BONENT Certified Hemodialysis Technologist or
Technician (CHT) Dialysis Technician Exam Study
Guide
restrict sodium to - ANSWER//1500mg a day or less. Avoid slay,
process food, pickles and preserved meats. Pts can use no salt
spices and herbs instead Vitamins - ANSWER//Dialysis removed
water soluble vitamins so patients need to take 60-100mg
vitamin c 1-5mg folate 2mg vitamin b6 3mg vitamin b12 All OTC
vitamins must be approved by doctor Vitamins dialysis remove
- ANSWER//Biotin Folacin Niacin Panthenic acid Riboflavin (B2)
Thiamin Vitamins b6,b12,c Transient Patient -
ANSWER//Traveling patient Patients can lose hair due to -
ANSWER//Lack of protein during CKD Starting of dialysis Babies
born to women on dialysis have - ANSWER//50% survival rate
Patient education steps include - ANSWER//Readiness, need,
language, repeat, belief Solution - ANSWER//mixture of solvent
and solute Solvent - ANSWER//Fluid Solute - ANSWER//A
substance that is dissolved in a solution. What is the solution,
solvent, and solute in dialysis? - ANSWER//Solution-dialysate
Solvent-treated water Solute-electrolytes and glucose Why do
we match the electrolytes in dialsyate closely to patients blood?
- ANSWER//To avoid loss of electrolytes during tx Solubility -
ANSWER//How well a solute fully dissolved in a solvent
concentraion - ANSWER//Only so much solute can be dissolved
before a solvent become saturated (full) Why do we use 2
concentrates to make dialysate - ANSWER//To avoid the
formation of solids acid concentrate - ANSWER//Has calcium
and magnesium bicarbonate concentrate - ANSWER//Has
bicarb and carbonate When water has bicarb and carbonate....
- ANSWER//We can't add calcium and magnesium without
forming solids so we dilute with water Percipitate -
ANSWER//Solids that can form when some solutes mix , we
make dialysate out of 2 solutions to avoid this Diffusion -
ANSWER//Solutes move across membrane till both sides are
,equal when to solutions come in contact with a semipermeable
membrane. In dialysis waste diffuses across membrane to
dialysate Gradient - ANSWER//The difference between the 2
concentrations in both sides of the semipermeable membrane.
We use in dialysis to force waste out of blood, and to balance
electrolytes Hypotonic - ANSWER//Lower solutes than blood
Isotonic - ANSWER//Same solutes as blood Hypertonic -
ANSWER//More solute than blood Factors that affect diffusion
- ANSWER//Size of solute-smaller move more quickly and easily
Temperature-Warmer moves faster and fluids diffuse faster #
and size of dialyzer pores= larger pores faster diffusion Surface
area-larger more diffusion The direction of flow- of blood and
dialysate are flowing in opposite direction, diffusion is higher
countercurrent flow - ANSWER//Blood and dialysate flow in
opposite directions makin concentration gradient high
concurrent flow - ANSWER//Dialysate and blood flow in same
direction Makes dialysis 15% less effective. Can be used in
children to reduce symptoms Osmosis - ANSWER//The
movement of fluid to a higher solute contraction Used to pull
water out of blood Osmotic pressure gradient - ANSWER//a
difference in the solute concentration on the two sides of a
membrane Hydrolic pressure - ANSWER//From gravity or a
pump can reduce or overcome somatic pressure (reverse
osmosis) Filtration - ANSWER//Fluid that is pushed through a
filter by hydraulic pressure Ultrafiltration - ANSWER//removes
water from the blood during dialysis by pushing it across a
semipermeable membrane Convection - ANSWER//The transfer
of heat by the movement of a fluid Solute drag - ANSWER//As
solvent crosses membrane it brings smaller solutes with it
dialyzer - ANSWER//Semipermeable membrane, hollow fibers,
ports for blood and dialysate, compartment for blood and d
Design of dialyzer - ANSWER//End of fibers there are
polyurethane (potting) materials to hold open fibers Dialysate
flows around fibers from bottom to top to create a concurrent
flow Biocompatibility of dialyzer - ANSWER//How much it's like
,the human body , how well a membrane adsorbs protein is key
to whether it's biocompatible (the protein coats the inside of
the fiber so the blood doesn't detect a foreign substance and
cause an immune response. Characteristics of a dialyzer -
ANSWER//Biocompatibility How much surface area Molecular
weight cutoff ( largest molecule to pass through) UF coefficient
(how much water it can remove) Mass transfer coefficient (how
well a solute will pass through membrane) Clearance (how well
solutes are removed from blood Membrane materials -
ANSWER//Cellulose-plant fiber not biocompatible Modified
cellulose-chemically changed to be biocompatible Synthetic-
biocompatible very good and highly absorptive Dialyzer
clearance - ANSWER//The amount of blood cleared from solute
within a minute of tx at any given BFR and DFR Diffusion,
convection and adsorption can affect clearance What's in
dialysate - ANSWER//Acid Bicarb Sodium Magnesium
Potassium Calcium Chloride Glucose Actetate Citrate
Osmolarity (total solute level) must closely match -
ANSWER//Blood to keep to much water from diffusing across
membrane. What does potassium in dialysate do -
ANSWER//Helps bring patient to normal plasma levels What
does magnesium do in dialysate - ANSWER//Triggers enzymes
that are key to carb use What does glucose do in dialysate -
ANSWER//Prevent loss of blood glucose Can help diabetic and
malnourished pts Normal sodium range in the blood -
ANSWER//135-147 Dialysate is kept between 139and 144
Sodium Modeling - ANSWER//Sodium level is changed during tx
Starts out high and is lower throughout tx When sodium level
of dialysate is high more water is removed from blood Can
cause thirst, weight gain and high BP Capillary refill rate -
ANSWER//Time taken for water to move back into blood
stream In sodium modeling if the UFR is higher than the cap
refill rate what can happen? - ANSWER//Drop blood pressure
Bicarbonate - ANSWER//Nuetalizes acid that forms when cells
use protein for fuel It's considered a buffer ( helps keep a
, constant ph) Pts can't get rid of enough acid in their urine so
they are at a constant metabolic acidosis Bicarb is added to
maintain pts PH Ranges from 33-38 Helps with cramping,low bP,
nausea and fatigue after tx Actetate - ANSWER//Forms when
acetic acid reacts with bicarb Some will diffuse into
bloodstream and turn back into bicarb Citrate - ANSWER//Can
help reduce clotting of dialyzer and reduce heparin use Allows
for more reuse of a dialyzer Slowly lowers pts plasma ionized
calcium levels What does checking the conductivity do? -
ANSWER//Checks all the electrolytes The proportioning system
- ANSWER//system where dialysate is made by mixing fresh
concentrate with fixed amounts of treated water Fixed ratio
pump - ANSWER//machine take dry bicarb and mixed with RO
water inside the machine Servo-controlled -
ANSWER//Conductivity Sensors check the total ion levelnof the
mixture When we mix dialysate in the giant tanks in the back
that is part of the - ANSWER//Proportioning system The
monitoring system - ANSWER// Conductivity test -
ANSWER//Machine tests by pair of electrodes places in
dialysate. Machine applies a charge and delivers current
Temperature test - ANSWER//Should be between 35-38 When
dialysate is to hot hemolysis can happen , protein can also be
broken down When dialysate is to cold the patient can feel cold
and less diffusion will occur Flow rate - ANSWER//Can range
from 0-1000 Higher dialysate flow improves dialyzer efficiency
Flow rate alarms can be caused by - ANSWER//Low water
pressure Dialysate pump failure A blockage in dialysate path A
flow rate that was not requested Blood leak -
ANSWER//Dialyzer membranes can tear letting blood and
dialysate mix Or could have major blood loss Blood could be
contaminated by non sterile dialysate Detect by a light shining
though dialysate that can detect color change When alarm
occurs blood pump stops and venous line clamps to prevent
further blood loss If blood leak occurs do not return blood
because dialysate isn't sterile and can cause infection Ph -
Technician (CHT) Dialysis Technician Exam Study
Guide
restrict sodium to - ANSWER//1500mg a day or less. Avoid slay,
process food, pickles and preserved meats. Pts can use no salt
spices and herbs instead Vitamins - ANSWER//Dialysis removed
water soluble vitamins so patients need to take 60-100mg
vitamin c 1-5mg folate 2mg vitamin b6 3mg vitamin b12 All OTC
vitamins must be approved by doctor Vitamins dialysis remove
- ANSWER//Biotin Folacin Niacin Panthenic acid Riboflavin (B2)
Thiamin Vitamins b6,b12,c Transient Patient -
ANSWER//Traveling patient Patients can lose hair due to -
ANSWER//Lack of protein during CKD Starting of dialysis Babies
born to women on dialysis have - ANSWER//50% survival rate
Patient education steps include - ANSWER//Readiness, need,
language, repeat, belief Solution - ANSWER//mixture of solvent
and solute Solvent - ANSWER//Fluid Solute - ANSWER//A
substance that is dissolved in a solution. What is the solution,
solvent, and solute in dialysis? - ANSWER//Solution-dialysate
Solvent-treated water Solute-electrolytes and glucose Why do
we match the electrolytes in dialsyate closely to patients blood?
- ANSWER//To avoid loss of electrolytes during tx Solubility -
ANSWER//How well a solute fully dissolved in a solvent
concentraion - ANSWER//Only so much solute can be dissolved
before a solvent become saturated (full) Why do we use 2
concentrates to make dialysate - ANSWER//To avoid the
formation of solids acid concentrate - ANSWER//Has calcium
and magnesium bicarbonate concentrate - ANSWER//Has
bicarb and carbonate When water has bicarb and carbonate....
- ANSWER//We can't add calcium and magnesium without
forming solids so we dilute with water Percipitate -
ANSWER//Solids that can form when some solutes mix , we
make dialysate out of 2 solutions to avoid this Diffusion -
ANSWER//Solutes move across membrane till both sides are
,equal when to solutions come in contact with a semipermeable
membrane. In dialysis waste diffuses across membrane to
dialysate Gradient - ANSWER//The difference between the 2
concentrations in both sides of the semipermeable membrane.
We use in dialysis to force waste out of blood, and to balance
electrolytes Hypotonic - ANSWER//Lower solutes than blood
Isotonic - ANSWER//Same solutes as blood Hypertonic -
ANSWER//More solute than blood Factors that affect diffusion
- ANSWER//Size of solute-smaller move more quickly and easily
Temperature-Warmer moves faster and fluids diffuse faster #
and size of dialyzer pores= larger pores faster diffusion Surface
area-larger more diffusion The direction of flow- of blood and
dialysate are flowing in opposite direction, diffusion is higher
countercurrent flow - ANSWER//Blood and dialysate flow in
opposite directions makin concentration gradient high
concurrent flow - ANSWER//Dialysate and blood flow in same
direction Makes dialysis 15% less effective. Can be used in
children to reduce symptoms Osmosis - ANSWER//The
movement of fluid to a higher solute contraction Used to pull
water out of blood Osmotic pressure gradient - ANSWER//a
difference in the solute concentration on the two sides of a
membrane Hydrolic pressure - ANSWER//From gravity or a
pump can reduce or overcome somatic pressure (reverse
osmosis) Filtration - ANSWER//Fluid that is pushed through a
filter by hydraulic pressure Ultrafiltration - ANSWER//removes
water from the blood during dialysis by pushing it across a
semipermeable membrane Convection - ANSWER//The transfer
of heat by the movement of a fluid Solute drag - ANSWER//As
solvent crosses membrane it brings smaller solutes with it
dialyzer - ANSWER//Semipermeable membrane, hollow fibers,
ports for blood and dialysate, compartment for blood and d
Design of dialyzer - ANSWER//End of fibers there are
polyurethane (potting) materials to hold open fibers Dialysate
flows around fibers from bottom to top to create a concurrent
flow Biocompatibility of dialyzer - ANSWER//How much it's like
,the human body , how well a membrane adsorbs protein is key
to whether it's biocompatible (the protein coats the inside of
the fiber so the blood doesn't detect a foreign substance and
cause an immune response. Characteristics of a dialyzer -
ANSWER//Biocompatibility How much surface area Molecular
weight cutoff ( largest molecule to pass through) UF coefficient
(how much water it can remove) Mass transfer coefficient (how
well a solute will pass through membrane) Clearance (how well
solutes are removed from blood Membrane materials -
ANSWER//Cellulose-plant fiber not biocompatible Modified
cellulose-chemically changed to be biocompatible Synthetic-
biocompatible very good and highly absorptive Dialyzer
clearance - ANSWER//The amount of blood cleared from solute
within a minute of tx at any given BFR and DFR Diffusion,
convection and adsorption can affect clearance What's in
dialysate - ANSWER//Acid Bicarb Sodium Magnesium
Potassium Calcium Chloride Glucose Actetate Citrate
Osmolarity (total solute level) must closely match -
ANSWER//Blood to keep to much water from diffusing across
membrane. What does potassium in dialysate do -
ANSWER//Helps bring patient to normal plasma levels What
does magnesium do in dialysate - ANSWER//Triggers enzymes
that are key to carb use What does glucose do in dialysate -
ANSWER//Prevent loss of blood glucose Can help diabetic and
malnourished pts Normal sodium range in the blood -
ANSWER//135-147 Dialysate is kept between 139and 144
Sodium Modeling - ANSWER//Sodium level is changed during tx
Starts out high and is lower throughout tx When sodium level
of dialysate is high more water is removed from blood Can
cause thirst, weight gain and high BP Capillary refill rate -
ANSWER//Time taken for water to move back into blood
stream In sodium modeling if the UFR is higher than the cap
refill rate what can happen? - ANSWER//Drop blood pressure
Bicarbonate - ANSWER//Nuetalizes acid that forms when cells
use protein for fuel It's considered a buffer ( helps keep a
, constant ph) Pts can't get rid of enough acid in their urine so
they are at a constant metabolic acidosis Bicarb is added to
maintain pts PH Ranges from 33-38 Helps with cramping,low bP,
nausea and fatigue after tx Actetate - ANSWER//Forms when
acetic acid reacts with bicarb Some will diffuse into
bloodstream and turn back into bicarb Citrate - ANSWER//Can
help reduce clotting of dialyzer and reduce heparin use Allows
for more reuse of a dialyzer Slowly lowers pts plasma ionized
calcium levels What does checking the conductivity do? -
ANSWER//Checks all the electrolytes The proportioning system
- ANSWER//system where dialysate is made by mixing fresh
concentrate with fixed amounts of treated water Fixed ratio
pump - ANSWER//machine take dry bicarb and mixed with RO
water inside the machine Servo-controlled -
ANSWER//Conductivity Sensors check the total ion levelnof the
mixture When we mix dialysate in the giant tanks in the back
that is part of the - ANSWER//Proportioning system The
monitoring system - ANSWER// Conductivity test -
ANSWER//Machine tests by pair of electrodes places in
dialysate. Machine applies a charge and delivers current
Temperature test - ANSWER//Should be between 35-38 When
dialysate is to hot hemolysis can happen , protein can also be
broken down When dialysate is to cold the patient can feel cold
and less diffusion will occur Flow rate - ANSWER//Can range
from 0-1000 Higher dialysate flow improves dialyzer efficiency
Flow rate alarms can be caused by - ANSWER//Low water
pressure Dialysate pump failure A blockage in dialysate path A
flow rate that was not requested Blood leak -
ANSWER//Dialyzer membranes can tear letting blood and
dialysate mix Or could have major blood loss Blood could be
contaminated by non sterile dialysate Detect by a light shining
though dialysate that can detect color change When alarm
occurs blood pump stops and venous line clamps to prevent
further blood loss If blood leak occurs do not return blood
because dialysate isn't sterile and can cause infection Ph -
