FRESENIUS EXAM
3 things a PCT MUST REPORT TO AN RN REGARDING BLEEDING OF THE ACCESS -
ANS-1) Any bleeding during dialysis
2) Bleeding > 20 mins post dialysis
3) Visible break in pores and skin close to get entry to
30 minute assessments encompass - ANS-1) crucial signs and symptoms
2) vascular get entry to
three) system assessments
(if the affected person will become unstable this have to be finished evey 5 minutes till the
patient will become strong)
6 methods to save you contamination of the vascular get admission to - ANS-1) wash get
admission to for 1 full minute previous to cannulation
2) staff-hand hygiene and glove alternate prior to cannulation
three) access evaluation each treatment
4) disinfect web page in step with protocol
five) rotate needle sites
6) aseptic set up of the ECC
Abnormal bruit sound? - ANS-High pitched or no sound, and or decreased whooshing
Advantages to an AVF
(5) - ANS-1) Decrease thrombosis
2) Less infection
3) Cost lower
4) Morbidity & mortality reduced
five) Increased lifestyles of get entry to, right blood flow
Advantages to an AVG?
(four) - ANS-1) Large surface to cannulate
2) Easy to cannulate
three) Healing time quick
4) Easy to implant, construct, and restore
Air embolism is?
Causes
s/s
prevention
interventions - ANS-a massive amount of air into the bloodstream
,- reasons -an empty saline bag, disarmed air detector, unfastened arterial connection, dialyzer
leak
s/s- air in line, coughing, visual disturbances, hypotension, anxiety
ensure venous line is threaded through clamp, hold >300ml in Saline bag, double clamp NS.
Never go away machine whilst rinsing pt again, go back blood with saline and not air.
Interventions- COLT
Clamp strains, flip off blood pump, location patient on left side, trendelenburg
Alarms to reveal the dialysate to make certain it's miles secure to use: - ANS-1) conductivity
alarm
2) temperature alarm
Allergic reactions
s/s - ANS-an over response of the immune machine to a substance
itching, hives, pruritis, crimson/irritated skin, restlessness, facial/neck, swelling, fever, sudden
onset of chilling, watery eyes, mild cough, trouble respiratory, annoying, nausea, belly cramping,
muscle pain and or chest or again pain.
Amp lighting are a visible cue for? - ANS-Adequacy
Green= spkK/v >1.4
Yellow= spKt/v <1.4 (intervention required)
Red= machine is alarming
anaphylaxis is - ANS-a severe, potentially life threatening reaction
Angina
initial interventions
causes
s/s - ANS--Chest pain
-notify RN obtain vs, turn off UF decrease BFR, administer NS and O2, assess pain, notify MD,
administer meds, and initiate emergency response if needed
s/s- SOB, pale, ashen, cool, clammy skin, N/V, CP radiating pain, abdominal discomfort,
heartburn, light headedness, dizzy
Antegrade is? - ANS--needle placement with the direction of the blood flow
Any blood loss > than ---- is an detrimental occasion? - ANS-100 ml
Arrhythmia
preliminary interventions
reasons
s/s - ANS--abnormal coronary heart charge
,-reveal pulse pre and post tx, affirm dialysate rx, display IFR and EDW, tx signs
causes- growing old, heart disorder, electrolyte imbalance
s/s- no signs, skipping coronary heart, fluttering
Arterial needle placement can be placed how? - ANS-Antegrade and or retrograde
As fluid shifts in the course of dialysis what changes can arise? - ANS-Blood pressure, fluid and
electrolyte shifts.
At what minimal need to the blood stress be checked? - ANS-half-hour
At what time have to primed lines be discarded? - ANS-If the strains have now not been used
inside 4 hours.
AVF and AVG affected person interview questions?
(four) - ANS-1) Pain or bleeding
2) Numbness or tingling
three) Medication adjustments
four) Checking thrill daily? Any changes
AVF/AVG cannulation manner:
(9) - ANS-1) Use rope and ladder
2) Determine the route of blood go with the flow
3) Disinfect skin with authorized disinfection agent and permit to dry.
Four) Always practice a tourniquet on a AVF every time you cannulate
5) Pull pores and skin within the contrary direction of needle insertion
6) Insert needle bevel up
7) Needle hints need to be 1.5-2 inches apart (prevents recirculation)
8) Do no longer flip or rotate needle after insertion to save you infiltration
9) Tape needles in vicinity per processes
AVG concerns: - ANS--website online rotation is essential and stops (one-web site-itis) so as to
decreased the AVG existence.
-Never place needles in a Psuedoanurysm.
Biocompatibility is? - ANS-a term to explain a dialyzer membrane this is extra just like the
human body and less likey to reason an immune reaction.
Blood leak
s/s
reasons
interventions - ANS-S/S
-blood leak alarm (important leak will make dialysate pink in dialysate direction or crimson
Hansen
-minor will take a look at nice with blood check strip but will no longer be evident to the naked
eye
reasons- defective or damaged dialyzer, flawed priming, wrong or inadequate heparinization,
clotting, and blood line kink
, interventions- look at dialyzer earlier to use, do no longer use dropped or broken dialyzer, high
nicely, entire strain checking out, avoid clotting and kinking, look into and take a look at dialysate
fro presence of blood.
(if confirmed blood leak, STOP remedy and DO NO RETURN BLOOD, if take a look at bad,
reset alarm and retest in 5 min, if nevertheless bad get rid of device and tag for provider)
Blood leaks are? - ANS--These are tears within the dialzyer membranes that permits blood to
leak into the dialysate
Bradycardia
initial interventions
causes
s/s - ANS--a heart charge <60
-screen pulse pre and publish tx, <60 notify RN, initiate emergency protocol
-causes- dialysate bath, lab values, medications, co-morbidities, treatment related
s/s-SOB, dizziness, syncope, CP, fatigue, confusion, exercise intolerance
Can patients was their own access?
How long? - ANS-Yes!
Wash for 1 minute prior to dialysis
Cardiac complications
(7) - ANS-1) bradycardia
2) tachycardia
3) arrhythmias
4) angina
5) dyspnea
6) disequilibrum (swelling in brain tissue)
7) hypoglycemia
Cauese of AP increased pressure - ANS--causes
-kinks, clamls. Or occlusions in line
-BFR too high,
-needle placement,
-clotting/stenosis, vessel spasm
-poor cardiac status
- hypotension,
-high hematocrit
-CVC issues
(prevent by monitoring patient and responding to alarms stat, Interventions will be required to
resolve increased pressure)
Causes of orthrostatic hypotension and interventions - ANS-causes- hypovolemia, inaccurate
EDW, overeating before dialysis, other medical conditions
-medications for a high b/p and heart disease
-long periods of immobility
3 things a PCT MUST REPORT TO AN RN REGARDING BLEEDING OF THE ACCESS -
ANS-1) Any bleeding during dialysis
2) Bleeding > 20 mins post dialysis
3) Visible break in pores and skin close to get entry to
30 minute assessments encompass - ANS-1) crucial signs and symptoms
2) vascular get entry to
three) system assessments
(if the affected person will become unstable this have to be finished evey 5 minutes till the
patient will become strong)
6 methods to save you contamination of the vascular get admission to - ANS-1) wash get
admission to for 1 full minute previous to cannulation
2) staff-hand hygiene and glove alternate prior to cannulation
three) access evaluation each treatment
4) disinfect web page in step with protocol
five) rotate needle sites
6) aseptic set up of the ECC
Abnormal bruit sound? - ANS-High pitched or no sound, and or decreased whooshing
Advantages to an AVF
(5) - ANS-1) Decrease thrombosis
2) Less infection
3) Cost lower
4) Morbidity & mortality reduced
five) Increased lifestyles of get entry to, right blood flow
Advantages to an AVG?
(four) - ANS-1) Large surface to cannulate
2) Easy to cannulate
three) Healing time quick
4) Easy to implant, construct, and restore
Air embolism is?
Causes
s/s
prevention
interventions - ANS-a massive amount of air into the bloodstream
,- reasons -an empty saline bag, disarmed air detector, unfastened arterial connection, dialyzer
leak
s/s- air in line, coughing, visual disturbances, hypotension, anxiety
ensure venous line is threaded through clamp, hold >300ml in Saline bag, double clamp NS.
Never go away machine whilst rinsing pt again, go back blood with saline and not air.
Interventions- COLT
Clamp strains, flip off blood pump, location patient on left side, trendelenburg
Alarms to reveal the dialysate to make certain it's miles secure to use: - ANS-1) conductivity
alarm
2) temperature alarm
Allergic reactions
s/s - ANS-an over response of the immune machine to a substance
itching, hives, pruritis, crimson/irritated skin, restlessness, facial/neck, swelling, fever, sudden
onset of chilling, watery eyes, mild cough, trouble respiratory, annoying, nausea, belly cramping,
muscle pain and or chest or again pain.
Amp lighting are a visible cue for? - ANS-Adequacy
Green= spkK/v >1.4
Yellow= spKt/v <1.4 (intervention required)
Red= machine is alarming
anaphylaxis is - ANS-a severe, potentially life threatening reaction
Angina
initial interventions
causes
s/s - ANS--Chest pain
-notify RN obtain vs, turn off UF decrease BFR, administer NS and O2, assess pain, notify MD,
administer meds, and initiate emergency response if needed
s/s- SOB, pale, ashen, cool, clammy skin, N/V, CP radiating pain, abdominal discomfort,
heartburn, light headedness, dizzy
Antegrade is? - ANS--needle placement with the direction of the blood flow
Any blood loss > than ---- is an detrimental occasion? - ANS-100 ml
Arrhythmia
preliminary interventions
reasons
s/s - ANS--abnormal coronary heart charge
,-reveal pulse pre and post tx, affirm dialysate rx, display IFR and EDW, tx signs
causes- growing old, heart disorder, electrolyte imbalance
s/s- no signs, skipping coronary heart, fluttering
Arterial needle placement can be placed how? - ANS-Antegrade and or retrograde
As fluid shifts in the course of dialysis what changes can arise? - ANS-Blood pressure, fluid and
electrolyte shifts.
At what minimal need to the blood stress be checked? - ANS-half-hour
At what time have to primed lines be discarded? - ANS-If the strains have now not been used
inside 4 hours.
AVF and AVG affected person interview questions?
(four) - ANS-1) Pain or bleeding
2) Numbness or tingling
three) Medication adjustments
four) Checking thrill daily? Any changes
AVF/AVG cannulation manner:
(9) - ANS-1) Use rope and ladder
2) Determine the route of blood go with the flow
3) Disinfect skin with authorized disinfection agent and permit to dry.
Four) Always practice a tourniquet on a AVF every time you cannulate
5) Pull pores and skin within the contrary direction of needle insertion
6) Insert needle bevel up
7) Needle hints need to be 1.5-2 inches apart (prevents recirculation)
8) Do no longer flip or rotate needle after insertion to save you infiltration
9) Tape needles in vicinity per processes
AVG concerns: - ANS--website online rotation is essential and stops (one-web site-itis) so as to
decreased the AVG existence.
-Never place needles in a Psuedoanurysm.
Biocompatibility is? - ANS-a term to explain a dialyzer membrane this is extra just like the
human body and less likey to reason an immune reaction.
Blood leak
s/s
reasons
interventions - ANS-S/S
-blood leak alarm (important leak will make dialysate pink in dialysate direction or crimson
Hansen
-minor will take a look at nice with blood check strip but will no longer be evident to the naked
eye
reasons- defective or damaged dialyzer, flawed priming, wrong or inadequate heparinization,
clotting, and blood line kink
, interventions- look at dialyzer earlier to use, do no longer use dropped or broken dialyzer, high
nicely, entire strain checking out, avoid clotting and kinking, look into and take a look at dialysate
fro presence of blood.
(if confirmed blood leak, STOP remedy and DO NO RETURN BLOOD, if take a look at bad,
reset alarm and retest in 5 min, if nevertheless bad get rid of device and tag for provider)
Blood leaks are? - ANS--These are tears within the dialzyer membranes that permits blood to
leak into the dialysate
Bradycardia
initial interventions
causes
s/s - ANS--a heart charge <60
-screen pulse pre and publish tx, <60 notify RN, initiate emergency protocol
-causes- dialysate bath, lab values, medications, co-morbidities, treatment related
s/s-SOB, dizziness, syncope, CP, fatigue, confusion, exercise intolerance
Can patients was their own access?
How long? - ANS-Yes!
Wash for 1 minute prior to dialysis
Cardiac complications
(7) - ANS-1) bradycardia
2) tachycardia
3) arrhythmias
4) angina
5) dyspnea
6) disequilibrum (swelling in brain tissue)
7) hypoglycemia
Cauese of AP increased pressure - ANS--causes
-kinks, clamls. Or occlusions in line
-BFR too high,
-needle placement,
-clotting/stenosis, vessel spasm
-poor cardiac status
- hypotension,
-high hematocrit
-CVC issues
(prevent by monitoring patient and responding to alarms stat, Interventions will be required to
resolve increased pressure)
Causes of orthrostatic hypotension and interventions - ANS-causes- hypovolemia, inaccurate
EDW, overeating before dialysis, other medical conditions
-medications for a high b/p and heart disease
-long periods of immobility
