ICHD Nurse & PCT training study guide 2023 with
complete solution
Explain the 4 transport mechanisms that play a role in hemodialysis
1. Ultrafiltration
2. Convection
3. Diffusion
4. Osmosis
Define Ultrafiltration
Fluid pushed through the semipermeable membrane (SPM)
Define Convection
Solutes dragged across SPM along with fluid
Define Diffusion
Particles moving from area of high concentration to low concentration
Define Osmosis
Fluid moving from area of low to high concentration
What are the kidneys excretory functions?
To normalize electrolytes, remove waste, provide fluid and nutrient balance
How do we replace normal excretory kidney functions?
By normalizing electrolytes and providing fluid balance through ultrafiltration
What is the function of the acid concentrate?
Provides the concentration gradient for diffusion
What is the function of bicarbonate in the dialysate solution?
Buffers the acid concentration
What is the function of bicarbonate when it diffuses into the patients blood?
Normalizes body pH
Signs and symptoms of hyperkalemia
> 6.5 symptoms: extreme muscle weakness, abnormal heart rhythm, and possible
cardiac arrest
Signs and symptoms of hypokalemia
> 3.5 symptoms: fatigue, muscle weakness, paralysis, and resp. failure, cardiac
instability, arrhythmias, cardiac arrest
What is the normal body pH range?
7.35 - 7.45
What are the kidneys' endocrine functions?
Renin secretion, Erythropoietin secretion, Vitamin D activation
How do we replace normal endocrine kidney functions?
Provide medications
How much of normal kidney function is replaced by hemodialysis?
15%
What is uremia and what does it affect?
Uremia is a buildup of waste in the blood due to kidney failure and it affects all body
systems
What are the most common causes for CKD in the USA?
,1. Diabetes
2. Hypertension
3. Polycystic Kidney Disease
Outline the treatment goals for a patient with CKD
1. Slowing the progression of CKD
2. Managing comorbitities and complications
3. Controlling symptoms
4. Minimizing the affects of CKD on patients' lifestyles
5. Kidney replacement therapy modality education
6. Encouraging patients to actively participate in their healthcare
Why is it important to know what caused your patient's CKD?
So the nurse and PCT can inquire about possible problems during data collection and
assessment
Signs & Symptoms of fluid imbalance
1. Hypertension
2. Edema
3. Shortness of breath
Why is sodium imbalance important?
Leads to volume expansion, increased CO, increases peripheral vascular resistance,
and increased BP
Systematic effects of CKD- what would you advise for a patient who complains of dry
and itchy skin?
Use hyper-fatty soaps and lotions. Caution pt: safety at home, provide emotional
support, control diabetes and phos.
Systematic effects of CKD- what would you advise for a patient who complains of
Peripheral Neuropathy (nerve pain in extremities)?
Monitor patient for changes in motor function, decreases strength in legs, C/O restless
legs, burning feet. Advise pt not to walk barefoot, have good foot care practices
Systematic effects of CKD- what would you advise for a patient who complains of GI
problems?
Inform RN & physician of any bleeding problems/constipation/diarrhea/ER visits, take
meds as ordered
Systematic effects of CKD- what would you advise for a patient who complains of
psychological problems?
Verbalize struggles to core team and the social worker
What does hypertension lead to?
Left Ventricular Hypertrophy
What is pericarditis?
Inflammation of the membrane (pericardial sac) around the heart
What is included in pericarditis treatment (tx)?
Decrease heparin, give more frequent dialysis
What is the red cell life span of dialysis patients?
60 days which is 1/2 of normal 120 days
Why are dialysis patients anemic?
, 1. Primary: lack of the hormone erythropoietin (EPO)
2. Secondary: inadequate iron stores, inadequate dialysis, malnutrition, blood loss
during tx
How can you prevent contributing to lower hemoglobin and blood loss in dialysis
patients?
Verify Epogen dose is correct and administered, rinse back until venous line is pink
tinged, and avoid repeat lab draws
What are the 4 key elements affected in CKD-Mineral Bone Disorder (MBD)?
Calcium, phosphorus, potassium, vitamin D (calcitriol) - all lead to CKD-MBD when they
are abnormal
What are symptoms of CKD-MBD in addition to bone disease?
Soft tissue calcification, itching, muscle weakness, pathological fractures, tendon
ruptures, compression of vertebrae, atherosclerosis, heart disease
What is your role in CKD-MBD management?
1. Report symptoms urge patients to take meds (home & tx)
2. Report noncompliance problems related to nonadherence
Define the term AKI
1. Term incorporates a wide spectrum of kidney issues
2. Includes acute kidney failure as well as less catastrophic kidney function changes
3. May dialyze in an out-patient facility until kidney function recovers
Give 3 examples of pre, intra, and post-renal causes of AKI
Pre: obstruction, volume depletion, impaired cardiac function
Intra: ischemic ATN, sepsis, SIRS, septic shock, anaphylaxis drugs, Goodpasture
syndrome, acute glomerulonephritis, trauma, open heart surgery
Post: obstruction, oliguric, bladder rupture, pregnancy
Explain the difference between AKI and CKD
Eliminating the cause of AKI can often lead to the rectum of kidney function but in CKD
you cannot eliminate the causes such as HTN, Diabetes, genetic disorders (PKD)
How do you help in restoring kidney function in AKI?
Find the causes
What do you need to consider in regards to their vascular access with AKI patients?
Patients will typically have a dialysis catheter (CVC), be careful to avoid catheter related
infections
How do you protect kidneys form further injury with AKI?
Avoid substances to the kidney which may be toxic
What is important when monitoring weight and BP?
1. Keep a little extra fluid on them so it is available to the kidneys when they start
filtering/ultra-filtrating on their own
2. AKI patients are at an increased risk for complications: Hypovolemia and hypotension
What makes dialysis patients more susceptible to HAIs?
Immunosuppressed and more vulnerable to infection which leads to the 2nd most
common cause of death in the population
Why are dialysis patients at an increases risk for acquiring a HAI at the facility?
Prolonged access to the patients blood, especially those with a CVC access making
them more at risk
What is the most common transmission route for HAIs?
complete solution
Explain the 4 transport mechanisms that play a role in hemodialysis
1. Ultrafiltration
2. Convection
3. Diffusion
4. Osmosis
Define Ultrafiltration
Fluid pushed through the semipermeable membrane (SPM)
Define Convection
Solutes dragged across SPM along with fluid
Define Diffusion
Particles moving from area of high concentration to low concentration
Define Osmosis
Fluid moving from area of low to high concentration
What are the kidneys excretory functions?
To normalize electrolytes, remove waste, provide fluid and nutrient balance
How do we replace normal excretory kidney functions?
By normalizing electrolytes and providing fluid balance through ultrafiltration
What is the function of the acid concentrate?
Provides the concentration gradient for diffusion
What is the function of bicarbonate in the dialysate solution?
Buffers the acid concentration
What is the function of bicarbonate when it diffuses into the patients blood?
Normalizes body pH
Signs and symptoms of hyperkalemia
> 6.5 symptoms: extreme muscle weakness, abnormal heart rhythm, and possible
cardiac arrest
Signs and symptoms of hypokalemia
> 3.5 symptoms: fatigue, muscle weakness, paralysis, and resp. failure, cardiac
instability, arrhythmias, cardiac arrest
What is the normal body pH range?
7.35 - 7.45
What are the kidneys' endocrine functions?
Renin secretion, Erythropoietin secretion, Vitamin D activation
How do we replace normal endocrine kidney functions?
Provide medications
How much of normal kidney function is replaced by hemodialysis?
15%
What is uremia and what does it affect?
Uremia is a buildup of waste in the blood due to kidney failure and it affects all body
systems
What are the most common causes for CKD in the USA?
,1. Diabetes
2. Hypertension
3. Polycystic Kidney Disease
Outline the treatment goals for a patient with CKD
1. Slowing the progression of CKD
2. Managing comorbitities and complications
3. Controlling symptoms
4. Minimizing the affects of CKD on patients' lifestyles
5. Kidney replacement therapy modality education
6. Encouraging patients to actively participate in their healthcare
Why is it important to know what caused your patient's CKD?
So the nurse and PCT can inquire about possible problems during data collection and
assessment
Signs & Symptoms of fluid imbalance
1. Hypertension
2. Edema
3. Shortness of breath
Why is sodium imbalance important?
Leads to volume expansion, increased CO, increases peripheral vascular resistance,
and increased BP
Systematic effects of CKD- what would you advise for a patient who complains of dry
and itchy skin?
Use hyper-fatty soaps and lotions. Caution pt: safety at home, provide emotional
support, control diabetes and phos.
Systematic effects of CKD- what would you advise for a patient who complains of
Peripheral Neuropathy (nerve pain in extremities)?
Monitor patient for changes in motor function, decreases strength in legs, C/O restless
legs, burning feet. Advise pt not to walk barefoot, have good foot care practices
Systematic effects of CKD- what would you advise for a patient who complains of GI
problems?
Inform RN & physician of any bleeding problems/constipation/diarrhea/ER visits, take
meds as ordered
Systematic effects of CKD- what would you advise for a patient who complains of
psychological problems?
Verbalize struggles to core team and the social worker
What does hypertension lead to?
Left Ventricular Hypertrophy
What is pericarditis?
Inflammation of the membrane (pericardial sac) around the heart
What is included in pericarditis treatment (tx)?
Decrease heparin, give more frequent dialysis
What is the red cell life span of dialysis patients?
60 days which is 1/2 of normal 120 days
Why are dialysis patients anemic?
, 1. Primary: lack of the hormone erythropoietin (EPO)
2. Secondary: inadequate iron stores, inadequate dialysis, malnutrition, blood loss
during tx
How can you prevent contributing to lower hemoglobin and blood loss in dialysis
patients?
Verify Epogen dose is correct and administered, rinse back until venous line is pink
tinged, and avoid repeat lab draws
What are the 4 key elements affected in CKD-Mineral Bone Disorder (MBD)?
Calcium, phosphorus, potassium, vitamin D (calcitriol) - all lead to CKD-MBD when they
are abnormal
What are symptoms of CKD-MBD in addition to bone disease?
Soft tissue calcification, itching, muscle weakness, pathological fractures, tendon
ruptures, compression of vertebrae, atherosclerosis, heart disease
What is your role in CKD-MBD management?
1. Report symptoms urge patients to take meds (home & tx)
2. Report noncompliance problems related to nonadherence
Define the term AKI
1. Term incorporates a wide spectrum of kidney issues
2. Includes acute kidney failure as well as less catastrophic kidney function changes
3. May dialyze in an out-patient facility until kidney function recovers
Give 3 examples of pre, intra, and post-renal causes of AKI
Pre: obstruction, volume depletion, impaired cardiac function
Intra: ischemic ATN, sepsis, SIRS, septic shock, anaphylaxis drugs, Goodpasture
syndrome, acute glomerulonephritis, trauma, open heart surgery
Post: obstruction, oliguric, bladder rupture, pregnancy
Explain the difference between AKI and CKD
Eliminating the cause of AKI can often lead to the rectum of kidney function but in CKD
you cannot eliminate the causes such as HTN, Diabetes, genetic disorders (PKD)
How do you help in restoring kidney function in AKI?
Find the causes
What do you need to consider in regards to their vascular access with AKI patients?
Patients will typically have a dialysis catheter (CVC), be careful to avoid catheter related
infections
How do you protect kidneys form further injury with AKI?
Avoid substances to the kidney which may be toxic
What is important when monitoring weight and BP?
1. Keep a little extra fluid on them so it is available to the kidneys when they start
filtering/ultra-filtrating on their own
2. AKI patients are at an increased risk for complications: Hypovolemia and hypotension
What makes dialysis patients more susceptible to HAIs?
Immunosuppressed and more vulnerable to infection which leads to the 2nd most
common cause of death in the population
Why are dialysis patients at an increases risk for acquiring a HAI at the facility?
Prolonged access to the patients blood, especially those with a CVC access making
them more at risk
What is the most common transmission route for HAIs?
