DaVita

When dialyzing a patient with acute kidney injury, one task of the patient care teammates is to monitor blood pressure and weight closely. Why is it important?

hypovolemia and hypotensive episodes can cause renal ischemia and can further damage the kidneys

CKD can have its orgin pre-renal , intra-renalm or post renal. Which of the following conditions is an intra-renal cause of CKD

HTN

Knowing what caused your patient's CKD

is important because the underlying disease could cause health complications that can impact the dialysis treatment

When a PCT documents the extent of a patient's edema, for example as +3

the PCT is preforming an assessment which is not allowed legally

When a patient has an irregular heartbeat,

the automatic BP reading may not be accurate

Which of the following is a data collection

HR 72

at what time should the post treatment data collection be completed

after the treatment has been completed

the A in smart communication stands for

actual- just report the facts

which of the following events is defined as a near miss

the wrong dialyzer was set up and primed for a patient, but it was caught before dialysis was initiated and the dialyzer was replaced

using the \__________ approach is one way to fill out an REM

SBAR

What is your main priority when returning a patient's blood with the hand crank during a power outage?

you must be vigilant in watching for air in the blood lines

what problem will cause an increase in the patient's VP

a clot in the venous drip chamber

Which blood test must be performed at regular intervals on patients susceptible to HPB

HBsAg

who is accountable for appropriate patient and teammate scheduling in the acute setting

you are dialyzing a patient and the only available HPB surveillance test is a HBsAb of 8. What are the machine disinfection requirements after dialyzing this patient?

the machine must be heat disinfected at the end of each day

What is the most common factor contributing to bacteremia in dialysis patients?

use of catheters for HD

which infectious disease requires frequent hand washing instead of using alcohol based hand gels

active clostridioides difficile infection

What precautions must be used when handling lab specimens?

universal precautions

waiting only five seconds between lowering the blood pump speed and drawing the post treatment blood sample could

cause the post treatment BUN reading to be falsely low (wait 15 seconds)

which may cause a decrease in the hemoglobin of a patient with ESRD

infection/inflammation

fluid overload and HTN lead to LVH, this means

hypotensive episodes are more likely to occur during the dialysis treatment

your role in CKD-MBD management includes

reminding the patient who is eating a snack during dialysis to take his phosphate binder

your role in anemia management includes

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

the licensed nurse has delegated a specific task to a PCT, but the PCT gets called away before performing this task. Can the PCT asek another PCT to take over?

no, a task delegated by the licensed nurse to a non-licenced teammate cannot be re-delegated by this teammate

the licensed nurse delegated a task to the PCT, Nicole, but Nicole has not performed this task during the last 2.5 months. What is Nicole's responsibility in the delegation communication process?

Nicole is to inform the nurse that she performed the task only infrequently

what is the nurse's responsibility in the delegation supervision process?

to determine the level of supervision needed and to monitor the NAP's performance of the task accordingly

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

diffusion

during dialysis, the movement of bicarb from the dialysate into the blood

helps normalize body pH

the kidneys excretory functions include

normalizing electrolytes

what distance should be observed between needle tips and away from each other when cannulating an internal vascular access?

1.5 inches

the nephrologist has ordered 16 gauge needles and a 400 BFR for your patient. You

ask the nephrologist to order a 15 gauge needles for the ordered BFR

your patient prefers two places on her AVG to insert the needles because they hurt a lot less than when you cannulate different sites. You tell the patient

inserting the needles into the same small area can over time damage your graft

what is the appropriate intervals for total chlorine testing?

prior to the first patient shift and within every 4 hours

what is acceptable limit for total chlorine in the water leaving the carbon filter

0.1 or less

which is the primary device for purifying the water used in dialysis

the RO

ICEBOAT?

2 Identifiers
Consent valid
Equipment is functioning
Hep B status
Orders are complete
Access is patent
Documentation is timely
? any questions/concerns

Your patient complains of ringing in the ears, being nauseated and having cold clammy skin. The most likely causes is

Hypotension

What is a likely cause for dysrhythmias?

Hypotension, heart disease, or rapid changes in K

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

Supine

What do you do for a patient with an air emblolism?

Clamp lines, put patient on left side, Trendelenburg, attempt to aspirate the air, administer O2 per MD, monitor VS closely, initiate CPR if needed, notify code team

Why is thirst control and limiting interdialytic weight gains a shared responsibilyt between the healthcare team and the patient?

Caregivers can contribute to Na loading during dialysis causing an increased thirst and fluid intake between treatments

Preventing hypotensive episodes during dialysis treatment is important because they are associated with

a higher mortality rate

The mortality risk for patient who experience two or more episodes of intradialytic hypotension per week increases to

70%

which condition may impair a patient's increase in pulse rate as a response to hypovoilemia

autonomic neuropathy

a patient's protein status is affected by nutritional and non-nutritional factors. what can you do to prevent a drop in your patient's albumin?

prevent HAIs

Calciphylaxis (soft tissue calcification) is a consequence of which out or range labs?

Ca, PTH, Phosphorus

How do phosphate binders work?

they prevent the phosphorus in food from being absorbed when taken with meals

The method to protect against infection by pathogenic microorganisms when preparing and administering medications is called

aseptic technique

Why must you wait 3-5 minutes after administering the initial heparin bolus before initiating treatment?

takes 3-5 minutes for heparin to become systemic

When do you take PO4 binders?

with meals and snacks

\#1 thing we do

patient safety

Conductivity acceptable rrange

13-15.5 and +/- 0.4 of the machine

pH of dialysate

6.9-7.6

blood pH

7.35-7.45

When is the RO checked?

before the first patient and every 4 hours afterwards

Bicarb lasts for how long once opened?

24 hours

Acid lasts for how long when opened?

30 days
if additives discard after treatment

lifespan of a RBC for dialysis patient

60 days

Ultrafiltration

fluid passing thru a membrane

Convetion

solute being dragged across the semipermeable membrane

Diffusion

particles from high to low concentrations

Osmosis

fluid from lower to higher concentration

How much air can cause a patient harm?

10mL

What is the solution of bleach to clean up a spill?

1:10

2 independent nursing functions

patient care and technical skills

2 common routes for CVC infection

into cath via contact of the insertion site and via cath lumen- scrub the hub for 60 seconds each limb

Most common cause for CKD in USA

DM

What is the percent of kidney function lost before going on dialysis

75%

HD replaces what percent of kidney function

15%

What is the direct result of intravascular fluid overload

HTN

Patient with cardiac disease are 10x more likely to develop intra HTN

LVH

Offer a patient of this is an example of oral sodium loading

broth

this electrolyte is often elevated with patients with severe itching

phosphorus

kidneys regulate BO by realeasing

renin

hormone stimulated in bone marrow production

erythropoeitin

Excess of this electrolyte causes slowing of the hearts electrical system

k

mucosal alteration in the stomach of patients with AKI can lead to this

anorexia

what is the inflammation aroudn the heart called

pericarditis

restless leg syndrome is a complication of

peripheral neropathy

measures the RBC by weight

HgB

what is the diminished quality and quality of RBC

anemia

what is classified as bone disease associated with renal failure

CKD-MBD

the vitamin converts vit d into which hormone

Calictrol

these procedures can causes significant blood loss in our patients

access procedures

maintaining a normal serum Ca levels are the primary function of this hormone

PTH

this disease is the leading cause of death at all stages in CKD

cardiac

this skin color is associated with the decrease circulation of RBC from secondary anemia

pale

it is important to use this team approach when dealing with psychological patients

multidisplinary

What is the reason for a meerCAT audit

to prepare for survey readiness

one thing to improve CAT audit scores

practice good hand hygiene

one thing to improve meerCAT score

store look-a-like, sound-a-like products appropriately

Why is the order of lab draw important

samples in subsequent tubes are not contaminated with additives from the previous

what do you want the level of albumin to be

\>4

if drawing labs during dialysis how do you label them?

DRAWING DURING DIALYSIS

BUN lab draws post dialysis

turn off or decrease UR to 50
decrease DFR to 300 or place machine in bypass
reduce BFR to 100
wait 15 seconds for AVG/AVF and CVC (WAIT 15 seconds!!)
Obtain from A Line

Why is drawing the correct amount for blood cultures improtant

too much blood may create a false positive

When do we test Hep B

need to have it every 28 days drawn for negative and susceptible, if negative and immune every 365 days. if unknown draw patient

Rule of 6 is good for?

new AVF to guide

what is LOOK LISTEN AND FEEL?

assessment without needles

inflow stenosis is

with AVF, venous stenosis, water hammer pulse