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AKI ✔✔acute kidney injury— abrupt loss of kidney function, expected to restore itself
Examples of Pre-renal AKI ✔✔rental artery stenosis, low blood pressure
Examples of intra-renal AKI ✔✔high blood pressure, high blood sugar, chemotherapy
Examples of post-renal AKI ✔✔Uretal stenosis, kidney stones, bladder cancer
How do you help in restoring kidney function in AKI patients? accurate weights, dialysate baths, maintain BPs ✔✔Ensure adequate dialysis—
How do you protect kidneys from further injury in AKI? ✔✔Watch blood pressures
What is important when monitoring weight and BP in AKI patients? don't pull too much, don't leave too wet, watch pressures closely ✔✔Prevent further injury—
AKI patients are at risk for which complications? ✔✔Hypotension, chronic kidney disease
What do you need to consider in regard to AKI vascular accesses?so take good care of their accesses ✔✔They may not return soon
Explain the difference between CKD and AKI ✔✔CKD will not resolve itself, it is permanent
Outline the treatment goals for someone with CKD ✔✔Slow it's progression Manage comorbidities and complicationsControl symptoms Minimize effect on lifestyleModality education Encourage active participation in care What are the most common causes of CKD?disease ✔✔Diabetes, hypertension, polycystic kidney
BFR for needle gauge 16 ✔✔250-350 ml/min
BFR for needle gauge 15 ✔✔350-450 ml/min
BFR for needle gauge 14 ✔✔>450 ml/min
Procedure for post BUN lab draw? ✔✔Turn off or decrease UF to 50 ml/hr Decrease DFR to 300 or place in bypassDecrease BFR to 100 Wait 15 secObtain from arterial line
Lab draw mistakes that would falsely increase Kt/Vsec, pulling from the venous line ✔✔Not decreasing BFR, not waiting 15 full
Lab draw mistakes that would falsely decrease Kt/V ✔✔Diluting pre BUN with saline Waiting longer than 15 sec
What are examples of a nurse assessment?respiration rate and sounds, cause of temperature abnormalities, cause of unusual access findings ✔✔Edema (pitting), heart sounds and quality,
What are examples of a PCT data collection?access ✔✔Swelling, heart rate, temperature, observe
What is the role of the PCT prior to treatment initiation?findings to nurse ✔✔Data collection, report abnormal
What is the role of the licensed nurse prior to treatment initiation?abnormal findings, report to MD as needed ✔✔Assess patient, evaluate
When is a pre-treatment assessment by the licensed nurse required?needed by the state, and always if there are abnormal findings in the data collection ✔✔Always when it is
What BP reading error can be caused by a cuff that is too small? ✔✔High BP
What BP reading error can be caused by a cuff that is too large? ✔✔Low BP
What is included in the measures of effectiveness on the clinical pyramid?hospitalization/re-hospitalization, patient experience of care ✔✔Mortality,
Name some examples of what you can do to prevent DQI dips related to lab drawdorder of draw ✔✔Follow Label accuratelyFedEx tracking numbers
Why do we document in the medical record?record, communication tool ✔✔Proof of care, data continuity, permanent legal
List six occurrences when to chart ✔✔Change from baseline Change in conditionProcedure or treatment Medication given/reaction to itPatient teaching Care plan review and interventions
What is a possible consequence of poor or incomplete documentation?lawsuits, audits ✔✔No proof of care,
What are the six items documented after administering medication? ✔✔Time RouteAmount MedicationPatient Teammate name How do you document late entries? ✔✔Sign, write late entry, don't change the time, current info
How do you document charting errors? ✔✔Single line through Note error in entryDate SignatureCredentials Chart correct info
Calculate interdialytic weight gain ✔✔Pre-weight (-) last post weight
What are the consequences of sodium loading during dialysis?intake ✔✔Increased thirst and fluid Increased fluid weight gainHigher UF rate More hypotension during treatment State three ways we can contribute to sodium loading during dialysismuch saline, giving salty foods like broth ✔✔sodium modeling, too
What are the consequences of fluid overload? ✔✔Hypertension and left ventricular hypertrophy
What are the consequences and risks of hypovolemia?fluid gain between treatments ✔✔Hypotension, increased thirst and
Conductivity alarm causes and interventionsbicarbonate, Ca or Mg precipitate, line or filter debris ✔✔Causes— no concentrate, improperly mixed Intervention— check all of the above, bypass, pull machine Temperature alarm causes and interventionscalibration ✔✔Causes— off more than 2 degrees, improper Intervention— reset, recalibrate, pull machine Blood leak detector alarm causes and interventionscalibration, defective dialyzer ✔✔Causes— blood in dialysate, improper Interventions— test, no rinse back, change delivery system TMP alarm causes and interventions ✔✔Causes— clotting in dialyzer, plugged transducer Intervention— change transducer, no rinseback and new system Power alarm causes and interventionsunplugged ✔✔Causes— electrical overload, local power outage, Interventionssaline to empty—manually rinseback, take patients off, take out of venous chamber, watch for
Air/foam detector alarm causes and interventionsclamping saline ✔✔Causes— air in drip chamber, not Interventions— recirculate, replace lines Treatment options for ESRD ✔✔Kidney transplant PDHD Palliative care CAPD (Continuous Ambulatory Peritoneal Dialysis)drains, flushed, fills and dwells solution ✔✔Every four hours, patient manually
CCPD (Continuous Cycle Peritoneal Dialysis) ✔✔8-12 hours, overnight patient PD dialysis
Benefits of PD ✔✔Home based, flexible schedule Fewer dietary restrictionsSteady/gentle treatment
Needle freeLess anemia Allows active lifestyleImproved transplant outcomes Preserved residual renal function Types of home hemodialysis ✔✔Conventional, short daily, nocturnal, solo
Benefits of home hemodialysis ✔✔Home based, flexible schedule Fewer dietary restrictionsImproved clinical outcomes May allow for easier travelIndependent treatment
Key concepts of "Reasonable and Prudent" Standard of Care for Nephrology Nursingcare that a reasonable and prudent nephrology nurse would give under same circumstances ✔✔1. Give
- Do what they would do and don't do what they wouldn't3. Nephrology nursing is key
What are v-tags and why are them important?related to infection control in dialysis ✔✔CMS regulations and interpretive guidance Are required to allow Medicare patients to dialyze in facility What is the most common route of HAI transmission? ✔✔Contact
What is the most important intervention you can do to prevent HAIs? ✔✔Hand hygiene
What is the most common infectious complication in HD patients?infections ✔✔Bacterial access
What germs cause the most common infections in HD patients? ✔✔MRSA and VRE
Why is wearing gloves so important? ✔✔Bacteria on hands can survive washing
Why do you need to perform hand hygiene before and after wearing gloves?holes in gloves allow bacteria/particles to pass through ✔✔Microscopic
Is a cleaned dialysis machine considered a 'clean' area? ✔✔Nope
When are sharps containers being removed from the treatment floor? ✔✔3/4 full State the 3 KDOQI strategies to decrease the risk of infections when working with a CVC ✔✔Healthcare worker education and training CVC care and site surveillanceCVC infection surveillance
HBsAg ✔✔hepatitis B surface antigen = infection
Anti-HBs ✔✔Antibody to HBsAg; indicates immunity to hepatitis B
Anti-HBcIgM ✔✔Hepatitis B core antibody = natural immunity
Clotting time for an SST? ✔✔15-30 minutes
How can you prevent contributing to blood loss? ✔✔Rinseback blood, clot after pulling needles
What is pericarditis? What is the special treatment for this issue?pericardial sac, hold heparin ✔✔inflammation of the
Examples of psychological problems caused by CKDsexual dysfunction, work disruption, rehab struggles ✔✔Depression, behavioral problems,
What are the four key elements affected in CKD-MBD? ✔✔Ca, Ph, PTH, and calcitriol
What are symptoms of CKD-MBD in addition to bone disease?metabolizing Ca, PO4, PTH and Vit D ✔✔Abnormalities in Soft tissue calcification What is your role in CKD-MBD management?meals ✔✔Remind to take phosphorus binders during
What does the DARN acronym stand for? ✔✔Desire AbilityReason Need When should the communication style Directing be used?procedure or prescribing medications ✔✔When training to perform a
When should the communication style Following be used?seeing through the patients eyes ✔✔Allowing time to digest sad news,
When should the communication style Guiding be used? ✔✔To be a knowledgeable resource
What are the three core communication skills to be used? ✔✔Asking, listening, informing
What does RULE stand for? ✔✔Resist the righting reflex Understand your patients motivationsListen to your patient
