BONENT EXAM QUESTIONS AND ANSWERS WITH SOLUTIONS 2024

In center hemo must be done - ANSWER 3x a week for about 4 hours Cons of in center HD - ANSWER Most limitation on Diet, fluid than other modalities Requires the most medication Most symptoms Patients who run 4 hour tx - ANSWER Are 30% less likely to die than pts who run shorter times Each 30 mins extra of tx increase life by 7% Patients are 50% more likely to die after - ANSWER 2 day no treatment weekend, the last 12 hours of the 2 days the risk of death triples diastolic blood pressure - ANSWER When the heart is at rest. Benefits of nocturnal in center - ANSWER You get 2x as many txs as standard because it is longer and more gentle with fluid removal Rarely cramp Easy on heart Fewer limitations on food and drink Free days 72% better survival rate than standard in center You check blood pressure with - ANSWER Stethoscope and sphygmomanometer Nocturnal in center hemo must be done - ANSWER 3x a weeks about 8 hours per tx If BP site is below the heart.... - ANSWER The reading will be to high Benefits of nocturnal home hemo - ANSWER Better protein level Don't need binders No fluid limits Fewer symptoms Less heart damage Live as long as people who get a deceased kidney transplant If BP site is above the heart.... - ANSWER The reading will be to low Home hemo must be done - ANSWER 3x a week 4 -6 hours per tx Benefits of PD - ANSWER Can do alone at home or work Only need 1 -2weeks of training Allows for a more normal diet Allows pt to feel more normal peritonitis - ANSWER inflammation of the peritoneum, this can scar the peritoneum and make PD no longer possible, can be avoided by doing a sterile exchange 2 types of PD - ANSWER Continuous ambulatory peritoneal dialysis (CAPD) Automated peritoneal dialysis (APD) - uses cycled at night done 8 -10 hours during sleep During in center HD how much blood is outside of body at a time - ANSWER 1/2 cup Short Daily Home Hemodialysis must be done - ANSWER 5 -6days a week for the 2.5 -4 hour per tx a bp cuff that is too small or to loose will cause a - ANSWER Higher reading Nocturnal home hemomust be done - ANSWER At home 3 -7 nights a week 8 hours per tx A no cuff that is to big for a patients arm ... - ANSWER Lower reading Why would someone want to do more HD than standard? - ANSWER Longer or more frequent HD is gentle and cause fewer symptoms and may help Pt live longer, home puts pt in charge peritoneal dialysis - ANSWER the lining of the peritoneal cavity acts as the filter to remove waste from the blood through tiny blood vessels. Placed in abdomen and sometimes chest wall Dialysate sits in catheter for a few hours and excess water and waste flows from BV to the dialysate. The dialysate is then drained and replaced. (Exchange) Pt can use a cycle mahjne while they sleep Can also be done by hand 4xa day and can be done anywhere. In dialysis patients the reason BP drops during or close to the end of tx is because - ANSWER The total blood volume drops, from the water removal regular respiration rate - ANSWER 12 -16 breaths per minute In dialysis patients water may enter the lungs due to water weight gains this can cause - ANSWER Sob or trouble breathing Payment for dialysis - ANSWER Medicare pays for 80% of dialysis Medicare makes rules a clinic must follow to provide coverage of tax. Pt who don't have Medicare before CKD a pt must wait 3 months for it to cover in center but it will cover home -hemo right away. 2011 change how they pay for dialysis and created a "bundle" (composite rate, labs,drugs and home training) Quality Incentive Program - ANSWER Pay for performance, Cuts pay by 2% if measures aren't met. (Kt/v and hemoglobin) ESRD networks - ANSWER Oversees quality of care, 18 mostly nonprofit organizations. Renal physicians association(RPA) - ANSWER 1993 nephrologist made first clinical practice guidelines, including minimum dose of HD , when to start and stop HD and care for kidney disease for pt not on HD National Kidney Foundation (NKF) - ANSWER 1995, experts set guidelines for anemia, adequacy, and vascular access KDOQI - ANSWER Kidney Disease Outcomes Quality Initiative, improves care and outcomes of all people with kidney disease Dialysis Outcomes and Practice Pattern Study - DOPPS - ANSWER Help pts love longer by finding patterns incenter that can be changed to improve outcome state survey - ANSWER An inspection of the facility by state surveyors for compliance with rules and regulations of Medicare. If clinics don't follow they must make a plan of correction. Continuous Quality Improvement (CQI) - ANSWER Finding problems and fixing them. 4 step process 4 steps of continuous quality improvement - ANSWER 1.identify the problem - collect data and figure out how to fix 2.analyze problem -see if there is a standard or guideline to fix it, look at patterns or trends 3.cause of problem? 4.Plan,do,check,act - make a plan to fix, try plan, check results and make changes if needed Professionalism - ANSWER The quality of performing at a high level and conducting oneself with purpose and pride Boundaries - ANSWER Never share personal life or concerns with patients, never date pts, never borrow money, never invite to home or events, never except tips or money, do not sexually harass