Final Version of DaVita test (solved)

Final Version of DaVita test (solved) what treatment factors decrease K in the Kt/v to decrease? - ANSWER not waiting 3-5 minutes after heparin, decreasing BFR, DFR, and BVP what factors influence "V" in Kt/v - ANSWER accurate data entry by nurses in snappy, sex age, weight, and amputation what are the needle gauges and prescribed blood flow rates? - ANSWER they are inversely related 17g 200-250 15g 250-350 15g 350-400 14 g 400 - 450 what is the procedure for post BUN lab draw? - ANSWER if pt wants off early, still draw the labs and educate patient about the risks. Redraw next time a pt runs full tx to show pt difference what lab draw mistakes would falsely increase Kt/V - ANSWER not waiting the full 15 seconds What is important when monitoring weight and BP in AKI patients? - ANSWER keep patients wet (hydrated) and avoid hypotensive episodes = cause renal ischemia What do you need to consider in regards to CVCs? - ANSWER follow P&P b/c the risk of infection is so high Why is it important to know what caused a patients chronic renal failure? - ANSWER we need to know about possible problems during data collection and assessment What is the role of the PCT prior to tx initiation? - ANSWER assessment of pt if any abnormal findings or if the pt is in an acute condition what happens in the BP cuff is the wrong size - ANSWER loose BP-- high reading tight BP -- low reading why is it so bad to squeeze the BP cuff if its connected to the machine? - ANSWER it can damage the internal BP mechanism Why is it so important that we document in the medical record? - ANSWER it provides data for continuity and planning of care when do pre-treatment data collection and assessment take place? - ANSWER collection: before tx assessment: w/in 1 hr if pt is stable when is post-treatment data collection and assessment performed? - ANSWER post treatment-- not before treatment or when they are disconnected what are the consequences of poor or incomplete documentation - ANSWER can open attack on your care What are the six items needed in charting meds? - ANSWER 1. med/dosage 2. date/time 3. route 4. reason (remember this!) 5. pt response 6. signature What are the 5 Ws to be used when completing an AOR? - ANSWER who what when where why how What are the 4 consequences of sodium loading during dialysis? - ANSWER 1. increased thirst 2. increased fluid intake 3. increased intradialytic weight gain = htn 4. increased UFR what is the purpose of UF profiling? - ANSWER change the way fluid is remodeled during the tx and allows for vascular refilling what are the consequences of hypovolemia during tx? - ANSWER attempting to remove a lot of fluid -- hypovolemia during tx -- loss of renal function, ischemia, and increased mortality rate what must the machine's conductivity and pH reading supposed to be? - ANSWER machine and manual conductivity: w/in +/-0.4 pH range: 6.9 - 7.6, measured to verify acid/base balance is in acceptable range at what temperature does hemolysis occur? - ANSWER 42 degrees C What do we do in a power outage? - ANSWER remove venous line from air detector, clamp, before starting hand crank and be diligent in watching for air in blood lines what causes a high venous pressure alarm? - ANSWER kink in tubing, clotting in venous drip chamber, infiltration, venous stenosis what are the risks of doing things "your way" and not the P&P way? - ANSWER it can lead to civil liabiliy what makes dialysis pts more susceptible to healthcare acquired infections? - ANSWER prolonged access to pts blood, and immunocompramised why are dialysis pts at an increased risk for acquiring HAIs at the facility? - ANSWER contact transmission what is the most common transmission route for HAIs - ANSWER contact transmission-- hands what is the most important invention you can do to prevent HAIs? - ANSWER handwashing what is the most common infectious complication in hemodialyisis pts? - ANSWER per the CDC, the most common factor contributing to bacteremia is use of CVCs What germ causes the most common infections in hemodialysis pts? - ANSWER MRSA which can remain on surfaces for days w/ plastic vinyl being most favorable to their survival why is wearing gloves so important? - ANSWER decrease risk of hand contamination and prevent transfer of organisms already on hands what is the correct procedure in regards to your hands when you have causal contact w/ a pt - ANSWER no gloves but must perform hand hygiene before care on pts Successful lab draw must knows - ANSWER follow order the lab draws to prevent specimen from being contaminated w/ other tube additives, double labeling tubes prohibits processing rules for spinning samples - ANSWER only spin tube of some kind of size and fill level and should be placed opposite of each other What are the symptoms of hyperkalemia? - ANSWER extreme muscle weakness abnormal HR, cardiac arrest what are the symptoms of hypokalemia? - ANSWER fatigue, muscle weakness, respiratory failure what is the primary cause of erythropoietin? - ANSWER primary cause how can you prevent contributing to blood loss? - ANSWER --adequate heperanization --ensure epo given -- completely rinse back blood --avoid repeat lab draws what is pericarditis? what is included in its treatment? - ANSWER w/ dialysis hold or decrease heparin systemic effects of CRF what should you do for a pt that complains of dry, itchy skin - ANSWER use hyperfatted soaps and lotions what should you do for a pt that complains of peripheral neuropathy? - ANSWER educate pt not to walk barefoot, frequent foot checks, check temp of bathwater What are the four key elements affected in CKD-MBD - ANSWER Ca2+ PO4 parathyroid hormone vitamin D what are the symptoms of CKD-MBD in addition to bone disease? - ANSWER soft-tissue calcification what is the best way to help pts successfully change behaviors? - ANSWER inspire behavior change through support, compassion, and empathy What does DARN stand for? - ANSWER desire, ability, reason, need FYI from Meghan: know the questions at the end of the motivational interviewing hand out (one of the PCTs at Red Hawk told me this_) - ANSWER fyi when should the communication style "directing" be used? - ANSWER best used when training to perform procedures what are the three core communication skills to be used w/in the communication style? - ANSWER asking listening informing what is the righting reflex? - ANSWER automatic intervention of a healthcare practitioner who observes pt doing something detrimental to his/her health What is reflective listening? - ANSWER includes main aspects of what the pt said during the entire communication what are the four transport mechanisms that play a role in hemodialysis? - ANSWER ultrafiltration convection diffusion osmosis what is important when monitoring pt weight and BP? - ANSWER keep patients wet and avoid hypotensive episodes b/c it can cause kidney injury what do you need to consider in regards to their vascular access? - ANSWER follow P&P to prevent infections why is it important to know what caused your patient's CRF? - ANSWER to inquire about possible problems during data collection and assessment how often do we screen for Hep C? - ANSWER yearly for patients and teammates tips to remember for successful lab draws - ANSWER 1) follow order of lab draws to prevent specimens from being contaminated with other tube additives 2) double labeling tubes prohibits processing