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Questions And Answers
List the four transport mechanisms that play a role in hemodialysis - correct answer ✅Ultrafiltration Convection Diffusion Osmosis Explain ultrafiltration in hemodialysis - correct answer ✅Fluid is pushed through the semipermeable membrane (SPM). Think: wringing out a wet rag. Explain convection in hemodialysis - correct answer ✅Solutes DRAG across the semipermeable membrane with fluid Explain diffusion in hemodialysis - correct answer ✅PARTICLES move from HIGH concentration to LOW concentration Explain osmosis in hemodialysis - correct answer ✅FLUID moves LOW concentration to HIGH concentration
Questions And Answers
What are the kidneys' excretory functions? - correct answer ✅To normalize electrolytes, remove wastes, provide fluid and nutrient balance How do we replace normal excretory kidney functions? - correct answer ✅By using acid concentrate to help normalize electrolytes and ultrafiltration to provide fluid balance What is the function of acid concentrate - correct answer ✅Provides the concentration gradient for diffusion and helps normalize electrolytes What is the function of bicarbonate in the dialysate solution? - correct answer ✅It buffers the acid concentrate What is the function of bicarbonate when it diffuses into the patient's blood? - correct answer ✅It normalizes body pH
Questions And Answers
How much of normal kidney function is replaced by HD? - correct answer ✅15% What is uremia? - correct answer ✅Uremia is a buildup of wastes in the blood due to kidney failure What does uremia affect? - correct answer ✅Uremia affects all body systems What are the most common causes of CKD in the US? - correct answer ✅diabetes, HTN and polycystic kidney disease List the treatment goals for a pt. w/ CKD - correct 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
Questions And Answers
-encouraging patients to actively participate in their healthcare Why is it so important to know what caused your pt.'s CKD? - correct answer ✅So the RN and PCT can ask about possible problems during data collection and assessment List some S/Sx of fluid imbalance - correct answer ✅HTN, edema, and SOB Why is sodium balance important? - correct answer ✅Leads to volume expansion, increased cardiac output, increased peripheral vascular resistance and increased BP List some systemic effects of CKD - correct answer ✅-Dry, itchy skin -Peripheral neuropathy in the extremities -GI problems (N/V) -Psychological problems (anxiety, depression)
Questions And Answers
What would you advise for a pt. with psychological problems? - correct answer ✅Verbalize struggles to IDT (core team), especially the social worker A common cause of HTN in dialysis patients is: - correct answer ✅Fluid overload What does HTN lead to? - correct answer ✅Left ventricular hypertrophy Left ventricular hypertrophy leads to: - correct answer ✅Ischemic heart disease, arrhythmia, myocardial infarction, and sudden death. Define pericarditis - correct 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? - correct answer ✅Decrease or stop heparin and give more frequent dialysis
Questions And Answers
Why are dialysis patients anemic? - correct answer ✅The lifespan of their red blood cell is 60 days, 1/ of the normal 120 days. What is the primary cause of anemia in dialysis patients? - correct answer ✅Lack of the hormone erythropoietin (EPO) What are secondary causes of anemia in dialysis patients? - correct 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? - correct answer ✅-Verify epogen dose is correct and administered -Rinse back until venous line is pink tinged -Avoid repeat lab draws
Questions And Answers
What is your role in CKD-MBD management? - correct answer ✅-report symptoms, -urge patients to take meds (home & treatment) -report noncompliance problems related to nonadherence Define AKI - correct answer ✅-Wide spectrum of kidney issues -Includes acute renal failure & renal function changes -May dialyze in an out-patient facility until kidney function recovers Give 3 examples of prerenal causes of AKI - correct answer ✅Obstruction, volume depletion and impaired cardiac function Give 3 examples of intrarenal causes of AKI - correct answer ✅Ischemic ATN, sepsis, SIRS, septic shock, anaphylaxis drugs, goodpasture syndrome, acute glomerulonephritis, trauma, open heart surgery
Questions And Answers
Give 3 examples of postrenal causes of AKI - correct answer ✅Obstruction, oliguria, bladder rupture and pregnancy Explain the difference between AKI and CKD - correct answer ✅Eliminating the cause of the AKI can often lead to the return of kidney function. You cannot eliminate the cause of CKD which is HTN, Diabetes, genetic disorders (PKD) In the outpatient facility, how do you help in restoring kidney function? - correct answer ✅Find the cause of the AKI In the outpatient facility, what do you need to consider in regards to pt. vasc. access? - correct answer ✅Patients will typically have a dialysis catheter- be careful to avoid catheter related infections How do you protect kidneys from further injury? - correct answer ✅Avoid substances to the kidney which may be toxic (radiographic contrast, amphotericin B, low dose aspirin, NSAIDS)
Questions And Answers
What is the most important intervention you can do to to prevent HAIs - correct answer ✅Hand hygiene What is the most common infectious complication in hemodialysis patients? - correct answer ✅Vascular access infection What is the most common cause of bacterial infections in dialysis patients? - correct answer ✅• The use of catheters for hemodialysis treatments What germ causes the most common infections in hemodialysis patients? - correct answer ✅Methicillin-resistant Staphylococcus aureus (MRSA) - Must pay attention to infection control! Proper hand hygiene, cleaning & disinfecting procedures to prevent spread of infection (viable on surfaces for days) Why is wearing gloves so important? - correct answer ✅It reduces the risk of hand contamination and prevents the transfer of organisms already on hands
Questions And Answers
Why do you need to perform hand hygiene before and after wearing gloves? - correct answer ✅Gloves are not impervious and have microscopic pores Explain the acceptable hand hygiene technique when caring for a patient with active C-diff - correct answer ✅Handwashing with soap and water per policy is the only acceptable hand hygiene What is the difference between OSHA and CMS infection control requirements? - correct answer ✅OSHA: Requires employers to provide workers with a safe workplace CMS: Concerned with patient care and patient safety What are V-tags and why are they important? - correct answer ✅They state specific regulations to be met within a condition such as infection control, providing interpretive guidance for each regulation and citing deficiencies by tag #
Questions And Answers
How can you tell when an area or sink is clean or dirty in your facility? - correct answer ✅It is clearly labeled with a 'clean' or 'dirty' sign What do surveyors use to verify infection control training and education has been completed for teammates? - correct answer ✅Documentation of infection control training in the teammate's file or transcript Explain the HBV classification and state which test is performed monthly on HBV susceptible patients - correct answer ✅• HBsAg: Hepatitis B surface Antigen - tested monthly for susceptible pts and non-responders
- Anti-HBs: Hepatitis B Surface Antibody
- Anti-HBcIgM: Hepatitis B Core AB-IGM Which patient care assignments are appropriate when caring for Hepatitis B patients? - correct answer ✅• Caring for HBsAg positive and Hepatitis B immune patients at the same time
- Caring for Hepatitis B susceptible patients and those in the process of receiving the vaccination at the same time
Questions And Answers
- Caring for Hepatitis B immune and susceptible patients at the same time How often are machine alarm tests performed? - correct answer ✅Before the initiation of each patient treatment How long can a dialyzer be set up for once recirculation is complete? - correct answer ✅2 hours Why can't a dialyzer remain set up longer than the allotted time? - correct answer ✅It can grow bacteria Manual Conductivity must match _____________________ on the Fresenius (FMC) 2008K and K2 dialysis delivery system displayed conductivity - correct answer ✅+/- 0.4 mS True or False: Checking independent conductivity is NOT required when using the Fresenius 2008T or T BlueStar models or B Braun
Questions And Answers
and prudent nephrology nurse would give under the same or similar circumstances.
- Actions a reasonable and prudent nephrology nurse would do, as well as actions the nurse would avoid doing
- The skills and knowledge expected of a nephrology nurse is key to the specialty of nephrology nursing Who established the Standards of Care for Nephrology Nursing and for what purpose? - correct answer ✅• American Nephrology Nurses Association (ANNA) establish the standards of care and scope of practice for Nephrology nursing
- Standards of Care can serve as a basis for many areas including policy and procedures, protocols, educational offerings, regulatory systems, and more. What are three considerations when delegating nursing care activities? - correct answer ✅• Must be within the nurses scope of practice • Must be delegable by State Board of Nursing • Personnel must be adequately trained to perform activity
Questions And Answers
What role does DaVita's P&Pplay? - correct answer ✅• Provides evidenced-based guidance
- Meets CMS' Conditions for Coverage (CfC)
- Complies with state & federal laws What are the risks of performing activities your way? - correct answer ✅Not providing safe evidence-based care can lead to Civil Liability What are the four reasons why we document in the medical record? - correct answer ✅• Proof care was rendered
- Provides data continuity
- Communication tool
- Permanent legal record List six occurrences when to document - correct answer ✅• Baseline assessment
- Change from baseline assessment
- Change in patient's condition
