Davita RISE PCT Study Guide Questions
& Answers(GRADED A)
List the four transport mechanisms that play a role in hemodialysis - ANSWER
Ultrafiltration
Convection
Diffusion
Osmosis
Explain ultrafiltration in hemodialysis - ANSWER Fluid is pushed through the
semipermeable membrane (SPM). Think: wringing out a wet rag.
Explain convection in hemodialysis - ANSWER Solutes DRAG across the
semipermeable membrane with fluid
Explain diffusion in hemodialysis - ANSWER PARTICLES move from HIGH
concentration to LOW concentration
Explain osmosis in hemodialysis - ANSWER FLUID moves LOW concentration to HIGH
concentration
What are the kidneys' excretory functions? - ANSWER To normalize electrolytes,
remove wastes, provide fluid and nutrient balance
How do we replace normal excretory kidney functions? - ANSWER By using acid
concentrate to help normalize electrolytes and ultrafiltration to provide fluid balance
What is the function of acid concentrate - ANSWER Provides the concentration gradient
for diffusion and helps normalize electrolytes
What is the function of bicarbonate in the dialysate solution? - ANSWER It buffers the
acid concentrate
What is the function of bicarbonate when it diffuses into the patient's blood? - ANSWER
It normalizes body pH
What are some S/Sx of hyperkalemia? - ANSWER K+ > 6.5 mEq
extreme muscle weakness, dysrhythmias, and possible cardiac arrest
What are some S/Sx of hypokalemia? - ANSWER K+ < 3.5 mEq
fatigue, muscle weakness, paralysis, resp. failure, cardiac instability, arrhythmias,
cardiac arrest
What is the normal blood pH range? - ANSWER 7.35 - 7.45
,What are the kidneys' endocrine functions? - ANSWER Renin secretion
Erythropoietin secretion
Vitamin d activation
How do we replace normal endocrine kidney functions? - ANSWER By providing
medications
How much of normal kidney function is replaced by HD? - ANSWER 15%
What is uremia? - ANSWER Uremia is a buildup of wastes in the blood due to kidney
failure
What does uremia affect? - ANSWER Uremia affects all body systems
What are the most common causes of CKD in the US? - ANSWER diabetes, HTN and
polycystic kidney disease
List the treatment goals for a pt. w/ CKD - ANSWER -slowing the progression of CKD
-managing comorbidities and complications
-controlling symptoms
-minimizing the effects if CKD on pt. lifestyles
-kidney replacement therapy modality education
-encouraging patients to actively participate in their healthcare
Why is it so important to know what caused your pt.'s CKD? - ANSWER So the RN and
PCT can ask about possible problems during data collection and assessment
List some S/Sx of fluid imbalance - ANSWER HTN, edema, and SOB
Why is sodium balance important? - ANSWER Leads to volume expansion,
increased cardiac output,
increased peripheral vascular resistance
and increased BP
List some systemic effects of CKD - ANSWER -Dry, itchy skin
-Peripheral neuropathy in the extremities
-GI problems (N/V)
-Psychological problems (anxiety, depression)
What would you advise for a pt. with dry, itchy skin? - ANSWER -use hyper-fatted soaps
and lotions
-assess for safety at home
-provide emotional support
-control diabetes and phosphorus
, What would you advise for a pt. with peripheral neuropathy? - ANSWER -Monitor pt. for
changes in motor function, decreased strength in legs, C/O restless legs, and burning
feet.
-Advise not to walk barefoot
-Practice good foot care
What would you advise for a pt. with GI problems? - ANSWER -inform RN and MD of
any bleeding problems, constipation, diarrhea
- inform RN and MD of ER visits
-Take meds as ordered (stool softeners, immodium, etc.)
What would you advise for a pt. with psychological problems? - ANSWER Verbalize
struggles to IDT (core team), especially the social worker
A common cause of HTN in dialysis patients is: - ANSWER Fluid overload
What does HTN lead to? - ANSWER Left ventricular hypertrophy
Left ventricular hypertrophy leads to: - ANSWER Ischemic heart disease, arrhythmia,
myocardial infarction, and sudden death.
Define pericarditis - ANSWER An inflammation of the membrane (pericardial sac) that
surrounds the heart due to fluid an waste build up
What is the Tx for pericarditis? - ANSWER Decrease or stop heparin and give more
frequent dialysis
Why are dialysis patients anemic? - ANSWER The lifespan of their red blood cell is 60
days, 1/2 of the normal 120 days.
What is the primary cause of anemia in dialysis patients? - ANSWER Lack of the
hormone erythropoietin (EPO)
What are secondary causes of anemia in dialysis patients? - ANSWER -Inadequate iron
stores,
-inadequate dialysis,
-malnutrition,
-blood loss during Tx
How can you prevent contributing to lower hemoglobin and blood loss in dialysis
patients? - ANSWER -Verify epogen dose is correct and administered
-Rinse back until venous line is pink tinged
-Avoid repeat lab draws
What are the four key elements contributing to CKD-Mineral Bone Disorder (MBD) -
ANSWER -Calcium
& Answers(GRADED A)
List the four transport mechanisms that play a role in hemodialysis - ANSWER
Ultrafiltration
Convection
Diffusion
Osmosis
Explain ultrafiltration in hemodialysis - ANSWER Fluid is pushed through the
semipermeable membrane (SPM). Think: wringing out a wet rag.
Explain convection in hemodialysis - ANSWER Solutes DRAG across the
semipermeable membrane with fluid
Explain diffusion in hemodialysis - ANSWER PARTICLES move from HIGH
concentration to LOW concentration
Explain osmosis in hemodialysis - ANSWER FLUID moves LOW concentration to HIGH
concentration
What are the kidneys' excretory functions? - ANSWER To normalize electrolytes,
remove wastes, provide fluid and nutrient balance
How do we replace normal excretory kidney functions? - ANSWER By using acid
concentrate to help normalize electrolytes and ultrafiltration to provide fluid balance
What is the function of acid concentrate - ANSWER Provides the concentration gradient
for diffusion and helps normalize electrolytes
What is the function of bicarbonate in the dialysate solution? - ANSWER It buffers the
acid concentrate
What is the function of bicarbonate when it diffuses into the patient's blood? - ANSWER
It normalizes body pH
What are some S/Sx of hyperkalemia? - ANSWER K+ > 6.5 mEq
extreme muscle weakness, dysrhythmias, and possible cardiac arrest
What are some S/Sx of hypokalemia? - ANSWER K+ < 3.5 mEq
fatigue, muscle weakness, paralysis, resp. failure, cardiac instability, arrhythmias,
cardiac arrest
What is the normal blood pH range? - ANSWER 7.35 - 7.45
,What are the kidneys' endocrine functions? - ANSWER Renin secretion
Erythropoietin secretion
Vitamin d activation
How do we replace normal endocrine kidney functions? - ANSWER By providing
medications
How much of normal kidney function is replaced by HD? - ANSWER 15%
What is uremia? - ANSWER Uremia is a buildup of wastes in the blood due to kidney
failure
What does uremia affect? - ANSWER Uremia affects all body systems
What are the most common causes of CKD in the US? - ANSWER diabetes, HTN and
polycystic kidney disease
List the treatment goals for a pt. w/ CKD - ANSWER -slowing the progression of CKD
-managing comorbidities and complications
-controlling symptoms
-minimizing the effects if CKD on pt. lifestyles
-kidney replacement therapy modality education
-encouraging patients to actively participate in their healthcare
Why is it so important to know what caused your pt.'s CKD? - ANSWER So the RN and
PCT can ask about possible problems during data collection and assessment
List some S/Sx of fluid imbalance - ANSWER HTN, edema, and SOB
Why is sodium balance important? - ANSWER Leads to volume expansion,
increased cardiac output,
increased peripheral vascular resistance
and increased BP
List some systemic effects of CKD - ANSWER -Dry, itchy skin
-Peripheral neuropathy in the extremities
-GI problems (N/V)
-Psychological problems (anxiety, depression)
What would you advise for a pt. with dry, itchy skin? - ANSWER -use hyper-fatted soaps
and lotions
-assess for safety at home
-provide emotional support
-control diabetes and phosphorus
, What would you advise for a pt. with peripheral neuropathy? - ANSWER -Monitor pt. for
changes in motor function, decreased strength in legs, C/O restless legs, and burning
feet.
-Advise not to walk barefoot
-Practice good foot care
What would you advise for a pt. with GI problems? - ANSWER -inform RN and MD of
any bleeding problems, constipation, diarrhea
- inform RN and MD of ER visits
-Take meds as ordered (stool softeners, immodium, etc.)
What would you advise for a pt. with psychological problems? - ANSWER Verbalize
struggles to IDT (core team), especially the social worker
A common cause of HTN in dialysis patients is: - ANSWER Fluid overload
What does HTN lead to? - ANSWER Left ventricular hypertrophy
Left ventricular hypertrophy leads to: - ANSWER Ischemic heart disease, arrhythmia,
myocardial infarction, and sudden death.
Define pericarditis - ANSWER An inflammation of the membrane (pericardial sac) that
surrounds the heart due to fluid an waste build up
What is the Tx for pericarditis? - ANSWER Decrease or stop heparin and give more
frequent dialysis
Why are dialysis patients anemic? - ANSWER The lifespan of their red blood cell is 60
days, 1/2 of the normal 120 days.
What is the primary cause of anemia in dialysis patients? - ANSWER Lack of the
hormone erythropoietin (EPO)
What are secondary causes of anemia in dialysis patients? - ANSWER -Inadequate iron
stores,
-inadequate dialysis,
-malnutrition,
-blood loss during Tx
How can you prevent contributing to lower hemoglobin and blood loss in dialysis
patients? - ANSWER -Verify epogen dose is correct and administered
-Rinse back until venous line is pink tinged
-Avoid repeat lab draws
What are the four key elements contributing to CKD-Mineral Bone Disorder (MBD) -
ANSWER -Calcium
