Patient Care Technician - Module 8: Water Treatment Questions Answered 100% correct

Patient Care Technician - Module 8: Water Treatment Questions Answered 100% correct We can disinfect and regenerate carbon tanks. True or False? FALSE: We cannot disinfect or regenerate carbon tanks; we can only backwash them and replace them. Does backwashing the carbon tanks remove substances the carbon has absorbed? Yes or No? NO: Backwashing does NOT remove substances the carbon tank has absorbed. When the GAC (granular activated charcoal) in the tank can no longer absorb enough chlorine, the water leaving the tank will have higher chlorine levels. Backwashing does NOT remove substances the carbon tank has adsorbed. When the GAC (granular activated charcoal) in the tank can no longer absorb enough chlorine, the water leaving the tank will have higher chlorine levels. When this happens, the tank is "_________". exhausted When the carbon tank becomes exhausted, the ____ tank is removed, and the _____ tank may be moved into the first spot, and a ____ tank placed in the second spot. first, second, fresh New carbon tanks must be ______ before use. rinsed Backwashing GAC (granular activated charcoal) tanks is vital to prevent the premature breakthrough of ______ into the water. chlorine When monitoring the carbon tanks, the water system must be working for at least ___ minutes before you run your first test. 15 The water system must be working for at least 15 minutes before you take a sample to test. If you take a sample when you start up the system, you will be testing water that has been in the tank over-night. This will not give you a true sample of what the carbon tank will produce at normal flow rate. It is important to ensure the carbon tanks do not __________ when patients are dialyzing. backwash If the RO membrane is not working, water _____ or _____ will be reduced. quality, quantity RO systems must be disinfected with either ____ or _______. heat, chemicals Over time, the radiant energy of a UV light fades. True or False? True The quartz sleeve must be cleaned to stay clear so the water is exposed to light. Additionally, the lamps must be replaced before they weaken, and at least anually. What do submicron and ultrafilters remove from the water? microbes Submicron filters reduce the level of ______. bacteria Ultrafilters remove both ______ and ________. bacteria, endotoxins Over time, submicron and ultrafilters can become ________ with microbes. overgrown Routine bacterial and endotoxin testing will reveal issues. The filters must be cleaned, disinfected, or replaced per your clinic's guidelines. Since _______ is removed during pretreatment, there is nothing in the product water to prevent the growth of microbes. chlorine As a result, the storage tanks and pipes are the perfect spots for bacteria to grow and form biofilm. It may be necessary to scrub the inside of the tank to dislodge biofilm. We must clean and disinfect the storage tank, distribution piping, and hose to the dialysis machines at least _____ a month. once These steps must also be taken after an invasive repair to the water treatment system. CMS requires in-center DI systems to have an automated way to keep water from an "exhausted" tank from reaching ______ patients. exhausted Water with a resistivity of less than 1 megohm-cm is not safe for dialysis. A stop-valve or divert to drain system must be used. When resistivity of the produce water drops below 1 megohm-cm, the alarm sounds and the product water is sent to the drain or kept from reaching the point of use. The RO ________ is the most important part of the RO system. membrane We test RO performance with _______________, a measure of how well the membrane removes TDS in the water, in parts per million (ppm). percent rejection We measure RO product water quality with _________. conductivity (the level of TDS in the water, in ppm) *The conductivity monitor should account for temperature to give a consistent reading. CMS requires us to take action when the percent rejection of RO performance is less than ___%. 90 ***Remember: Percent rejection alone does not reflect water quality. The percent rejection level will depend on your product water analysis. AAMI does not say that <90% is unsafe, but that it requires action. The action is to validate that your system delivers safe quality product water. Which is more pure, DI water or RO water? DI water Since DI water is more pure than RO water, its conductivity is too low to check accurately. Instead, we monitor DI product water for resistance to the flow of electricity. This is the opposite of conductivity. We monitor DI water for ________ to the flow of electricity. resistance Patients must not be dialyzed with DI water that has a resistivity of less than __ megohmn-cm, measure at the DI output. 1 The ________ and ___ of dialysate must be tested before each treatment conductivity, pH Conductivity within +/- 5% of the nominal machine value; pH in the range 6.9 - 7.6. Mature biofilm is almost impossible to remove. True or False True In some cases, we must replace all or part of the distribution system to remove biofilm. Total chlorine is composed of what? free chlorine and chloramines Free chlorine and chloramines are strong oxidants: they react with oxygen to destroy cell walls. Both may be added to city water to kill bacteria. What remove chlorine and chloramines from water by adsorption? carbon tanks However, we cannot predict when the tank will "exhaust" and lead to breakthrough, so we must test often. The importance of careful testing for chlorine cannot be stressed enough. Patients who are exposed to dialysate with these contaminants will be harmed and could die. The danger we see in dialysis is destruction of what? RBCs (red blood cells) Patients exposed to higher levels of chloramines in dialysate may have _____________; which is when red blood cells cannot carry oxygen. methemoglobinemia Patients exposed to higher levels of chloramines in dialysate may have _____________; which is when red blood cells burst open. hemolysis Patients exposed to higher levels of chloramines in dialysate may have _____________; which is a shortage of red blood cells due to the RBC breakdown. hemolytic anemia The limit for free chlorine in dialysate is _______. 0.5 mg/L The limit for total chlorine is _______. 0.1 mg/L There is no direct test for chloramines. True of False? True To measure chloramines, you must do two tests, one for total chlorine and one for free chlorine. The chloramine level is the difference between two results. The chloramine level is the difference between what two test results? total chlorine and free chlorine ANSI/AAMI says water used for dialysis should contain no more than __ mg/L of sodium and __ mg/L of potassium. 70, 8 ANSI/AAMI says water used for dialysis should contain no more than 70 mg/L of ______ and 8 mg/L of _______. Sodium and potassium are removed by RO or DI. sodium, potassium Sodium and potassium are removed by what? RO or DI CMS requires that we test for ____ chlorine: - At the start of each treatment day - At the start of each patient shift. - Every 4 hours if your clinic does not have set shifts. total Hard water contains _______ and __________. calcium, magnesium Hard water contains calcium and magnesium. If too high levels of these minerals reach patients, the result may be ___________________. hard water syndrome List 6 signs and symptoms hard water syndrome can cause in dialysis patients: - nausea and vomiting - muscle weakness - severe headaches - skin flushing - high or low blood pressure - calcium crystals in the soft tissues of the patient's body over time, causing pain, injury or death