What is the definition of dry weight?
Dry weight is the ideal patient weight post dialysis, set by the physician after a physical assessment.
Who sets the patients dry weight?
The physician.
What are three common symptoms of hypovolemia?
SOB, edema, hypertension.
List two reasons why AV fistulas are superior to other types of dialysis access?
They last longer and have less risk of infection.
What is a stenosis?
The narrowing of the vessel.
What is a false aneurysm?
A false aneurysm is not all the way around the vein, its often caused from infiltration, and it tends to heal well, it has the same skin texture vs. a true aneurysm which has thin shiny skin.
Betadine must be stuck ______?
Dry.
Alcohol must be stuck ______?
Wet.
What is the purpose of creating a bridge with tape when securing a fistula needle?
To secure the needle.
List three foods high in phosphorous?
Cola, pizza, and mac and cheese.
How much fluid can a dialysis patient consume in one day?
1,000-1,200 cc per day.
Why is potassium controlled by the renal diet?
Potassium is restricted to prevent complications causing arrhythmias.
List the only three medications a CHT can administer?
Lidocane, ns, heparin
List one common antibiotic given in the dialysis center?
Vancomycin
What is the leading cause of renal failure in the US?
DM
List four causes of renal failure other than DM?
PKD, SLE, Wilms tumors, and Goodpasture’s syndrome
Do nephrons regenerate if damaged?
no
List four things healthy kidneys do?
Healthy kidneys help the body regulate blood pressure; they excrete waste, and reabsorb what the body needs.
What are two things dialysis patients can do to maintain skin integrity?
Oil and lotion
What causes pseudogout?
Psuedogout is caused by calcium phosphate deposited in large and medium joints.
What causes bad breath in dialysis patients?
Uremia.
What is the main thing dialysis patients can do minimize manifestations of CRF?
Maintain a proper diet and take their phosphate binders.
What are the most common medical complications in dialysis?
Fluid overload and hypotension
What is pericarditis?
Pericarditis is the inflammation of the sac that surrounds the heart
What is commonly used to treat pericarditis?
An increase in time and antibiotics is used to treat pericarditis
Why is dialysis disequilibrium syndrome dangerous?
DDS is dangerous because it can cause cerebral edema.
What is the common treatment for cramps?
Administer normal saline.
Why do dialysis patients have secondary hyperparathyroidism?
Excess phosphorous is excreted by the kidneys
What can patients do to minimize secondary hyperparathyroidism?
Take binders and have a good diet
Where are the parathyroid glands located?
Dorsal to the thyroid gland
What causes anemia in dialysis patients?
The kidneys inability to produce erythropoietin
What is the primary treatment for anemia?
EPO
Why is iron important in controlling anemia?
It helps with RBC production
How do you know you have a major blood leak?
Positive hemastix and blood in the efferent dialysate line
What is hypotension?
Low bp
What access has the least complications?
fistula
What is hypertension?
High bp
What are the characteristics of acute renal failure?
Fast, reversible, 50% recovery
Are most dialysis patients on Medicare?
yes
What tests need to be done to determine secondary hyperparathyroidism?
Pth, calcium and phosphorous
What tube is a STAT potassium done in?
Red tiger top
What tube is aluminum drawn in?
Dark blue
What tube in an H&H done in?
lavender
What color tube is used when drawing PT and INR?
Light blue
How long should most tubes clot for?
45 min
What are universal precautions?
Treat everyone as if they are infected
What is exsanguination?
Extreme blood loss
Do all patients who receive kidney transplants wait on a list?
no
What does Kt/v stand for?
Clearance, time, and volume
What does a hardness test check for?
Minerals in the water
Which route is lidocane given?
id
Which route is Heparin given?
iv
Which route is NS given?
iv
When should labs be drawn?
Before heparin
Is it true that all dialysis patients must restrict their potassium intake?
yes
The movement of a fluid from an area of low concentration to an area of high concentration is called what?
osmosis
When should binders be taken?
With meals and snacks
What is the purpose of hand washing?
To prevent the spread of bacteria to patients, staff, and their families
What causes a metallic taste?
uremia
What causes pseudogout in dialysis patients?
Calcium phosphate deposits in the medium and large joints
What is a water culture test for?
To check for bacteria in the water
Can ARF be reversible?
yes
Burning at the venous needle site indicates what?
Sterilant infusion
Fluid is removed by what principal?
ultrafiltration
Muscle cramping usually occurs when?
When there is rapid removal of fluid usually from fluid overload
Why is secondary hyperparathyroidism dangerous?
It causes metastatic califications and cardiac problems
What does a social worker do?
Assist with travel arrangements, housing, finances. And insurance as well as provide counseling
What is the proper technique for assessing an access?
Visually inspect the access then feel for the thrill
What causes DDS?
Rapid removal of BUN and high BUN levels
Nausea and vomiting are usually caused from what?
Low bp
When is a post BUN done?
After treatment
What is a concentration gradient?
A difference in concentration on either side of a spm
Dialysis fluid removal is caused by what?
ultrafiltration
When are water cultures done?
Every month
Can carbon tanks regenerate?
no
When should you discard a dialyzer because of its fiber bundle?
When it reaches 80%
Adequacy can be improved by what?
An increase in time
What is AV an abbreviation for?
Arterial venous
What is normally the prescribed BFR for a graft?
400-450
Can a fistula develop a true aneurysm?
yes
Who owns the patient’s records?
The facility
When should an event be documented?
As soon as possible after it happens
What is the description of a transplant?
A form of kidney replacement therapy
What is adequate dialysis?
When a patient is asymptomatic
Why is sodium typically restricted in the renal diet?
To prevent thirst
Are all renal diets the same?
No, it depends on their labs
What are the functional units of the kidneys?
nephrons
Will a person with one kidney require dialysis?
No, people can survive with one kidney
If you have diabetic neuropathy you might also have what?
hypertension
Does ARF have a high mortality rate?
Yes, 50%
If a patient has SOB and edema they probably have what?
hypervolemia
What is pericarditis?
Inflammation of the sac around the heart
What is azotemia?
Retention of nitrogenous material in the blood
Is anemia in dialysis usually from lack of erythropoietin?
yes
What is an AMA?
Against medical advice
How big are the kidneys?
5x1x2
Where are the kidneys located?
retroperitoneal
What is angina?
Chest pain
How long can a dialyzer be up?
2 hours
What is the kt/v for a diabetic?
1.4
What is the kt/v for a non-diabetic?
1.2
What is the biggest concern when hemolysis occurs?
Cardiac problems from released potassium
What does sterile mean?
Free from contamination
What is the classic triad for pericarditis?
Fever, chest pain, and friction rub
What is the second step in treating hypotension?
Give saline
What factors affect diffusion?
Membrane pore size, temperature, dialyzer size, concentration gradient, and solute size
What lab values are used to determine adequacy?
Pre and post BUN
What is hypovolemia?
When a patient is under dry weight
What type of access is created when you connect a vein an and artery?
fistula
What access needs exercise?
fistula
May hypertonic saline be used in the dialysis center?
yes
What is the concentration of hypertonic saline?
23.4%
What is Kayexcelate used for?
To reduce serum potassium
..sorry if you find spelling errors...I'm lazy and tired......BTW this post is so tiny because I already know if you are using it to study you will just copy and paste it into something else and print it off
Wednesday, November 14, 2007
Wednesday, October 31, 2007
other questions
What are some of the causes of seizures in dialysis patients?
Some causes of seizures are Hypotension, pre-existing seizure disorder, Hypoglycemia, Disequilibrium Syndrome. & many other things….
When should a patient take their phosphate binders?
Patients should take their phosphate binders before meals and snacks.
बेफोरे माल्स ऎंड स्नाच्क्स
What is an osmotic agent used in dialysis?
Normal Saline is the osmotic agent used in dialysis.
What is a cardiac tamponade?
Cardiac tamponade results from the compression on the heart by pericardial fluid.
कोम्प्रेस्सिओं ओं थे हार्ट बी फ्लुइड
What is pericarditis?
Pericarditis is an inflammation of the sac around the heart.
What is pruritus?
Pruritus is commonly known as itching.
इत्चिंग
Why do patients experience DDS?
Patients experience DDS from the rapid removal of urea from the blood and an osmotic gradient between the blood and the brain.
What is the most frequently seen medical complication in the dialysis center?
Hypotension is the most frequently seen complication is dialysis.
What kind of medication is Vancomycin?
Vancomycin is an antibiotic used to treat serious bacterial infections.
अन्तिबिओटिक
What are the common concentrates of Heparin?
Heparin comes in 1,000 5,000 and 10,000 U/ml, it is made out of beef lung or pig intestine. I have no clue what the common concentrations are!
What route is Lidocane given?
Lidocane is given ID.
What are the steps to responding to an unresponsive patient?
The steps for responding to an unresponsive patient are - call for help, stop dialysis, return the blood, remove all needles, begin CPR per RN order, notify MD, and Document the status.
What is the percentage of hypertonic solution?
The percent of hypertonic solution in dialysis is 23.4%.
Some causes of seizures are Hypotension, pre-existing seizure disorder, Hypoglycemia, Disequilibrium Syndrome. & many other things….
When should a patient take their phosphate binders?
Patients should take their phosphate binders before meals and snacks.
बेफोरे माल्स ऎंड स्नाच्क्स
What is an osmotic agent used in dialysis?
Normal Saline is the osmotic agent used in dialysis.
What is a cardiac tamponade?
Cardiac tamponade results from the compression on the heart by pericardial fluid.
कोम्प्रेस्सिओं ओं थे हार्ट बी फ्लुइड
What is pericarditis?
Pericarditis is an inflammation of the sac around the heart.
What is pruritus?
Pruritus is commonly known as itching.
इत्चिंग
Why do patients experience DDS?
Patients experience DDS from the rapid removal of urea from the blood and an osmotic gradient between the blood and the brain.
What is the most frequently seen medical complication in the dialysis center?
Hypotension is the most frequently seen complication is dialysis.
What kind of medication is Vancomycin?
Vancomycin is an antibiotic used to treat serious bacterial infections.
अन्तिबिओटिक
What are the common concentrates of Heparin?
Heparin comes in 1,000 5,000 and 10,000 U/ml, it is made out of beef lung or pig intestine. I have no clue what the common concentrations are!
What route is Lidocane given?
Lidocane is given ID.
What are the steps to responding to an unresponsive patient?
The steps for responding to an unresponsive patient are - call for help, stop dialysis, return the blood, remove all needles, begin CPR per RN order, notify MD, and Document the status.
What is the percentage of hypertonic solution?
The percent of hypertonic solution in dialysis is 23.4%.
Monday, October 29, 2007
Blood Values
Here are some of the typical labratory value ranges for dialysis patients vs. normal values.
Soduim:
normal value- 135-145 mEq/L
dialysis patient- 135-145 mEq/L (same)
Potassium:
normal value- 3.5-4.5 mEq/L
dialysis patient- less than 6.0 mEq/L
Phophorus:
normal value- 4.5-5.5 mg/dL
dialysis patient- less than 5.5 mg/dL
more to come...
Soduim:
normal value- 135-145 mEq/L
dialysis patient- 135-145 mEq/L (same)
Potassium:
normal value- 3.5-4.5 mEq/L
dialysis patient- less than 6.0 mEq/L
Phophorus:
normal value- 4.5-5.5 mg/dL
dialysis patient- less than 5.5 mg/dL
more to come...
Accepted Normal Blood Values for Dialysis Patients
I found a great article on blood values that was published in Voice of the Diabetic (volume 13, number 2).
http://www.nfb.org/Images/nfb/Publications/vodold/vsum9816.htm
http://www.nfb.org/Images/nfb/Publications/vodold/vsum9816.htm
More questions
1. Describe in detail how to prepare for cannulation.
To prepare an access site for cannulation - first, visualize the access, then feel for the thrill (if no thrill is present check for bruit), then sterilize the area with betadine in a circular motion (clean to dirty).
2. What type of access is prone to infection?
Catheters are the type of access most prone to infections.
3. What type of access can be made from gortex?
Grafts can be made from synthetic material such as gortex.
4. When the blood in the access stops flowing the access is said to be _______?
When the blow in the access stops flowing the access is said to be CLOTTED.
5. The connection of two hollow vessels is called?
The connection of two hollow vessels is known as an anastimosis.
6. Name the most commonly used vessels for a central venous catheter?
The vessels commonly used for catheters are the jugular vein (inter-jugular), the subclavian vein, and the femoral vein.
7. What is the name of the preferred access - known for having minimal complications?
The preferred access is the fistula.
8. What is the typical placement of the venous needle?
The venous needle is typically placed up towards the heart in the direction of flow.
9. What is the typical placement of the arterial needle?
The arterial needle is usually placed down away from the heart.
10. List the two most common causes of renal failure.
The two most common causes of renal failure are DM and hypertension.
11. What are the characteristics of ARF?
ARF is sudden, reversible (with a 50% mortality rate), and rapid.
12. What are the characteristics of CRF?
CRF is insidious, irreversible (100% mortality rate without dialysis or transplant), and slow.
13. What does DM damage that causes renal failure?
DM damages the kidneys by causing necrosis of the small blood vessels in the kidneys.
14. What is azotemia?
Azotemia is the retention of nitrogenous substances in the blood.
15. List three hormones normal kidneys make and state their purpose.
Aldosterone controls sodium reabsorbtion, Erythropoietin aids in the production of RBCs, and Renin converts vitamin D to calcitriol.
16. Where are the kidneys located?
The kidneys are located retroperitoneal.
17. What do healthy kidneys do?
Healthy kidneys help the body regulate blood pressure; they excrete waste, and reabsorb what the body needs.
18. What three “medications” can a dialysis technician administer?
Lidocane, Normal Saline, and Heparin can be given by a technician.
19. What is the “antidote” for Heparin?
The antidote for Heparin is Protamine Sulfate.
20. What route are phosphate binders taken?
Phosphate binders are taken by mouth (po).
21. What is Kayexcelate?
Kayexcelate is a potassium binder that eliminates k+ through the gut.
22. What route is lidocane administered?
Lidocane is administered ID.
23. Who is responsible for charting medication?
The person who administers the medication is responsible for charting it.
24. What makes protein high in biological value?
Protein that is high in biological value contains all 8 essential amino acids.
25. What percent of the renal diet should be made up of protein?
65% of the renal diet should be made up of protein that is high in biological value.
26. What is the function of calories in the renal diet?
The function of calories in the renal diet is to prevent the body from using protein for energy.
27. What is the typical fluid allowance for dialysis patients?
1,000-1,200 mg/per day is the typical fluid allowance for dialysis patients.
28. Why is sodium usually restricted in the renal diet?
Sodium is usually restricted to help reduce fluid intake by controlling thirst.
29. Why is potassium restricted for most dialysis patients?
Potassium is restricted to prevent complications causing arrhythmias.
30. Why is phosphorous restricted in the renal diet?
Phosphorus is restricted to prevent renal osteodystrophy and metastatic calcifications.
31. List foods that are high in phosphorous.
Food high in phosphorous include milk, whole grains, pizza, mac and cheese, ice cream, nuts, hot dogs and sausage, COLA, peanut butter, peas and dried beans, yogurt and pudding, liver and organ meat, cream soup, pork and beans, and CHOCOLATE!
32. List foods that are high in potassium.
Food high in potassium include milk, yogurt, cheese, apricots, banana, cantaloupe, dates, dried figs, guava, honey dew, grapefruit, Japanese persimmon, kiwi, mango, nectarine, orange, papaya, fresh pears, prunes, tangelo, avocado, green beans, chard, Chinese cabbage, cooked spinach, sweet potato, tomato, vegetable juice, nuts, chocolate, salt substitutes, and dried beans and peas.
33. Name several foods that have a high liquid content and are not beverages.
Melons, gelatin, sauces, gravy, and ice have a high liquid content.
34. Who owns the records?
The dialysis unit owns the patient record.
35. Name three people with access to the patient records.
The physician, the nurses, and the patient all have access to the patient record.
36. How do you correct a charting error?
Strike out the mistake by drawing a line through the word, sign your name (first initial and last name…in cursive DONOT PRINT), date it, and then make the correction.
37. How do you sign the records?
You sign your name using your first initial and last name. Followed by your professional title. The entry must be in cursive, DO NOT PRINT.
38. When must an event be charted?
As soon as possible after an event has occurred.
39. Who documents that a medication was given?
The person who administers the medication is the person who charts it.
40. What is the abbreviation for “without”?
An S with a line over it.
41. What is the symbol for increase?
The symbol for increase is an arrow pointing up.
42. Why are patients typically hypothermic?
Patients are typically hypothermic because of an elevated BUN.
43. What items are in a general survey?
Items in a general survey include mobility, level of awareness, visible signs of distress, and complaints/history.
44. How often should you check the patient’s blood pressure?
Blood pressure should be checked every 30 minutes.
45. What are symptoms of hypervolemia?
Symptoms of hypervolemia include edema, SOB, elevated BP, and defaulting breathing while lying down.
46. What are the symptoms of pericarditis?
Fever, chest pain, and friction rub are symptoms of pericarditis.
To prepare an access site for cannulation - first, visualize the access, then feel for the thrill (if no thrill is present check for bruit), then sterilize the area with betadine in a circular motion (clean to dirty).
2. What type of access is prone to infection?
Catheters are the type of access most prone to infections.
3. What type of access can be made from gortex?
Grafts can be made from synthetic material such as gortex.
4. When the blood in the access stops flowing the access is said to be _______?
When the blow in the access stops flowing the access is said to be CLOTTED.
5. The connection of two hollow vessels is called?
The connection of two hollow vessels is known as an anastimosis.
6. Name the most commonly used vessels for a central venous catheter?
The vessels commonly used for catheters are the jugular vein (inter-jugular), the subclavian vein, and the femoral vein.
7. What is the name of the preferred access - known for having minimal complications?
The preferred access is the fistula.
8. What is the typical placement of the venous needle?
The venous needle is typically placed up towards the heart in the direction of flow.
9. What is the typical placement of the arterial needle?
The arterial needle is usually placed down away from the heart.
10. List the two most common causes of renal failure.
The two most common causes of renal failure are DM and hypertension.
11. What are the characteristics of ARF?
ARF is sudden, reversible (with a 50% mortality rate), and rapid.
12. What are the characteristics of CRF?
CRF is insidious, irreversible (100% mortality rate without dialysis or transplant), and slow.
13. What does DM damage that causes renal failure?
DM damages the kidneys by causing necrosis of the small blood vessels in the kidneys.
14. What is azotemia?
Azotemia is the retention of nitrogenous substances in the blood.
15. List three hormones normal kidneys make and state their purpose.
Aldosterone controls sodium reabsorbtion, Erythropoietin aids in the production of RBCs, and Renin converts vitamin D to calcitriol.
16. Where are the kidneys located?
The kidneys are located retroperitoneal.
17. What do healthy kidneys do?
Healthy kidneys help the body regulate blood pressure; they excrete waste, and reabsorb what the body needs.
18. What three “medications” can a dialysis technician administer?
Lidocane, Normal Saline, and Heparin can be given by a technician.
19. What is the “antidote” for Heparin?
The antidote for Heparin is Protamine Sulfate.
20. What route are phosphate binders taken?
Phosphate binders are taken by mouth (po).
21. What is Kayexcelate?
Kayexcelate is a potassium binder that eliminates k+ through the gut.
22. What route is lidocane administered?
Lidocane is administered ID.
23. Who is responsible for charting medication?
The person who administers the medication is responsible for charting it.
24. What makes protein high in biological value?
Protein that is high in biological value contains all 8 essential amino acids.
25. What percent of the renal diet should be made up of protein?
65% of the renal diet should be made up of protein that is high in biological value.
26. What is the function of calories in the renal diet?
The function of calories in the renal diet is to prevent the body from using protein for energy.
27. What is the typical fluid allowance for dialysis patients?
1,000-1,200 mg/per day is the typical fluid allowance for dialysis patients.
28. Why is sodium usually restricted in the renal diet?
Sodium is usually restricted to help reduce fluid intake by controlling thirst.
29. Why is potassium restricted for most dialysis patients?
Potassium is restricted to prevent complications causing arrhythmias.
30. Why is phosphorous restricted in the renal diet?
Phosphorus is restricted to prevent renal osteodystrophy and metastatic calcifications.
31. List foods that are high in phosphorous.
Food high in phosphorous include milk, whole grains, pizza, mac and cheese, ice cream, nuts, hot dogs and sausage, COLA, peanut butter, peas and dried beans, yogurt and pudding, liver and organ meat, cream soup, pork and beans, and CHOCOLATE!
32. List foods that are high in potassium.
Food high in potassium include milk, yogurt, cheese, apricots, banana, cantaloupe, dates, dried figs, guava, honey dew, grapefruit, Japanese persimmon, kiwi, mango, nectarine, orange, papaya, fresh pears, prunes, tangelo, avocado, green beans, chard, Chinese cabbage, cooked spinach, sweet potato, tomato, vegetable juice, nuts, chocolate, salt substitutes, and dried beans and peas.
33. Name several foods that have a high liquid content and are not beverages.
Melons, gelatin, sauces, gravy, and ice have a high liquid content.
34. Who owns the records?
The dialysis unit owns the patient record.
35. Name three people with access to the patient records.
The physician, the nurses, and the patient all have access to the patient record.
36. How do you correct a charting error?
Strike out the mistake by drawing a line through the word, sign your name (first initial and last name…in cursive DONOT PRINT), date it, and then make the correction.
37. How do you sign the records?
You sign your name using your first initial and last name. Followed by your professional title. The entry must be in cursive, DO NOT PRINT.
38. When must an event be charted?
As soon as possible after an event has occurred.
39. Who documents that a medication was given?
The person who administers the medication is the person who charts it.
40. What is the abbreviation for “without”?
An S with a line over it.
41. What is the symbol for increase?
The symbol for increase is an arrow pointing up.
42. Why are patients typically hypothermic?
Patients are typically hypothermic because of an elevated BUN.
43. What items are in a general survey?
Items in a general survey include mobility, level of awareness, visible signs of distress, and complaints/history.
44. How often should you check the patient’s blood pressure?
Blood pressure should be checked every 30 minutes.
45. What are symptoms of hypervolemia?
Symptoms of hypervolemia include edema, SOB, elevated BP, and defaulting breathing while lying down.
46. What are the symptoms of pericarditis?
Fever, chest pain, and friction rub are symptoms of pericarditis.
Pericarditis
My favorite website for listening to heart sounds auscultation period is texasheartinstitute.org. They have a great link to listen to PERICARDITIS which is often caused by kidney failure.
http://www.texasheartinstitute.org/Education/CME/explore/events/upload/Acute_Pericarditis_3.mp3
http://www.texasheartinstitute.org/Education/CME/explore/events/upload/Acute_Pericarditis_3.mp3
Sunday, October 28, 2007
Frequently asked questions
1. How is water contaminated?
Absorbed gas from the atmosphere, dissolved minerals from the ground, pesticide residue, industrial discharge, and chemicals added in water treatment (ie. Flouride)
2. What is the importance of pure water?
the average patient is exposed to more water than the average person WITHOUT the ability of selective absorption.
3. What is an endotoxin?
An endotoxin is a chemical component of a cell wall of gram negative bacteria that causes a pyrogen reaction.
4. Why are endotoxins bad?
Endotoxins are “bad” because they cause pyrogen reactions.
5. What is the acceptable CFU for water cultures?
An acceptable CFU is below 50.
6. Where are chlorine and chloramine levels checked?
The chlorine and chloramine levels are checked in the carbon tanks.
7. Why is water pretreated?
Water is pretreated to reduce the spread of disease.
8. What is Kt/V?
Kt/v is fractional urea clearance. Kt/v describes the percent of total body water cleared of urea in a single dialysis treatment.
9. What does K in Kt/v mean?
K is the clearance of plasma urea.
10. What is the t in Kt/v?
T is the treatment time.
11. What does v stand for in Kt/v?
V is the urea distribution volume.
12. When are chlorine and Chloramine levels checked?
The chlorine/chloramine levels are checked every patient shift or four hours whichever comes first.
13. What is the acceptable level for chlorine?
The acceptable level for chlorine is less than 0.1
14. What lab values are used to calculate Kt/v?
The lab values used to calculated Kt/v are Pre-BUN and Post-BUN.
15. What are the signs and symptoms of inadequate dialysis?
Decreased interdialytic weight gain, low serum albumin levels, and decreased food intake are signs of inadequate dialysis.
16. Why is a recirculation study done?
A recirculation study is done when there is a low Kt/v in a seemingly adequate dialysis prescription.
17. What can be changed in the dialysis prescription to improve dialysis?
An increase in time may be prescribed for inadequate dialysis.
18. What is the diabetic Kt/v?
A diabetic Kt/v is 1.4.
19. What is the non-diabetic Kt/v?
A non-diabetic Kt/v is 1.2.
20. What is First Use Syndrome?
First use syndrome is a cluster of symptoms associated with the use of new dialyzers.
21. What three chemicals are used for reprocessing?
Renalin, Formaldehyde, and bleach.
22. What sterilants are used in dry dialyzers and lines?
Gamma Irradiation and Ethel Oxide.
23. Who may not be allowed to participate in reuse?
Patients may not participate in reuse if they have refused, if they are HIV positive, Hepatitis B positive, or have Hepatitis C with elevated enzymes.
24. Why are dialyzers preprocessed?
Dialyzers are preprocessed to establish original fiber bundle.
25. What test is done during and after priming?
A test for residual Renalin is done during and after priming.
26. Why is a presence test done?
A presence test is done to check for the presence of Renalin.
27. What are the risks associated with reuse?
Pyrogen reaction, inadequate dialysis, and getting the wrong dialyzer are all risks associated with reuse.
28. What two things need to be signed and checked in reuse?
The presence of Renalin in the dialyzer and acceptable levels of residual Renalin need to be checked and verified.
29. What is the most common cause of dialyzer reaction?
The most common cause of dialyzer reaction is a pyrogen reaction.
30. What are three ways to prevent air embolism?
Secure all connections , have 300cc of NS ready at all times, and don’t intentionally introduce air into the circuit.
31. What are the first two steps in treating air embolism?
Clamp the venous line/turn off the blood pump and put the patient in the recovery position.
32. Name three ways to prevent exsanguination.
Tape and bridge all connections without a leur lock, have good needle placement, and check the access frequently.
33. List four causes of hemolysis.
A pyrogenic contamination, a chemical injury, a mechanical injury, or a thermal injury.
34. What are the signs and symptoms of hemolysis?
Signs and symptoms include cherry pop plasma, abdominal pain, burning at the venous needle site, SOB, mental confusion, low bp, and lab tests that reveal a drop in hemoglobin and hematocrit.
35. What is the treatment for an anaphylactic reaction?
Administer an antihistamine.
36. What is a minor blood leak?
A minor blood leak has a positive hemastix and the dialysate lines are clear.
37. What is a major blood leak?
A major blood leak has occurred when the hemastix is positive and there is blood in the dialysate line.
38. What is the purpose of a transducer?
A transducer regulates the pressure in both the venous and arterial lines.
39. What tests are performed in an SST?
Pre-BUN and chemistry.
40. What lab tests are done in a lavender tube?
CBC and HNH.
41. What tests are done in a light blue tube?
INR and PT.
42. Describe a recirculation study procedure.
Wait 5 min. but no longer than 1 hour, simultaneously draw samples from the arterial port, venous port, and peripheral vein, place in tubes, clot for 45 min., and then spin for 20 min.
43. Describe the method for drawing post BUN.
Reduce the blood pump to 50, wait 30 seconds, take 4cc from the arterial port and put it red tube, clot for 45 min., then spin for 20 min.
44. What effect will heat have on blood samples?
Hemolysis.
45. What type of dialysate system do we use?
We use three stream proportioning with bicarbonate, acid solution, and purified water.
46. What are the components of dialysate?
Sodium, Potassium, Calcium, Magnesium, Chloride, Bicarbonate, Acetate, and Glucose.
47. What is a biocompatible dialyzer?
A synthetic dialyzer that has less of an immune respone.
48. What is dry dialysis?
Dry Dialysis is pure ultra filtration with no dialysate flowing and dialysis in bypass. The removal of fluid is enhanced but there is no waste clearance.
49. What are the signs and symptoms of hypovolemia?
Low bp, nausea/vomiting, poor skin turgor, and weakness.
50. What are the signs and symptoms of hypervolemia?
Elevated bp, edema, SOB, difficulty breathing while laying down.
51. What is the number one reason for reuse?
Cost containment.
52. What MUST be on a reuse dialyzer?
Name, date and time reprocessed, number of reuses, and volume.
53. What is the most common cause of hypothermia in dialysis patients?
Elevated BUN.
54. When should patient assessment begin?
A patient assessment should begin the moment a patient enters the unit.
55. What is a general survey?
A general survey includes the level of awareness/consciousness, mobility, visible signs of distress, and recent history/verbalization of concerns.
56. What is a systems survey?
A systems survey is an assessment of the skin, vascular system, and edema.
57. What is the normal BP ?
120/80
58. What is the normal range for pulse rates?
60-100 beats per minute.
59. What is the normal range for temperatures?
97-98° F.
60. What is the range for normal respiratory rate?
12-20 breaths per minute.
61. Which direction should the arterial needle point?
Down away from the heart but may be placed either direction.
62. Which direction should the venous needle point?
Up towards the heart in the direction of flow.
63. What is the cannulation angle for a graft?
45°
64. What is the cannulation angle for a fistula?
25° -30°
65. Describe osmosis.
Osmosis is the movement of a solvent through a semipermiable membrane from an area of low concentration to an area of higher concentration.
66. What is ultrafiltration?
Ultrafiltration is the movement of solutes and water across a semipermiable membrane as a result of pressure applied to the membrane.
67. What is diffusion?
Diffusion is the movement of particles from an area of high concentration to an area of low concentration through a semipermiable membrane.
68. Why is dry dialysis typically prescribed?
To treat fluid overload.
69. List three types of dialyzers.
Parallel Plate, hollow fiber, and biocompatible.
70. What is equilibrium?
Equilibrium is when the concentration of solutes is equal on both sides of the semipermiable membrane.
71. Define hydrostatic pressure.
Hydrostatic pressure is the pressure exerted by a sloution on the cell walls of its container.
72. What is colloidal oncotic pressure?
Colloidal Oncotic Pressure is the pressure exerted by solutes too big to diffuse across a semipermiable membrane.
73. Delta pressure should not exceed ______ per square inch.
15 lbs psi.
74. The normal dialysate temperature should be in what range?
36-37° C
Absorbed gas from the atmosphere, dissolved minerals from the ground, pesticide residue, industrial discharge, and chemicals added in water treatment (ie. Flouride)
2. What is the importance of pure water?
the average patient is exposed to more water than the average person WITHOUT the ability of selective absorption.
3. What is an endotoxin?
An endotoxin is a chemical component of a cell wall of gram negative bacteria that causes a pyrogen reaction.
4. Why are endotoxins bad?
Endotoxins are “bad” because they cause pyrogen reactions.
5. What is the acceptable CFU for water cultures?
An acceptable CFU is below 50.
6. Where are chlorine and chloramine levels checked?
The chlorine and chloramine levels are checked in the carbon tanks.
7. Why is water pretreated?
Water is pretreated to reduce the spread of disease.
8. What is Kt/V?
Kt/v is fractional urea clearance. Kt/v describes the percent of total body water cleared of urea in a single dialysis treatment.
9. What does K in Kt/v mean?
K is the clearance of plasma urea.
10. What is the t in Kt/v?
T is the treatment time.
11. What does v stand for in Kt/v?
V is the urea distribution volume.
12. When are chlorine and Chloramine levels checked?
The chlorine/chloramine levels are checked every patient shift or four hours whichever comes first.
13. What is the acceptable level for chlorine?
The acceptable level for chlorine is less than 0.1
14. What lab values are used to calculate Kt/v?
The lab values used to calculated Kt/v are Pre-BUN and Post-BUN.
15. What are the signs and symptoms of inadequate dialysis?
Decreased interdialytic weight gain, low serum albumin levels, and decreased food intake are signs of inadequate dialysis.
16. Why is a recirculation study done?
A recirculation study is done when there is a low Kt/v in a seemingly adequate dialysis prescription.
17. What can be changed in the dialysis prescription to improve dialysis?
An increase in time may be prescribed for inadequate dialysis.
18. What is the diabetic Kt/v?
A diabetic Kt/v is 1.4.
19. What is the non-diabetic Kt/v?
A non-diabetic Kt/v is 1.2.
20. What is First Use Syndrome?
First use syndrome is a cluster of symptoms associated with the use of new dialyzers.
21. What three chemicals are used for reprocessing?
Renalin, Formaldehyde, and bleach.
22. What sterilants are used in dry dialyzers and lines?
Gamma Irradiation and Ethel Oxide.
23. Who may not be allowed to participate in reuse?
Patients may not participate in reuse if they have refused, if they are HIV positive, Hepatitis B positive, or have Hepatitis C with elevated enzymes.
24. Why are dialyzers preprocessed?
Dialyzers are preprocessed to establish original fiber bundle.
25. What test is done during and after priming?
A test for residual Renalin is done during and after priming.
26. Why is a presence test done?
A presence test is done to check for the presence of Renalin.
27. What are the risks associated with reuse?
Pyrogen reaction, inadequate dialysis, and getting the wrong dialyzer are all risks associated with reuse.
28. What two things need to be signed and checked in reuse?
The presence of Renalin in the dialyzer and acceptable levels of residual Renalin need to be checked and verified.
29. What is the most common cause of dialyzer reaction?
The most common cause of dialyzer reaction is a pyrogen reaction.
30. What are three ways to prevent air embolism?
Secure all connections , have 300cc of NS ready at all times, and don’t intentionally introduce air into the circuit.
31. What are the first two steps in treating air embolism?
Clamp the venous line/turn off the blood pump and put the patient in the recovery position.
32. Name three ways to prevent exsanguination.
Tape and bridge all connections without a leur lock, have good needle placement, and check the access frequently.
33. List four causes of hemolysis.
A pyrogenic contamination, a chemical injury, a mechanical injury, or a thermal injury.
34. What are the signs and symptoms of hemolysis?
Signs and symptoms include cherry pop plasma, abdominal pain, burning at the venous needle site, SOB, mental confusion, low bp, and lab tests that reveal a drop in hemoglobin and hematocrit.
35. What is the treatment for an anaphylactic reaction?
Administer an antihistamine.
36. What is a minor blood leak?
A minor blood leak has a positive hemastix and the dialysate lines are clear.
37. What is a major blood leak?
A major blood leak has occurred when the hemastix is positive and there is blood in the dialysate line.
38. What is the purpose of a transducer?
A transducer regulates the pressure in both the venous and arterial lines.
39. What tests are performed in an SST?
Pre-BUN and chemistry.
40. What lab tests are done in a lavender tube?
CBC and HNH.
41. What tests are done in a light blue tube?
INR and PT.
42. Describe a recirculation study procedure.
Wait 5 min. but no longer than 1 hour, simultaneously draw samples from the arterial port, venous port, and peripheral vein, place in tubes, clot for 45 min., and then spin for 20 min.
43. Describe the method for drawing post BUN.
Reduce the blood pump to 50, wait 30 seconds, take 4cc from the arterial port and put it red tube, clot for 45 min., then spin for 20 min.
44. What effect will heat have on blood samples?
Hemolysis.
45. What type of dialysate system do we use?
We use three stream proportioning with bicarbonate, acid solution, and purified water.
46. What are the components of dialysate?
Sodium, Potassium, Calcium, Magnesium, Chloride, Bicarbonate, Acetate, and Glucose.
47. What is a biocompatible dialyzer?
A synthetic dialyzer that has less of an immune respone.
48. What is dry dialysis?
Dry Dialysis is pure ultra filtration with no dialysate flowing and dialysis in bypass. The removal of fluid is enhanced but there is no waste clearance.
49. What are the signs and symptoms of hypovolemia?
Low bp, nausea/vomiting, poor skin turgor, and weakness.
50. What are the signs and symptoms of hypervolemia?
Elevated bp, edema, SOB, difficulty breathing while laying down.
51. What is the number one reason for reuse?
Cost containment.
52. What MUST be on a reuse dialyzer?
Name, date and time reprocessed, number of reuses, and volume.
53. What is the most common cause of hypothermia in dialysis patients?
Elevated BUN.
54. When should patient assessment begin?
A patient assessment should begin the moment a patient enters the unit.
55. What is a general survey?
A general survey includes the level of awareness/consciousness, mobility, visible signs of distress, and recent history/verbalization of concerns.
56. What is a systems survey?
A systems survey is an assessment of the skin, vascular system, and edema.
57. What is the normal BP ?
120/80
58. What is the normal range for pulse rates?
60-100 beats per minute.
59. What is the normal range for temperatures?
97-98° F.
60. What is the range for normal respiratory rate?
12-20 breaths per minute.
61. Which direction should the arterial needle point?
Down away from the heart but may be placed either direction.
62. Which direction should the venous needle point?
Up towards the heart in the direction of flow.
63. What is the cannulation angle for a graft?
45°
64. What is the cannulation angle for a fistula?
25° -30°
65. Describe osmosis.
Osmosis is the movement of a solvent through a semipermiable membrane from an area of low concentration to an area of higher concentration.
66. What is ultrafiltration?
Ultrafiltration is the movement of solutes and water across a semipermiable membrane as a result of pressure applied to the membrane.
67. What is diffusion?
Diffusion is the movement of particles from an area of high concentration to an area of low concentration through a semipermiable membrane.
68. Why is dry dialysis typically prescribed?
To treat fluid overload.
69. List three types of dialyzers.
Parallel Plate, hollow fiber, and biocompatible.
70. What is equilibrium?
Equilibrium is when the concentration of solutes is equal on both sides of the semipermiable membrane.
71. Define hydrostatic pressure.
Hydrostatic pressure is the pressure exerted by a sloution on the cell walls of its container.
72. What is colloidal oncotic pressure?
Colloidal Oncotic Pressure is the pressure exerted by solutes too big to diffuse across a semipermiable membrane.
73. Delta pressure should not exceed ______ per square inch.
15 lbs psi.
74. The normal dialysate temperature should be in what range?
36-37° C
Saturday, October 27, 2007
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