Fresenius Nurse Final Exam Part 2 LATEST SOLUTION FOR 2025 EDITION GUARANTEED GRADE A+

Fresenius Nurse Final Exam Part 2 LATEST SOLUTION FOR 2025 EDITION GUARANTEED GRADE A+ What must be evaluated and documented pre-tx? Ambulation status, mental status, pre-weight, bp sitting and standing if patient is able, temperature, heart rate and rhythm, respirations, edema, GI status, skin color, access evaluation, hospitalizations since last tx, any new complaints or life changes What must be evaluated and documented during tx? Current time of evaluation, bp, BFR, DFR, safety checks, arterial/venous pressures, fluid removed/administered, access check-hemosafe device attached, patient's overall status, interventions, changes in dialysis presecription What must be evaluated and documented post-tx? Ambulation status, mental status, changes in condition, post weight, bp sitting and standing, temperature, heart rate and rhythm, respirations, edema, new complaints, evaluation of access including presence of thrill, condition of dressing Recommended body temperature range 96.4-98.9 What is the recommended interdialytic weight gain? 1.5-2.0 kg/day Signs and symptoms that EDW is too low (Too much fluid is being removed): Dizziness, nausea, vomiting, hypotension, cramps, fatigue that sometimes persist until the next tx Signs and symptoms that EDW is too high (Not enough fluid is being removed): Htn, headaches, SOB, edema, distended neck veins What is AW and how is it calculated? In the weight loss plan, AW means "available weight", this is calculated by subtracting the EDW from the patient's pre-tx weight What makes up the goal for fluid removal? The AW (available weight), priming and rinseback saline, and any other fluid the patient will receive during the tx (oral fluids, saline rinses, packed cells, IDPN, IVPB medications etc. ) ____________ is the measurement of how well we are cleaning wastes from our patients' blood Adequacy of Dialysis How can we measure how well we clean our patients' blood? By measuring the amount of wastes in the patient's blood before and after dialysis, we can calculate the amount of clearance we achieve. The following interventions improve the clearance of urea during hemodialysis: 1.Well functioning ___________ 2.Proper ____ of the circuit 3.Optimal _________ (autoflow 1.5 or 2 as ordered and ________ flow 4.Larger _______ and _______ 5.Ensuring needle tips are at _______ inches aprt 6. longer _______ 1. access 2. priming 3. dialysate & blood 4. dialyzer membrane and needle gauges 5. 1.5 to 2 inches 6. tx times What are 2 consequences of improperly primed dialyzer? 1. When the # of fibers available to affect clearance is greatly reduced, the result is a less effective tx for the patient. 2. Clotted fibers/ dialyzer will also result in a certain amount of blood loss for the patient, resulting in a potential for reduced hgb level. What is considered the best method currently available for determining tx effectiveness and is mandatory in all FMC clinics? UKM (Urea Kinetic Modeling) In addition to UKM, these are two other methods of determining adequacy. kt/V and URR Why is measuring the adequacy of the dialysis tx so important? When the tx is more effective, patients live longer and have fewer health problems. What does Kt/v stand for? K stands for the clearance (think k sound) of urea, t is the time in minutes, and v is the total volume of waste (urea) that exist in the patient What is the difference between spKt/v and eKt/v and how is it determined? ~single pool or spKt/v is the amount of dialysis having been delivered upon completion of the HD tx, it's the reduction from one pool of fluid (vascular space) ~double pool or eKt/v is the measured amount of dialysis accounting for the volume of urea distribution in both intracellular and extracellular compartments representing the amount of urea distribution of the entire body. What is FMCNA's goal for spKt/v and eKt/v? Minimum 1.4 L for spKt/v and 1.2 L for eKt/v OLC stands for On Line Clearance T machines are equipped with technology that that can measure single pool Kt/v. OLC test measure _____ transfer across the dialysis membrane which serves as a substitute for urea, so it's removal reflects how urea is removed. Sodium These lights on the HD machines provide a visual indicator for tx adequacy. AMP KECN is the acronym for ________ and refers to the clearance of sodium as measured by the conductivity changes during the OLC test. clearance effective by conductivity sodium KECN normal range is 200-300 KCEN should be less than The BFR Less than ____KECN is poor clearance and will not be used by Proton to generate and OLC Volume 150 Greater than ____ KECN indicates that the machine may potentially need temp and conductivity calibrated 350 How many KECN tests can be programmed into OLC? Between 3-6 test/ If a tx is 3-4 hours in length, 6 tests should be programmed. How long should blood tubes spin? Spin blood specimens for 10 minutes What lab tubes should not be spun in the centrifuge? Collection tubes containing anticoagulants Mechanical injury during drawing, extreme hot/cold temps, vigorous shaking, centrifuging bf clot forms, unbalanced centrifuge and fragile cell can all lead to Hemolysis of laboratory specimen Tubes not inverted enough to allow anticoagulant to mix, cold temps, outdated blood tubes, overfilled blood tubes, patient being clamped too long post cannulation can all lead to Clotting of blood specimens When is lab work drawn and which port would you draw the sample from? prior to administering heparin; arterial port What is the procedure for drawing post tx lab work? The UF is turned off, DFR turned off and BFR decreased to 100 for 15 seconds, Blood pump stopped, arterial and venous clamped; vacutainer to arterial bloodline port; invent sample 5-10 times How are infiltrations treated and where should venous/arterial be stuck post infiltration? Intermittent ice for 24 hours followed by intermittent heat as needed. Venous needle is place above site/ arterial is placed above or below What four things should be taught to patients in regards to preventing access from clotting? 1. Not to wear tight fitting clothing or jewelry 2. Not to sleep on arm 3. Not to let anyone draw labs or check BP 4. Not to carry heavy objects What is VAM? Vascular Access Monitoring is an assessment tool to help determine the rate of blood flow through an AV fistula or graft in ml/min What blood pump speed is required for a VAM access flow test? 200-300 ml/min When should an access flow test be conducted and why? It should be performed at the beginning of tx because patients are more hemodynamically stable and the access is not affected by UF What should be documented when conducting an access flow test? KECN 1 reading, KECN 2 reading, Access Flow reading What is a good access flow reading? ____ ml/min for grafts ____ ml/min for fistulas less than _____% from baseline What factors could produce a negative access flow value? CONTINUED...