Edema
HTN
Pulmonary edema /CHF/SOB
Why is Na+ balance important?
Lead to vol. expansion
Increased co
Increased peripheral vascular resistance
Increase BP
What is the primary cause of anemia?
What is secondary cause of anemia?
Inflammation around the heart
What is included in pericarditis tx?
-Decrease or stop heparin
-give lore frequent dialyis
What are the four key elements of CKD-MBD?
Ca+
PTH
Phosphorus
Vitamin D
What does DARN stand for?
Be used when training to perform procedures.
Best used to allow time to digest bad news or understand a patients Sx
Best used to help patients resolve change behavior problems
What does RULE stand for?
RESIST/RECOGNIZE
UNDERSTAND
LISTEN
EMPOWER
What are the three core communication skills to be used?
Provides a short of what the listener heard the pt. say at the moment
Reflects what the pt. feels and what they mean
Provides summary of the entire conversation and includes main aspect of what the pt. said
Is there any order to work through 5 stages of grief?
No right or wrong way some people get stuck
Can one experience 5 stages of grief more than once?
The Psychosocial assessment is completed by the social worker:
CMS requirement to be administered annually to all dialysis pts.
Counselor
Advocate
Coach
Educator
Result that can’t take care susceptible pt
Result that means pts. are immune
How long to store Epogen?
How long to store preservative like Heparin?
Controlled fluid removal by manipulation of hydrostatic pressure
Solutes are dragged accross the semipermeable membrane
Particles (solutes) move from area of higher solute concentration to an area of lower solute concentration
Fluid moves from lower solute concentration to higher solute concentration
What are the 4 kidney’s excretory functions?
Fluid balance
Electrolyte balance
Waste removal
Acid base balance
3 kidney’s endocrine functions
Activate Vit. D3
Renin secretion
Erythropoietin
What is the action of bicarbonate in the dialysate solution?
Buffer the acid concentrate
What is the function of bicarbonate when it diffuses into the pts. blood?
Degree to which individuals have the capacity to obtain process and understand basic health information and services needed to make appropriate health decision
To assist the pts. understanding of instruction by the pt.explaining the instructions or ask them to demonstrate back
What are the educational tips for visual learners?
Note taking
Quite surroundings
Color
Visual aids
Short lectures
Eye contact
What are the educational tips for auditory learners?
Repeat information
Read written notes out loud
Word association or mnemonics
Watch videos
Discuss explain
Time to read
Educational tips for tactile learners?
Background
music
Keep notes
Short lectures
Frequent short breaks
Role playing
What is the rule to use when teaching patients more complicated skills? What fo was the numbers refer to?
What are the 3 meds PCTS can administer per Davita P&P?
How long do we wait after administering the heparin bolus prior to tx inititation?
What is the time frame during which single use medications should be prepared administered?
How do you verify your needle is not in the access when administering lidocaine?
Aspiration (pull back) needle
How do you administer Topical Anesthetic Spray?
-Wash arm
-Clean site per P&P
-Spray for 4-10 seconds from a distance of 3-7 inches—-don’t frost the skin-numbing effect occurs with blanching
What does TRAMP stand for?
Time
Route
Amount
Medication
Patient
What prompts visit from a surveyor?
Initial survey for certification
Recertification every 2-3 years
Additional services
Relocation
Complaint
Follow up survey
Poor on DFR
Three types of CMS deficiencies
Standard deficiency
Condition
Immediate jeopardy
Enables the surveyors to quickly assure pt. safety prior to full audit
Explain what is meant by a Culture of Safety
Describe the four AVF evaluations for maturation based on the KDOQI rule of 6
600 ml flow through access
.6 cm in depth under the skin
.6 cm diameter
6-8 weeks post op maturation
When you listen “Water hammer pulse”
When you hear “whistling sound” in access
Needle gauge for initial cannulation
Per MD prder , used for arterial pull
Used to help engorge distula and stabilize vessel
Blood loss
Erosio
Stenosis
Thrombosis
Infection
Pseudo aneurysm
Steal
Syndrome
Site rotation healing time
Ddistance from anastomosis or between needle tips
Pt will need to be in supine position to decrease risk of air embolism
What role does the Davita’s P&P play?
Standard of care
Best demonstrated practices
Prima facie evidence
What are the risk of doing it your way?
Negligence
Proximate cause
Damages
Primary ion contributing to conductivity
Bfrs not reduced
Waiting only 5 seconds
Drawing post BUN from venous line
Lab draws mistakes that will result for falsy DECREASE Kt/V
Diluting pre tx Arterial BUN
Waiting longer than 15 secs
What factors influence V?
Amputation
Age
Sex
Height
Type of access
What factors influence t?
Running prescribe time
Encourage pt to run entire tx
Getting off early
Inadequate coagulation
Decreased BFR
Poor priming
Not following P&P
Pt not staying on tx as prescribed
Increased BFR
CorrecT DFR, dialyzer, TW-amputation factor
Prevent equipment damage
Pt.
Safety
__ in water used for dialysis causes anemia, bone ds., nausea and vomiting
Chlorine in water used for hemodialysis causes?
Excess ca+ and na+ in water used for dialysis causes
Excess ca+ and mag+ in water used for dialysis causes:
Water / dialysate culture results acceptable level?
Water dialysate culture results action level?
Water or dialysate culture results unacceptable level:
What removes chlorine/chloramine?
What is removed un hardness testing?
When do we test hardness test?
Response to final water quality alarm
Bypass
Notify CN/FA/biomed
If not restored terminate tx
AKI pts are at increased risk for which complications
Hypovolemia and hypotension
What are the most common causes for CKD in the USA?
Provides a powerful tool for assessing facility performance and improving the lives of pts
Why do we document in medical record
Proof that care was rendered
Provided
data continuity
Permanent legal records
Communication tool
What does SMART stands for?
Simple
Meaningful
Actual
Read
Teach
What are the 5 “W”s to be used when completing REM
What are the 3 things you should not include in REM
Personal opinions
Speculations
Venditas
What are the consequences of sodium loading
Excessive thirst
Fluid retention
ELevated BP
State 3 ways we can contribute to sodium loadin
Broth
Ns
Increase sodium in dialysate
Four phases pf PD exchange
Requires employers to provide workers with a safe workplace
Is concerned with patient care and patient safety
Cms regulations and interpretative guidance related to infexn control
Heb B surface antigen tested when