CCHT Exam 2022 Questions and Answers Graded A

What is an infection? - ANSWER An invasion of body tissue by organisms that are invisible to the eye. Dialysis surfaces must be disinfected with what solution? - ANSWER 1:100 bleach solution Large blood spills over ...

What is an infection? - ANSWER An invasion of body tissue by organisms that are invisible to the eye. Dialysis surfaces must be disinfected with what solution? - ANSWER 1:100 bleach solution Large blood spills over 10ml must be disinfected with what solution? - ANSWER 1:10 bleach solution What is Aseptic technique? - ANSWER Practices and procedures performed under carefully controlled conditions. Minimizing contamination by pathogens. When sterile meets sterile.. - ANSWER It remains sterile When sterile meets clean.. - ANSWER It becomes clean When sterile or clean meet dirty.. - ANSWER It becomes dirty PPE - ANSWER Personal Protective Equipment. Full face shield or mask, eyewear with full side shield, and fluid-resistant gowns and gloves. 3 blood borne pathogens that may be found in a dialysis unit - ANSWER Hepatitis B, Hepatitis C, and HIV What is an exposure incident? - ANSWER A bloody/body fluid splash/spray occurring to the eyes nose or mouth, or non-intact skin. What steps should you take if you have been exposed to the fluids? - ANSWER Wash/rinse immediately. Report to CM. Seek medical treatment. What is hepatitis? - ANSWER Inflammation of the liver due to various causes How can the viral form of hepatitis be spread? - ANSWER Hep A- via contaminated food and the oral-fecal route Hep B & C- via exposure to blood/body fluids Why are patients with Hep B dialyzed in isolation room? - ANSWER Extremely contagious, lives outside the body for extended periods. (up to 7 days) Why do we dialyze Hep C patients in the clinical area? - ANSWER Not as contagious as Hep B. HCV is not known to survive very long outside the body What blood test indicates infection with Hep B? - ANSWER HbsAg test for Hep B antigen, indicates actual viral presence. What blood test indicates the presence of immunity against Hep B? - ANSWER HbsAb test for antibodies, indicates immunity against Hep B Which vaccine provides long-term immunity to Hep B? - ANSWER Series of multiple injections of either Recombivax or Engerix Positive Tuberculin skin test, or exposure to TB - ANSWER Patients with active TB are contagious. How is Tuberculosis spread? - ANSWER Droplet of nuclei produced from infected individuals when they cough, sneeze, speak, or sing How do you prevent TB in a dialysis clinic? - ANSWER Patients who have active TB cannot dialyze in a hemodialysis clinic. 3 consecutive (-) sputum cultures before returning to the clinic What is VRE (Vancomycin-resistant enterococci)? - ANSWER Gram negative, round-shaped bacteria that commonly live in the intestinal tract. Can cause infection anywhere in the body, an resistant to several antibiotics. What is MRSA (Methicillian-resistant Staphlyococcus Aureus) - ANSWER "Staph". Normally found on the skin or in the nose. Harmless until they enter the body through a cut or other wound What precautions should you take when caring for MRSA/VRE? - ANSWER PPE, hand sanitation before next task, dedicated gown should be worn. CVC dressings should be disposed of in red BIO. DO NOT need isolation. Hands should be washed for 40-60 seconds. What is C-Diff? - ANSWER Clostridium difficile, hand washing is required. Why is hand hygiene important? - ANSWER Single most important infection control measure to prevent the spread of infection. What are the anatomical structures of the urinary system in order of urine flow? - ANSWER 2 kidneys, 2 ureters, 1 bladder, and 1 urethra What are the functions of a healthy kidney? - ANSWER Removal of waste products (creatinine, urea, and uric acid). Regulate fluid, acid base, and electrolytes. What is urea? - ANSWER By-product of protein metabolism What is creatinine? - ANSWER By-product of muscle metabolism Uric acid - ANSWER Naturally in the body, as a result of the metabolism of purine (muscle protein) that enters the body through dietary intake. What are the hormonal functions of the kidneys? - ANSWER Production of renin to help regulate/control BP, production of erythropoietin (stimulates RBC production), and regulation of calcium/phosphorus balance through the activation of Vit D. What is the nephron? - ANSWER Functional unit of the kidney. Tubular structure, filters blood to form urine. What is the glomerulus? - ANSWER Network of capillaries that performs the first step of filtering blood. Filters water and solutes into Bowman's capsule. What are the hormones secreted by the kidney? - ANSWER Renin and Erythropoietin Which of the functions of healthy kidneys can be replaced by dialysis? - ANSWER Removal of waste products and regulation of fluid balance. What is the function of renin? - ANSWER Hormone produced by the kidneys to regulate blood pressure, and on sodium and potassium balance. What is the function of erythropoietin? - ANSWER Stimulates the bone marrow to produce RBC. What is the synthetic form of Erythropoietin? - ANSWER Recombinant Epoetin Alfa (Epogen) Why must the kidneys activate Vit D? - ANSWER Helps to maintain good bone health by helping absorb calcium from foods eaten. What is the synthetic for of activated Vit D? - ANSWER Calcijex, Zemplar, and Hectorol What is the difference between ARF and CRF? - ANSWER ARF is sudden in onset; often reversible. CRF is slow, progressive and permanent. What are 3 common causes of renal failure? - ANSWER 1) Diabetes 2) Hypertension 3) Glomerulonephritis What are classic s/s of renal failure or uremia? - ANSWER Elevated serum levels of BUN/creatinine, phosphorus, and potassium, anemia, fluid overload, lethargy, weakness, edema, high b/p Why are renal failure patients acidotic? - ANSWER Kidneys control acid/base balance of the blood by excreting hydrogen atoms and producing a buffer (bicarbonate) What causes renal osteodystrophy (bone disease) - ANSWER Kidneys can no longer convert Vit D to its activated form. What needs to be considered when administering medications to patients with renal failure? - ANSWER Loss of renal function will decrease the elimination of medications and potentially cause toxicity. What is the purpose of a phosphate binder? - ANSWER Binds with phosphorus (from foods) in the gut, and then eliminates the excess phosphorus through the digestive system. What are Hectoral, Calcijex, and Zemplar? - ANSWER Helps patients absorb their dietary calcium in order to bone disease. What is anemia? - ANSWER Lack of RBC How is anemia treated? - ANSWER Epogen is a medication given to stimulate RBC production an keep the patients hemoglobin levels at an acceptable level. What is the desired hemoglobin level for dialysis patients? - ANSWER 10-11 g/dL How is hypertension treated? - ANSWER Dialysis treatment removes excess fluid which is a contributing factor or hypertension. Antihypertensive medications may be prescribed for patients What is Diabetes? - ANSWER A disease in which the body either does not produce or does not properly use insulin and therefore cannot properly regulate levels of glucose in the blood What are 3 s/s of low blood sugar? - ANSWER Double vision, hunger, thirst, restlessness, rapid pulse, confusion, seizures, and coma. Intracellular - ANSWER Inside the cell Extracellular - ANSWER Outside the cell Intravascular - ANSWER Inside the blood vessel Interstitial - ANSWER Between the cells What is homeostasis? - ANSWER Steady internal state of equilibrium in the body. What are electrolytes? - ANSWER Charged particles that can conduct an electrical current. Control motor, muscle, and nerve function. What is pH? - ANSWER The measure of acidity or alkalinity of solution, based on the number of acid ions. What is the normal pH of blood? - ANSWER 7.35-7.45 What is bicarbonate? - ANSWER A buffer that helps to maintain a constant pH in a solution even if a acid or base is added. What is metabolic acidosis? - ANSWER The state of too much acid in the blood What are symptoms of dehydration? - ANSWER Thirst, dry mucus membranes, sunken eyes, poor skin turgor. What are symptoms of fluid overload? - ANSWER Edema, cough, SOB, increased b/p, confusion What are 3 types of solutions? - ANSWER Hypertonic (containing more particles) Hypotonic (containing less particles) Isotonic (containing equal particles) What is diffusion? - ANSWER The movement of solutes from an area of GREATER concentration of solutes to an area of LESSER concentration. What factors affect the rate of diffusion? - ANSWER Concentration gradients, Molecular weight, temperature What is osmosis? - ANSWER Movement of fluid from an are of LESSER concentration to an area of GREATER concentration. At what point during treatment will diffusion cease to occur? - ANSWER Continue until the concentration of each electrolyte found in the patients blood is equal to the electrolyte concentrating in the dialysate. What is dialysate? - ANSWER Non-sterile solution, composed of purified water, acid solution, and bicarbonate solution. What is the function of dialysate? - ANSWER To remove waste products from the blood and balance electrolytes. What electrolytes are found in the dialysate? - ANSWER Sodium (NA), potassium (K), calcium (Ca), magnesium (Mg), and chloride (Cl) Why is dextrose added to dialysate? - ANSWER To prevent hypoglycemia What is the purpose of checking dialysate? - ANSWER To verify that the dialysate is compatible with human pH When should conductivity and pH be checked? - ANSWER Manually prior to the ignition of every treatment What are normal ranges for temperature? - ANSWER 35-39 C What are normal ranges for pH? - ANSWER 6.9-7.6 What are normal ranges for conductivity? - ANSWER 12.6-15.9 Why do we use biocompatible membranes in the dialyzer? - ANSWER Closely related to the cells and tissues of the human body, less likely to cause allergic reaction What are some factors used in the selection of a dialyzer for a patient? - ANSWER Body size, clearance needs, ultrafiltration needs and membrane biocompatibility. What are the compartments of the dialyzer? - ANSWER 1) Blood compartment 2) Dialysate compartment What separates the 2 compartments? - ANSWER The blood compartment is separated from the dialysate compartment by a semi-permeable membrane. What is a semi-permeable membrane? - ANSWER A membrane made from protein, with small pores or holes. Only certain molecules can fit through. What should be checked on a dialyzer before machine set up? - ANSWER Checked for sterility, structure damage, and be the size and brand ordered by the Dr How is dialysis delivered? - ANSWER The Hemodialysis Machine. How much saline should be infused through the dialyzer and extracorporeal circuit? - ANSWER 300 mLs to prime the dialyzer and circuit with normal saline. How much saline is used for a "fresh fill"? - ANSWER 50 mLs NS through the arterial and 250 mLs NS through the venous. When should the Hanson connectors be connected to the dialyzer? - ANSWER NS has been primed, both lines connected, test passed, and conductivity and pH checked. What position should the dialyzer be in during circulation? - ANSWER Venous end up How long can a dialyzer recirculate with saline before it is considered unsafe to use? - ANSWER 4 hours What volume should be used for fresh fill? - ANSWER 50 mL of saline from arterial and 250 mL of saline from venous What 3 processes occur in the dialyzer simultaneously? - ANSWER Diffusion, osmosis, and ultrafiltration What is ultrafiltration during dialysis? - ANSWER More than 1 type of pressure to remove fluid from the blood, positive and negative pressure combined. What direction does blood flow through the dialyzer as compared to dialysate flow? - ANSWER Blood and dialysate flow in a countercurrent flow. What is TMP? - ANSWER Transmembrane pressure, the pressure difference across the dialyzer membrane. How can you tell if a dialyzer is clotting? - ANSWER Rising TMP, rising venous pressure, dark blood in dialyzer, and air detector alarms. What is heparin? - ANSWER Anticoagulant that prevents clotting After heparin is given, how long must you wait before initiating treatment? - ANSWER 3-5 minutes When do you not give a patient heparin? - ANSWER 1) Allergic to it 2) Actively bleeding 3) Scheduled for surgery/Post surgery For how long can a patients blood be re-circulated during treatment interruption? - ANSWER 15 minutes, longer than 15 minutes blood needs to be given back 1 kg = - ANSWER 2.2 lbs What does "estimated dry weight" mean? - ANSWER Estimated weight of the patient without any s/s of edema What is adequacy of dialysis? - ANSWER Measurement of how well we are cleaning waste from the patients blood How can we measure how well we clean our patients blood? - ANSWER By measuring the amount of waste in the patients blood before and after dialysis. Clearance of urea is best described as? - ANSWER The amount of urea cleared from the blood in milliliters per minute (ml/min) What improves clearance of urea? - ANSWER Well-functioning access, proper priming, dialysate flow, blood flow, heparin Why is measuring the adequacy of the dialysis treatment important? - ANSWER When treatment is more effective, patients live longer and have fewer health problems.