DaVita ICHD Nurse/PCT Test Questions with Correct Answers

Cardiac Arrest: - ANSWERSDefinition: Cessation of heart beat. Signs/Symptoms: Absence of pulse, lack of respiration, unresponsiveness Interventions:Assess ABC's, get help, CPR, return blood, keep access open, call EMS, maintain patency of needles or CVC ports with NS Angina - ANSWERSDefinition: Chest pain or discomfort due to Coronary Heart Disease. Occurs when heart muscle doesn't get as much blood as it needs. May also feel discomfort in neck, jaw, shoulder, back or arm. Uncomfortable pressure, fullness, squeezing pain in center of chest. S/S: Chest pain, difficulty breathing, nausea Interventions: Reduce BFR to 150, reduce UFR, give O2, monitor cardiac rhythm/VS Dialysis Disequilibrium Syndrome (DDS) - ANSWERSDefinition: A condition in which rapid or drastic changes in the patient's extracellular fluid affect the brain S/S: Headache, hypertension, nausea, restlessness, convulsions/seizures, confusion, blurred vision Intervention: decrease BFR and DFR, shorter initial treatments, Hypertension - ANSWERSDefinition: high blood pressure (Pre-Dialysis: 140/90; Post 130/80) S/S: No symptoms, headache, dizziness, Irritability, Blurred vision, nervousness, edema secondary to fluid retention Intervention:Determine cause, maintain fluid balance take medications as prescribed, notify MD hypotension - ANSWERSDefinition: low blood pressure (Systolic: 90, Diastolic: 60 or drop in systolic more than 20 mm/hg S/S: flushing, yawning, dizziness, ear ringing, tachycardia, anxiousness, nausea/vomiting, cold clammy skin, seizures, cardiac arrest Interventions: place pt in supine position, decrease UFR to minimum, provide drinking water for less severe hypotension, give 100-200 mL saline for severe hypotension, monitor BP, notify RN Muscle Cramps - ANSWERSDefinition: painful muscle contractions in extremities or abdomen typically occurring due to rapid/excessive fluid removal. S/S: painful cramps usually occuring later in dialysis Intervention: massage or apply opposing force, give normal saline bolus, reduce UFR, assess dry weight Fever & Chills - ANSWERSDefinition: Any temp greater than 100° F or increase over baseline of 2° F with symptoms S/S: Temp 100°F, involuntary shaking, chills, hypotension, nausea, vomiting, headache, hypotension, tachycardia, hot flushed skin, dry mucous membranes Interventions: nurse must assess pt for possible cause of fever, notify treating nephrologist and obtain cultures per protocol, administer antibiotics as ordered Pyrogen Reaction - ANSWERSDefinitions: elevated temp- usually occurs 45-75 min into treatment as a result of pyrogens (endotoxins) S/S: chills, shaking, fever, hypotension, vomiting, muscle pain Intervention: Provide support, report pt s/s to RN, stop tx, do not return blood, notify MD. Seizures - ANSWERSDefinition: involuntary muscle spasms and loss of consciousness S/S: change in level of consciousness, twitching/jerking movements of the extremities Intervention: protect pt and access arm from harm, protect airway, administer O2, d/c dialysis Blood Loss - ANSWERSDefinition: loss of blood typically due to dislodged needle, bleeding at access site, disconnection of lines, system clotted and unable to return blood. S/S: hypotension, loss of consciousness, blood on floor, chair or clothing, blood lead detector alarm, VP alarm if needle dislodged or line separate, TMP alarm, visible clots in chamber Interventions: Manage symptoms, give saline replacement if needed, give O2, fix cause Clotted Dialyzer - ANSWERSDefinition: Dialyzer membrane clotted S/S: decrease in VP with no change in BFR, visible clots in the venous drip chamber or line, dark blood, unable to rinse back pt's blood Intervention: ensure proper use of heparin, monitoring pressures, maintain proper BFR. Change set up, determine cause Hemolysis - ANSWERSDefinition: rupture of red blood cells S/S: cherry red blood,anxiety, restlessness, abdominal cramping, back pain, chest tightness/dyspnea, seizures, thready pulse, hyper/hypotension Intervention: Stop blood pump, clamp lines, do not return blood, RN assess pt, administer O2, monitor VS and cadiac rhythm, check hemoglobin and K+ First Use Syndrom - ANSWERSDefinition: a group of symptoms that occur shortly after starting a treatment with a new dialyzer; may be caused by manufacturing residues in dialyzer S/S: Nervousness, chest pain, back pain, palpitations, itching, funny taste in mouth Intervention: notify RN, manage symptoms, d/c tx, notify MD Disinfectant Infusion - ANSWERSDefinition: disinfectant being infused into pt's blood stream as a result in a breach in protocol S/S: pain at venous needle site, itching, restlessness, respiratory distress/SOB, flushing, chest pain, tingling around lips, back pain, hemolysis Interventions: discard bicarb and rinse mixer according to policy, do not initiate treatments until residual tests are negative Dysrhythmias - ANSWERSDefinition: irregular heart beat S/S: irregular HR, palpitations Interventions: treat cause