenance W- water balance maintenance E- Electrolyte balance T- Toxin removal B- Blood pressure regulation E- Erythropoietin production D- Vitamin D metabolism What are the functions of a healthy kidney? •Remove waste products •Regulate(Synthesis): Fluid balance, electrolytes, and acid base balance •Endocrine/Enzyme: secrete erythropoietin (stimulates bone marrow) and Releases Renin (when released increases blood pressure) What is GFR (glomerular filtration rate), & How many stages? •GFR describes the flow rate of filtered fluid through the kidney •5 Stages (ranging from 1 being healthy to 5 being the worst) What are the types of Kidney failure? •ARF (Acute renal failure) •AKI (Acute kidney injury) •CRF(Chronic renal failure) What are the stages of Kidney failure? (Based on the types) •ARF(acute renal failure): sudden onset , usually reversible •AKI (acute kidney injury) •CRF (chronic kidney failure): slow onset, progressive, permanent What is polycystic kidney disease (PKD)? Inherited defect leading to bilateral enlarged kidneys with cysts What are the signs and symptoms of Renal failure? •signs: anemia , fluid overload, SOB, edema, hypertension, proteinuria (protein found in urine), yellow-gray appearance of the skin. •Symptoms: lethargic, weakness, headache, itching, fatigue, nausea, restlessness, mental status change, loss of appetite What is anemia? Signs and symptoms •anemia: a decrease in the oxygen-carrying ability of the blood •signs and symptoms: fatigue, decreased energy levels, SOB Which functions of healthy kidneys are replaced by dialysis? •Removal of waste products •Regulation of fluid. What are the three types of treatments for End of stage renal disease? 1: hemodialysis: uses an access to draw blood, sends it to the dialyzer then into the semipermeable membrane where diffusion removes the waste through filtration and ultrafiltration removes the fluid. 2: peritoneal dialysis: 2 types both use a permanently placed catheter in the patient's peritoneal cavity. 3: Transplantation: a working kidney surgically implanted What is the difference between Hemodialysis (HD) and peritoneal dialysis (PD)? HD: outpatient setting using an artificial kidney (dialyzer) to removes waste from patients blood. Fluid removal done through Ultrafiltration (UF), usually last 3-4 hours dialyze 3 times a week PD: done in the patients home, peritoneal membrane that filters waste, performed daily by completing several exchanges during the day or could be done during sleep hours. When is it known that a patient has developed a sensitivity to a dialyzer? Patients develop mild to severe reactions (rash, pain at site, hives, fever) or "First Use" syndrome due to inadequate rinsing. Blood specific alarms? Blood leak Air Detector Venous pressure Arterial pressure TMP Dialysate specific alarms? Conductivity (high)- Crenation Conductivity (low)- hemolysis Tempature: high or low Body Fluid Compartments •intracellular: inside the cell •extracellular: outside the cell •intravascular: inside the blood vessels •interstitial: in between the cells Diffusion movement of molecules from an area of high concentration to an area of low concentration Osmosis Movement of fluid from a lower concentration to a higher concentration Ultrafiltration Uses both negative and positive pressure to remove excess fluid. Why is the water used for dialysis treated? Because the Water contains contaminants, electrolytes, and impurities and they must be removed to protect the patient from harm. What is the difference between Chloramine and Chlorine? •both are used to treat water •Chloramine: contains bleach and ammonia •Chlorine: just bleach only What is the diasafe filter? A diasafe filter is found on the back of the hemodialysis machine that allows for the delivery of ultra pure dialysate. What factors affect the rate of diffusion The concentration gradient, The Temperature, The Surface Area Of the membrane, Nature of the solution What happens to diffusion when the dialyzer fibers clot? Diffusion is decreased, treatment adequacy decreases, permeability of the fibers decreases or is eliminated. Due to Inadequate heparinization or an improperly primed dialyzer. RESULTS: diffusion doesn't occur bcs the particles can't diffuse across the membrane. What is the largest factor that impacts ultrafiltration? PRESSURE What happens when the dialysate flow is turned off during treatment? The patients blood isn't cleaned, the adequacy of the treatment will decrease. What are the compartments of the dialyzer, and what separates them? Two compartments housed inside the plastic casing. The blood compartment is separated from the dialysate compartment by a semipermeable membrane. What is a semi-permeable membrane? A membrane made from protein, with small pores or holes. Only certain molecules can fit through. FYI: RBC AND PROTIENS ARE TO LARGE TO PASS, UREA, SODIUM, POTASSIUM, WATER CAN PASS THROUGH. What is countercurrent flow? Where two fluids flow in opposite directions. •Blood flows down into the dialyzer (Arterial to Venous) dialysate flows up (Venous to Arterial) ... this allows for better clearance and diffusion. What are the three types of solutions? hypotonic, hypertonic, isotonic Hypotonic CONTINUED...