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 snap ...

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 rules for spinning samples - ANSWER only spin tube of same kind, size, and fill level and should be placed opposite of each other systemic effects of CRF what would you advise for a pt who complains of dry, itchy, skin - ANSWER hyperfatty soaps and lotions systemic effects of CRF- what would you advise for a patient who complains of peripheral neuropathy? - ANSWER no walking barefoot, check water temp before baths what would you advise for a patient who complains of psychological problems? - ANSWER depression, brain fogginess what are the foru key elements affected in CKD-MBD - ANSWER Ca2+ Phosphorus Calcitrol Parathyroid what are symptoms of CKD-MBD in addition to bone disease? - ANSWER soft tissue classification what is your role in CKD-MBD in addition to bone disease? - ANSWER soft tissue calcification what is your role in CKD-MBD management? - ANSWER pt education how much normal kidney function is replaced by HD? - ANSWER 15% What does DARN stand for? - ANSWER D-- desire A-- ability R-- reason N--need One component of the directing style is: a) being in charge b) seeing through the other person's eyes c) understanding through listening - ANSWER a) being in charge One component of the following style is a) eliciting behavior through patient's own insights and motivations b) giving instructions c) understanding through listening - ANSWER c) understanding through listening One component of the guiding style is a) allowing to sort things out in one's own time b) being a knowledgeable resource c) expecting compliance - ANSWER b) being a knowledgeable resource The three core communication skills used in motivational interviewing are? a) monitoring, persuading, advising b) explaining, comprehending, adapting c) inquiring, directing, following d) asking, listening, informing - ANSWER d) asking, listening, informing The four guiding principles in motivational interviewing can be remembered by the acronym a) GUIDe b) RULE c) PRINce d) MOTIv - ANSWER b) RULE The righting reflex is defined as - ANSWER the automatic intervention of a healthcare practitioner who observes a patient doing something detrimental to his/her health The EPE (elicit-provide-elicit) approach allows the healthcare professional to work with the patient and emphasizes - ANSWER patient's active involvement in his/her own healthcare Summarizing during reflective listening a) recalls the patient's resistance statements to change and summarizes reasons for change b) summarizes strategies for change based on the practitioners expertise c) includes main aspects of what the patient said during the entire communication d) includes the practitioners opinion of what the patient said during the entire conversation - ANSWER a--> not 100% sure but pretty sure The best way to help patients successfully change behaviors is to a) scare them through describing serious health risks of the current behavior b) inspire behavior change through support, compassion, and empathy c) tell them how to accomplish the desired change d) list medically sound reasons why change is necessary - ANSWER b) inspire behavior change through support, compassion, and empathy Which of the following statements is NOT an underlying assumption of self management? a) regardless of the chronic condition, people have similar challenges with self-management b) people can learn the skills needed to better manage their diseases day to day c) people with complex chronic conditions such as ESRD have more difficulties with successful self-management d) people who understand and take control of their condition will be healthier and happier - ANSWER c) people with complex chronic conditions such as ESRD have more difficulties with successful self-management Which of the following is a basic principle of patient self-management? a) focusing primarily on dialysis prescription and adherence to treatment b) dealing with the consequences of illness, rather than just the physical disease c) taking on responsibility of the medical management of the illness