PCT test (Davita) Questions & Answers 2021/2022.

PCT test (Davita) Questions & Answers 2021/2022. what is REM and what is used to submit? - Risk Event Management and unsafe condition, near miss, and an adverse event Sterile means - free of all living microorganis ...

PCT test (Davita) Questions & Answers 2021/2022. what is REM and what is used to submit? - Risk Event Management and unsafe condition, near miss, and an adverse event Sterile means - free of all living microorganisms and spores clean means - not sterile, but disinfected such as a clean dialysis chair contaminated means - that a sterile or clean item has come in contact with non-sterile object dirty means - neither sterile or clean, but visibly contaminated Alcohol-bases hand rubs must contain - 60-95% ethyl alcohol, isopropyl alcohol, or a combination of both How long should you wash your hands for? - 20 seconds PPE includes what? - gloves, gowns, masks, protective eye gear environmental surfaces are cleaned with appropriate disinfectant such as a bleach solution - 1:100 one part bleach and 99 part water for visible blood or gross blood spills, a ______ bleach solution must be utilized - 1:10 1 part bleach and 9 parts water when preparing patient assignments, teammates who care for confirmed or suspected hep B surface antigen (HBsAg) positive patient(s) will only be assigned to simultaneously care for surface - antibody positive (immune) patients Although dialysis is a complex procedure, it is based on simple principles - use of a semipermeable membrane, diffusion, ultrafiltration, convection, and osmosis what are the 3 treatment goals to achieve in dialysis? - 1. Remove waste from the blood 2.remove excess water from the blood 3. balance blood electrolytes semipermeable membrane - thin sheet of natural or synthetic material that allows some small particles to pass through, while blocking other, larger ones. what is a dialyzer and the 2 compartments - artificial kidney and blood site and dialysate site what happens if the blood site and dialysate site mix? - = blood leak what is dialysate (3 things)? - RO water, acid bath, and bicarbonate what is an extracorporeal circuit? - bloodline, saline, and dialyzer=set up What is diffusion? - movement of dissolved particles across a semipermeable membrane from the side with the higher concentration to the side with the lower concentratio n. What is ultrafiltration? - removes water from the blood by pushing it across the semipermeable membrane What is convection? - or solute drag is when solutes move with the water across the semipermeable membrane. What is osmosis? - is the movement of water across a semipermeable membrane from the side with the lower solute concentration to the side with the higher solute concentration After a chemical disinfection with bleach, how do you verify that the machine is free of residual bleach before you start setting up? - check the fluid from the drain hose with residual chlorine test strip What is an acceptable test result when verifying the absence of residual bleach? - less than or equal to 0.5ppm What is strikethrough? - Saline rises in transducer allows for inaccurate readings. The back of transducer is checked for wet. If wet can contaminate machine. Pull for bio med. what is the only fluid we use to prime the blood lines and dialyze? - sodium chloride 0.9% (normal saline) what is proportioned dialysate? - even amounts of RO water, acid bath and bicarbonate The manual conductivity must match the dialysis delivery system displayed conductivity_________ - +/- 0.4 mS of the theoretical conductivity (TCD) for Fresenius delivery systems The maximum recirculation time after a machine has been set up prior to treatment initiation cannot exceed _____ hours. - 2 hours What is the rationale for limiting recirculation time? - bacterial proliferation in the extracorporeal circuit may occur Some blood lines are equipped with external transducer protectors. What is the correct procedure to be followed once strikethrough of an external transducer protector has occurred? - upon completion of treatment, the delivery system is to be removed from service and labeled with date, time, description of problem and name the teammate reporting the problem. the internal transducer protector will be changed by boomed tech. and delivery system will be disinfected prior to return use The acceptable range for proportioned dialysate pH is ____________ - 6.9-7.6 When are dialysate conductivity and pH testing required to be performed? - prior to initiating a treatment and whenever dialysate concentrate(s) (acid or bicarb) are changed or replaced during the course of the treatment If bleach and peracetic acid are mixed, a chemical reaction occurs, producing - toxic chlorine gas What are the two requirements that must be met prior to initiating system disinfection? - the treatment area must be patient free and no other processes are using the dialysis quality water What must be done to indicate the presence of disinfectant in the machines during system disinfection? - notification of the type of disinfection is prominently displaced on each delivery system How do we verify the absence of chemical disinfectant following system disinfection on the first treatment day following the disinfection? - facility teammates perform an independent chemical residual test prior to beginning the daily activities What is an acceptable test result when testing for the absence of peracetic acid? - a level or less than or equal to 1 ppm Dialysate with a conductivity that is too low causes.... - hemolysis, the bursting of RBCs. The color of hemolyzed blood is cranberry red. Dialysate with a conductivity that is too high causes... - crenation, a shriveling up of RBCs. The color of the blood will be dark. The transport mechanism of osmosis is responsible for.... - hemolysis and crenation as water leaves or enters RBCs. If the dialysate temperature becomes too hot... - it can hemolyze RBCs. A dialysate temperature too cold - s not life threatening but can chill the patient and cause hypothermic symptoms and may decrease diffusion Dialysate Flow Rate (DFR) - is ordered by the physician as part of the prescription blood leak detector? - checks for blood in dialysate during the treatment, air bubbles can cause false alarm during set up and priming and to correct check Hansen connectors and verify they are tight transmembrane pressure (TMP) - equal to the venous pressure minus the dialysate pressure measured in mmHg. Blood Flow Rate (BFR) - resistance to the flow establishes the pressures in the extracorporeal circuit Arterial Pressure (AP) - blood pump pulls blood from the vascular access, this pressure is negative Venous Pressure (VP) - After the blood leaves the dialyzer and is pushed through the venous drip chamber and back into the body, the pressure reading becomes positive water makes up about.. - 90% of dialysate what are the 3 processes that make up the water treatment? - pretreatment, water purification, and distribution what does AAMI stand for? - Association for the Advancement of Medical Instrumentation pretreatment consist of? - blending valve, black flow preventer, booster pump, depth filter, water softener, carbon tanks, RO pre-filter blending valve? - Mixes hot and cold water to allow the RO to function at the most efficient temperature, which is 77 F for conventional systems. between 65 F to 85 F Backflow Preventer - Prevents pre-treated water and disinfectants from backing up into the city water supply booster pump - expectation tank catches additional pressure booster pump gives off multimedia or depth filter - Filters out suspended particles like silt and sand in the water and traps solutes and other substances water softener - "Softens" hard water by removing calcium and magnesium from the incoming water carbon tanks - primary and secondary carbon tanks RO pre-filter - Removes fine carbon particles, resin beads and other debris; is placed just before the RO unit purification requires.. - water to pass through RO membranes followed by an ultrafilter the RO unit removes.... - removes bacteria, viruses, endotoxin, salts, particles and other solutes by reversing the transport mechanism osmosis RO membranes are very permeable to water but not to chemicals, substances that are not dissolved, or microorganisms and most substances..... - (90-99%) are rejected from the water. ultrafilter - also known as the pyrogen or endotoxin filter is placed at the end of the water treatment system prior to the first point of use and is capable of removing viruses, bacteria, and most endotoxin Observations and test results listed on the Daily Water Treatment Log are entered each facility operating day ______ to the start of dialysis treatments. - prior A ___________ reviews the Daily Water Treatment Log for completeness and verifies that all parameters are within specified limits. - licensed nurse Total Chlorine testing is done on a daily basis prior to the first patient treatment and every_______ hours until all activities that require use of dialysis quality water are completed. - four All total chlorine samples are to be drawn only after the water system has been operating for at least _____minutes. An acceptable total chlorine test result after the primary carbon tank is less than or equal to _____ppm. - 15 minutes and 0.1 ppm The Auto Chlorine Monitoring- Hach CM130- automatically monitors the ____________ every 5 minutes. - chlorine Hardness testing is done on water leaving the water softener at the ______of the treatment day. - end Hardness testing results that are greater than _______________ must be reported to the biomed teammate and the facility administrator to initiate corrective actions. - one grain per gallon contaminant chloramines sign and symptoms - hemolysis and anemia Water Analysis for chemical contaminants is performed at least annually and: (fill in the four occasions listed in the policy) - at system installation, when RO membranes are replaced, when seasonal variations in source water suggest worsening quality, and when RO rejection rate falls below 90% Bicarbonate concentrate acts as a.. - buffer The pH testing of the final dialysate verifies that the bicarbonate concentrate has been.... - prepared correctly Any residual acid concentrate from single gallon containers, storage containers, concentrate mixers, storage tanks and concentrate sampling containers... - must be neutralized wi th sodium bicarbonate powder prior to disposal this evaluation and assessment is performed by the ____________ and includes pertinent general information as well as hemodialysis specific information. - registered nurse (RN) Upon admission of a patient, an appropriate teammate will give the patient (or legal guardian) - a copy of the Patient Rights and Responsibilities who are the only ones that can perform assessments? - RN or charge nurse what are the six basic pre-treatment assessments? - pre-weight, mobility, vital signs, edema, the patients general disposition, and vascular access List three symptoms below that would alert you that a patient's target weight may have to be increased: - excessive cramping, hypotension, dizziness List three symptoms below that would alert you that a patient's target weight may have to be decreased: - hypertension, peripheral edema, congestion in the lungs, neck vein dissension how do you determine the interdialytic weight gain (IDWG)? - today's pre-treatment weight minus last treatment post weight how do you determine UF- goal? - today's pre-treatment weight minus the target weight plus the total amount of fluid - prime & rinseback, oral fluids and IV meds - to be received during the treatment he physician will determine the maximum hourly UF rate which should not exceed... - 13 ml/kg/hour for each patient as part of the dialysis orders ________________ is an electrolyte that has a major role in muscle contraction and high or low levels can lead to weakness and even cardiac arrest. - potassium Patients whose kidney failure is caused by diabetes are more likely to have _________________________ (nerve damage) which can affect their mobility. - neuropathy any temperature above 100 F.... - is considered a fever atients presenting pre-dialysis with a fever or a temperature that is 2 degrees over their usual baseline should be evaluated for the presence of a.... - systemic or access infection/inflammation and the charge nurse should be notified Compare the BP reading to the patient's usual readings and report any significant findings or changes to the charge nurse such as: - -systolic greater than 180 mm/Hg or less than 90 mm/Hg -diastolic greater than or equal to 100 mm/Hg -A 20mmHg difference (increase or decrease) from the patient's typical pre-treatment reading (systolic or diastolic) hypertension may be related to... - fluid volume excess, not adhering to prescription regimens, use of OTC cold medications, use of street drugs, renin response hypotension may be related to... - postural changes, recent medication dosage, dehydration/fluid loss, cardiovascular disease what is a normal heart rate? - 60-100 bpm ******CONTINUED