Nephrology Nursing and Dialysis Final Exam Review

Comprehensive vocabulary flashcards covering nephrology nursing standards, dialysis mechanics, kidney functions, patient monitoring, and clinical calculations based on the lecture notes.

Passing Score

An exam score of $80\%$ or greater is required to pass.

Reasonable and Prudent Standard of Care

The specific standard of care used in nephrology nursing practice.

Independent Nursing Functions

Actions a nurse can perform without a physician order, specifically patient care and technical skills.

Delegated Medical Functions

Tasks assigned by a physician to a nurse, including physician orders and protocols.

PCT Scope of Practice Delegation

Tasks delegated to a Patient Care Technician must be technical in nature, have predictable results, and carry minimal risk.

Optimal Nutrition Parameters

Defined as an albumin level $\ge 4.0\,g/dL$, a stable desirable target weight, adequate fat stores and muscle mass, and appropriate appetite and intake.

Hyperkalemia

A condition of high potassium that can be caused by certain foods, hemolysis, missed treatments, trauma, infection, constipation, bleeding, or uncontrolled blood sugar (DKA).

Hyperkalemia Symptoms

Symptoms include extreme muscle weakness, abnormal heart rhythm, and possible cardiac arrest.

Hypoalbuminemia (Non-nutritional Causes)

Low albumin levels caused by infection, inflammation, PD therapy (albumin loss in effluent), blood loss, fluid overload, or metabolic acidosis.

Hypocalcemia Symptoms

Symptoms of low calcium include muscle spasms, numbness, confusion, and seizures.

Kidney Endocrine Functions

Functions that include blood pressure regulation (RAS system), red blood cell production (Erythropoietin), and Vitamin D activation/calcium regulation.

Kidney Excretory Functions

Functions that include waste removal, electrolyte balance, acid-base balance, and fluid removal.

Hemodialysis Functionality

Replaces approximately $15\%$ of kidney function, specifically the excretory functions.

Filtration

Fluid passing through a semipermeable membrane controlled by hydrostatic pressure; it is a non-specific term often associated with the glomerulus.

Ultrafiltration

Controlled fluid removal achieved by the manipulation of hydrostatic pressure.

Convection

Also known as solute drag, where solutes are dragged across a semipermeable membrane along with fluid.

Diffusion

The movement of solutes/particles from an area of higher solute concentration to an area of lower solute concentration.

Osmosis

The movement of fluid from an area of lower solute concentration to an area of higher solute concentration.

Bicarbonate

A component in dialysate that helps normalize body pH through diffusion into the blood.

Phosphorus Binders

Medications that work like a sponge or magnet to attract phosphorus; they must be taken with food.

Uremia Symptoms

A build-up of waste in the blood characterized by itching, confusion, nausea, bad breath, and flu-like symptoms.

Renal Vitamins

Water-soluble vitamins that should be taken AFTER dialysis because they are removed during the treatment.

CKD Mineral Bone Disorder (Four Elements)

The four elements affected are calcium, phosphorus, parathyroid hormone ($PTH$), and calcitriol (active Vitamin D).

Conductivity

A measurement of the electrolyte concentration in the dialysate solution.

pH (in Dialysis)

A measurement of the acid-base balance of the dialysate solution.

High Venous Pressure Causes

Can be caused by kinks, clots, improper needle position, infiltration, or stenosis.

Low Venous Pressure Causes

Can be caused by blood tubing separation from the access, a drop in blood flow rate ($BFR$), or saline infusion.

High Arterial Pressure Causes

Can be caused by kinking/clamping of the line, high blood flow rate, or hypotension (low blood volume to pull from).

Chlorine and Chloramine Testing Limit

The result must be less than or equal to $0.1\,ppm$ (parts per million).

RO System Testing Requirement

The Reverse Osmosis ($RO$) system must be running for a minimum of $15\,\text{minutes}$ before water testing occurs.

Treatment Documentation Requirements

Nursing assessments must be completed and documented prior to treatment initiation.

Mandatory 15-Minute Monitoring

The minimum standard requires documenting blood pressure, heart rate, visible access, and secure line connections every $15\,\text{minutes}$.

Hand Hygiene

The single most important intervention in preventing the spread of infection.

Hepatitis B Transmission Precaution

A teammate cannot care for a Hepatitis B infected patient and a susceptible patient at the same time.

Bruit and Thrill

The two methods used to evaluate a graft or fistula: listening for the bruit (sound) and feeling for the thrill (vibration).

KDOQI Rule of 6

Criteria for fistula maturity: $6\,\text{weeks}$ post-op, $0.6\,cm$ depth below skin, $0.6\,cm$ width, and a blood flow of $600\,mL/min$ per report.

Steal Syndrome

A complication where the access steals blood from the distal limb, characterized by unilateral coldness, pallor, pain, and weak pulses beyond the access.

Stenosis Sound Indicators

Inflow stenosis sounds like a water hammer; outflow stenosis sounds like a high-pitched whistle.

Anuria

Urine output of less than $100\,mL$ in a $24\,\text{hour}$ period.

Oliguria

Urine output of less than $400\,mL$ in a $24\,\text{hour}$ period.

Hypovolemia

A low volume of blood that can cause organ stunning, loss of residual kidney function, and increased mortality.

Disinfectant Reaction Telltale Sign

The primary symptom is burning or pain at the venous needle site.

Air Embolism Initial Intervention

The first step is to stop the pump and clamp the lines.

Hemolysis

The bursting of red blood cells (marked by cherry-red blood) caused by high temperatures, chlorine, or faulty blood pump calibration.

UF Removal Goal Calculation

Formula: (Fluid Intake/Tea in $mL$) + (Prime and Rinseback in $mL$) + (Antibiotics in $mL$) + (Physician Ordered Fluid Weight Order in $mL$).

Mannitol

A short-acting medication that is dialyzed off during treatment.