DaVita Modules(1-4)

Ultrafiltration is defined as:

Controlled fluid removal by manipulation of hydrostatic pressure.

If a patient with acute kidney injury (AKI) dialyzes in the outpatient facility, one task of the patient care teammates is to monitor blood pressure and weight closely. Why is this important?

Hypovolemia and hypotensive episodes can cause renal ischemia and can further damage the kidneys.

***The underlying cause of prerenal kidney failure is hypovolemia or poor perfusion. Care must be taken to understand patients who are at high risk.

Your role in anemia management includes:

Rinsing back as much of the patient's blood as you can at the termination of each treatment.

During dialysis, the movement of bicarbonate from the dialysate into the blood:

Helps normalize body pH.

The transport mechanism when particles move from an area of higher solute concentration to an area of lower solute concentration is called:

Diffusion.

Hemodialysis patients are at increased risk for contracting Hepatitis B (T/F):

True.

A common reason of how Hepatitis B is transmitted from a patient to a healthcare worker is:

Needlestick injuries.

Appropriate personal protective equipment (PPE) should be worn whenever there is potential for contact with blood or bodily fluids , hazardous chemicals , contaminated equipment and environmental surfaces PPE includes:

Gloves, gowns, mask and eye protection (full face shield or goggles).

Handwashing at a designated clean sink should be performed for a minimum of:

30 seconds.

Contact transmission is the most important route through which infections are spread. Contact transmission is defined as:

Transmission of microorganisms through healthcare workers hands

Teammates caring for a patient with active Clostridioides difficile (C-diff) infection are required to:

Perform frequent hand washing with antimicrobial soap, as alcohol-based hand gels may not be effective to eliminate C. Diff.

To prepare a 1:100 bleach solution , you would:

Add 1 part bleach, 99 parts water.

A 1:10 bleach solution is used to:

Clean up visible blood or gross blood spills.

According to Policy and Procedure, gowns:

Must be fully snapped up (or tied at the neck and waist) and wrists covered.

Why is a "strikethrough" of an external pressure transducer protector of concern ?

Fluid could have entered the machine and contaminated the internal pressure transducer protector providing a reservoir for microorganisms and causing subsequent patient blood infections.

What is the safe range for dialysate pH?

Between 6.9 and 7.6

What is the correct procedure for residual bleach testing after chemical disinfection of distribution loops and equipment fluid pathways?

Residual bleach testing is performed after bleach disinfectant and prior to use.

Which is a true statement regarding the monitoring , testing , and verification of conductivity prior to each patient treatment for all Fresenius machine models and the B Braun system?

The B Braun machine conductivity is verified on the ENDLE machine screen manual conductivity testing with an independent meter must be within +/-0.4 MS of the theoretical conductivity TCD for both the B braun and fresenius machines

To avoid bacterial proliferation ( rapid reproduction ) within the extracorporeal circuit , once primed the recirculation of saline within the dialyzer and blood lines should not exceed ______ prior to initiating the hemodialysis treatment

2 hours

Machine alarm tests are performed:

Before the initiation of each patient treatment.

Procedures provide a step- by-step series of actions , processes , or measures to be taken to implement or address a particular activity , system, or problem. (T/F):

True.

When using an automatic blood pressure cuff on a patient with an irregular heartbeat:

The recorded blood pressure may be inaccurate.

This electrolyte plays a major role in muscle contraction and high or low levels can lead to weakness or cardiac arrest:

Potassium

Post-treatment, a patient complains of a headache and there was a noted temperature increase to 98.8°F from the pre- treatment baseline of 96.6°F. What follow up is required before patient discharge?

This is considered a fever which should be investigated.

For a patient who can stand a post-treatment blood pressure reading of ___ is considered an abnormal finding and should be reported to a licensed nurse, per DaVita Policy:

Standing systolic BP greater than 140 mmHg or less than 90 mmHg and standing diastolic BP greater than 90 mmHg or less than 50 mmHg.

What is considered a normal heart rate?

60-100 bpm

A patient has an adverse reaction within minutes of treatment initiation . The patient's pre-treatment data screen shows no patient information entered. What should have occurred prior to initiating treatment according to DaVita policy and procedure (P&P)?

There's no proof that pre-treatment safety checks were completed or the patient had been properly assessed.

The pre-treatment patient assessment by the licensed nurse is required:

It is required before treatment is initiated.

All pre-treatment data findings and machine safety checks are required to be entered into the IT Clinical System before treatment initiation (T/F):

True

If a PCT documents the extent of a patient's edema as +3 , the PCT is performing an assessment which is not within their scope of practice under local , state , or federal regulations (T/F)

True.

Why is it important post treatment to document the dialyzer appearance and hemostasis duration (the time it takes to stop actively bleeding) after removal of the needles from the arteriovenous fistula (AVF)/arteriovenous graft (AVG)?

An abnormal dialyzer appearance may signal potential issues such as blood clots or fiber damage, which can compromise the dialysis process.

Patient vital signs, well- being evaluations , and machine checks must be performed a minimum of:

Every 30 minutes.

What is true regarding documentation of an abnormal treatment event?

Document a description of the event, including licensed nurse notification, all the interventions taken, and the patient's response in the treatment record.

What is true regarding documentation of an abnormal treatment event?

Document a description of the event, including licensed nurse notification, all the interventions taken, and the patient's response in the treatment record

The purpose of documentation is to provide:

- proof that care was rendered

- provides continuity

- permanent legal record

- communication tool

Preventing hypotensive episodes during the dialysis treatment is important because:

Because hypotension is associated with

Removing too much fluid during treatment may cause

Patient vital signs , well- being evaluations , and machine checks must be performed a minimum of:

Every 30 minutes.

What is true regarding documentation of an abnormal treatment event?

Document a description of the event, including licensed nurse notification, all the interventions taken, and the patient's response in the treatment record.

The purpose of documentation is to provide:

- proof that care was rendered

- provides continuity

- permanent legal record

- communication tool

Mrs. Thirsty's target weight is 73kg. Her pre-dialysis weight is 76.3 kg. Her last post weight was 74.2 kg. What is Mrs. Thirsty's UF-goal today (not including prime & rinseback)?

3.3 kg (76.3-73.0=3.3 kg to shed until target weight is achieved.

What common symptoms would alert you that a patients target weight may need to be decreased ?

Hypertension, peripheral edema, lung congestion.

What three common symptoms would alert you that a patient's target weight may need to be increased?

Excessive nausea and vomiting, diarrhea, returning to clinic after hospitalization.

An arteriovenous fistula (AVF):

Connects an artery to a vein most commonly in the upper extremity.

The venous needle is placed:

Antegrade or with the flow of blood.

Which statement is true about Povidone lodine?

30 seconds wipe, 2 min dry time.

Which of the following is NOT an acceptable way of dressing cannulation sites post treatment?

Wrap and encircle the access extremity with tape or gauze.

When cannulating an arteriovenous fistula (AVF) or an arteriovenous graft (AVG), the needle tips should be:

At least 1.5 inches apart.

Use of an arm board to support an arteriovenous access extremity requires:

A physician's order.

Lavender tubes must be:

Inverted a minimum of 8 to 10 times to properly mix and avoid clotting.

After collecting a blood specimen, the vacutainer holder is___ after use.

Discarded (in the sharps bin).

What may cause hemolysis of a laboratory blood specimen?

Placing the tube directly on top of the machine, placing the tube too close to the centrifuge, placing the tube directly on an ice pack.

What are the five rights of proper lab draws?

Requisition, label, patient, container, collection date.

When labeling a lab tube , you should:

Never double label tube as laboratory is unable to process the specimens, and never write on the label. Verify the correct date and requisition date in IT clinical system if incorrect prior to shipping.

Which of the following factors would influence K of the Kt/V formula?

Blood volume processed (BVP).

When collecting the post-treatment blood urea nitrogen (BUN) adequacy lab, in order to ensure that you are drawing non- recirculated blood, which port should be used?

Arterial blood line port.

Before collecting the post-treatment blood urea nitrogen (BUN) adequacy lab, in order to ensure that you are drawing non- recirculated blood you must do what with the blood flow rate (BFR)?

1. Put in MIN

2. Reduce BFR to 300

3. Confirm in BYPASS

4. Reduce BFR to 100

5. Wait 15 seconds

Before drawing the post- treatment Blood Urea Nitrogen ( BUN ) adequacy lab , adjustments to the dialysate flow rate DFR must include:

300-500ml/per min.

To ensure an accurate result , when drawing the Blood Urea Nitrogen (BUN) adequacy lab post- treatment you should:

Wait 15 seconds and then draw blood from arterial port

INVERT, MIX, SPIN 15 MIN, REFRIGERATE.

What needle size should be used for a blood flow rate (BFR) prescription of 400 ml /min?

15 gauge

A sudden decrease in blood pressure of equal to or greater than ___ can be an indication that the patient is losing intravascular fluid too quickly.

20mmHg

Once rinseback is complete, what should be done before removing a patient's venous needle?

Check patient's sitting & standing blood pressure.

Because a pre - pump arterial pressure that becomes too negative can cause hemolysis, DaVita policy states that the arterial pressure must not exceed:

-260 mmHg.

The Patient Care Technician is allowed to administer per DaVita policy and under the supervision of the licensed nurse (as applicable under state law):

Normal saline, lidocaine, topical anesthetic spray, heparin (in some states).

Which statement is true regarding the administration of normal saline?

The teammate must remain with the patient to monitor the process until administration is complete and lines are securely clamped.

Which heparin unit strength is most commonly given during the dialysis treatment?

1000 units/ml.

Which is the acceptable way to distribute prescribed medication to patient stations?

Place in sterile field table top with the supplies.

Medications should only be drawn up for one shift of patients at a time and must be administered within 4 hours of preparation (except in states with stricter time limits) (T/F):

True.

An opened multi-dose vial must be labeled with the initials of the person opening the vial and:

The date open and date expiration (28 days from now) & time opened.

Topical anesthetic spray does not require a physician order because it is not an injectable medication. It can administered as needed per licensed nurse discretion (T/F):

True.

Which of the following is the unacceptable limit for water endotoxin result per DaVita policy?

Above 0.25 EU.

What is the primary device for water purification?

Reverse Osmosis (RO).

What does the Reverse Osmosis (RO) device remove?

Organic and inorganic contaminants, bacteria, and endotoxins.

Why do we treat water to purify it for use in dialysis?

Tap water contains contaminants that may not be harmful through ingestion but cause harm to the hemodialysis patient if not inactivated or removed.

What is the purpose of testing the conductivity (if specified by dialysis machine manufacturer) and pH of the final dialysate composition with an independent meter?

To ensure the quality and safety of the dialysate before it is used in dialysis treatment.

Prior to the use of dialysis quality water, including treatment initiations, what is the role of the licensed nurse in regards to the Daily Water Treatment Log?

The licensed nurse reviews the log for completeness, verifies all parameters are within specified limits, and initials and signs the log.

Total Water Hardness is checked:

At the end of the treatment day.

A teammate performs Total Chlorine testing from the primary carbon tank with both results being greater than 0.1 ppm. Total Chlorine testing results from the secondary carbon tank were less than 0.1 ppm . What is the correct action to take?

Test every 30 min.

If the initial and re-test of Total Chlorine from the primary carbon tank sample testing port shows a result greater than 0.1 ppm, then the teammate should understand:

Testing is performed after the secondary carbon tank.

Pre-treatment water samples for chlorine testing are collected after the RO has operated for at least ___ minutes.

15 minutes.

The three processes that make up the water treatment system are

Pre Treatment, Water Purification, Distribution.

In what position should you place a patient who experiences an intradialytic hypotension episode?

Flat supine position.

The patient complains of feeling nauseated and has cold clammy skin. The most likely cause is:

Hypotension.

The teammate finding a patient who has fallen or who has witnessed a patient fall will immediately notify:

Licensed nurse.

The dialysis treatment may be continued during and after a seizure provided the patient is closely monitored for safety , and responds appropriately to intervention(s) (T/F):

True.

While preparing to manually return the patient's blood using the hand crank method during a power failure, the teammate aseptically disconnects the arterial blood line from the arterial access connection and attaches it to the Y port or LockSite connector on the saline infusion line. It is important for the teammate to understand that the next step is to observe for the presence of air in the lines and if air is not present remove ___ from the ___.

Venous line; (from the) air lock chamber chamber-the line that clamps and unclamps, controlling the venous chamber pressure.

Emergency take off kits are to be available at each dialysis station and stored within the patient's reach (T/F):

True-at each dialysis station and within the patients reach.

An immediate symptom of a disinfectant infusion is pain at the:

Venous site.

In the case of an anaphylactic reaction , dialysis must be discontinued without returning the patient's blood (T/F):

True.

If a patient experiences a cardiopulmonary arrest during hemodialysis, all medical devices utilized for the patient treatment (including any disposables) are to be:

Sequestered.

Per DaVita policy, for severe hypotensive symptoms, if ordered by the physician, dialysis patient care technicians (PCTs) may give up to ____ ml of normal saline (per state and local Board of Nursing regulations) and then inform the licensed nurse for further evaluation and intervention.

200 ml of saline.

Which of the following is NOT an approved treatment intervention for intradialytic cramping?

Gloves filled with hot water.

Your role in Chronic Kidney Disease Mineral & Bone Disorder management includes:

Reminding pt who is eating a snack during dialysis to take their phosphate binder as prescribed.

Symptoms of hyperkalemia (high potassium) may include:

Nausea, numbness, tingling, diarrhea, stomach pain, arrhythmia, heart palpitations.

When taken with meals , how do phosphate binders work?

They prevent the phosphorus in food from being absorbed.

Which of the following is likely to cause a drop in the patients albumin protein status?

Inflammation and infection will cause an albumin level to drop.

Treatment options for patients with stage 5 chronic kidney disease (CKD) may include:

Hemodialysis (In center/home, or peritoneal dialysis), transplant, and conservative management of care.

The patient care technician can execute all of the following quality measures except:

Inform the physician of medication related side effects.

If one of a center's quality indicators shows underperformance, an action plan will be identified to improve performance (T/F):

True.

To assist in survey readiness you should:

Know and follow policies and procedures, be accountable and take initiatives, live out our mission and core values.

Not knowing the function or testing requirements of the water room equipment or performing chlorine water checks incorrectly will most likely result in an Immediate Jeopardy (T/F):

True.