Fresenius Final Exam Questions and Answers Already Passed

Fresenius Final Exam Questions and Answers Already Passed What is the number 1 infection control practice? ✔✔hand washing Who is dialyzed in an isolation room? ✔✔HBsAG+ patients True or False: Hep B is bloodborne ✔✔t ...

Fresenius Final Exam Questions and Answers Already Passed What is the number 1 infection control practice? ✔✔hand washing Who is dialyzed in an isolation room? ✔✔HBsAG+ patients True or False: Hep B is bloodborne ✔✔true Who is dialyzed in a separation room? ✔✔MRSA, VRE, or VRSA patients Where are active TB patient's dialyzed in? ✔✔in the hospital in a negative pressure room If potential exposed to HIV, in how much time should you receive prophylaxis treatment? ✔✔within 2 hours What is the urinary system made up of? ✔✔2 kidneys, 2 ureters, bladder, and a urethra Where does blood enter the kidney? ✔✔Through the renal artery What is ADH? ✔✔antidiuretic hormone What does ADH do? ✔✔It affects the healthy kidney by reducing the excretion of urine What are the kidneys four functions? ✔✔excretory, endocrine, regulatory, and filtration What hormones do the kidneys produce? ✔✔renin, erythropoietin, and calcitrol What does renin do? ✔✔It constricts blood vessels (vasoconstriction) which increases blood pressure What does erythropoietin do? ✔✔It signals bone marrow to produce RBC's What is the #1 and #2 cause of chronic renal failure? ✔✔#1 is DM and #2 in HTN What is uremia? ✔✔The build up of waste products in the blood What is dialysate made up of? ✔✔purified water, acid, and bicarbonate What electrolytes are in the acid solution portion of the dialysate? ✔✔calcium and potassium True or False: Dialysate is sterile ✔✔False. it is biocompatible and CLEAN. What is the purpose of the diasafe filter? ✔✔It ultra purifies the dialysate before it goes into the dialyzer which prevents endotoxins from entering the dialyzer/dialysate What is diffusion? ✔✔The movement of solutes across a semipermeable membrane from higher concentration to lower. What is the diffusion rate affected by? ✔✔It is affected by concentration gradient, temperature, and countercurrent flow. What is osmosis? ✔✔It is the movement of water from lower concentration of solutes to a higher concentration What is ultrafiltration? ✔✔It is the use of negative and positive pressures to pull excess fluid from patient What is the pt's "available weight"? ✔✔It is how much weight is needed to be removed to get the pt down to their EDW What are the 3 bod compartments? ✔✔Intravascular, intercellular, and interstitial What are the interventions for hypotension? ✔✔Place pt in reclining position with feet elevated. Turn UF down or off. Give bolus if needed. Notify RN. What causes cramping? ✔✔Shifting of electrolytes, attempting to pull large amount of fluid in short time, or going below EDW What do you do if a pt is complaining of chest pain? ✔✔Turn down BFR, and turn off UF. RN give O2, and MAYBE nitro if needed. When does disequilibrium syndrome possibly occur? ✔✔If pt's BUN is extremely high or if it is pt's first treatment What does hemolyzed blood have excess amounts of? ✔✔potassium What can occur if the arterial pressure is greater than -250? ✔✔hemolysis What is adequacy measured in? ✔✔urea kinetic modeling (UKM) What is used for measuring the level of kidney function in CRF patients? ✔✔glomelular filtration rate (GFR) What is Fresenius's goal for spktd/v? ✔✔1.4 What are the two types of alarms on the dialysis machine? ✔✔blood and dialysate What does the blood leak alarm indicate? ✔✔Fibers inside the dialyzer are broken causing blood and dialysate to mix together. What does an air detector alarm indicate? ✔✔That air is detected in the machine which causes the clamp to secure completely below venous chamber. What does the VP alarm indicate? ✔✔Venous pressure too high. Caused by kinks in lines, infiltration, clots, etc. What does the AP alarm indicate? ✔✔Arterial pressure is too high. Caused by blockage, clots, etc What does the TMP pressure alarm indicate? ✔✔There is a pressure difference across the membrane fibers inside the dialyzer What occurs if conductivity is too low? ✔✔Means it is a hypotonic solution and can cause hemolysis What occurs if conductivity is too high? ✔✔Means it is a hypertonic solution which causes crenation How do you draw post BUN labs? ✔✔1. Turn UF and DFR off. 2. Decrease BFR to 100 for 15 seconds then stop pump. 3. Clamp line. 4. Collect sample from arterial port How long does it take a fistula to mature? ✔✔4-6 weeks How long after can you cannulate a graft? ✔✔1-2 weeks after placement What is an infiltration? ✔✔It is when blood escapes from the blood vessels into tissue. How far apart should the venous and arterial needles be? ✔✔1-2 inches By the time kidney function reaches stage 5, how much percent function is left? ✔✔10-15% What does uremia cause? ✔✔N/V/D, and loss of appetite What happens when there is a decrease in production of calcitrol? ✔✔There is decreased absorption of calcium from the gut as well as a rise in PHT What are the two types of peritoneal dialysis? ✔✔Continuous cycling peritoneal dialysis (CCPD) and continuous ambulatory peritoneal dialysis (CAPD) What is "exchange"? ✔✔PD fluid placed in peritoneal cavity for period of time (dwell time) then drained, and refilled again. Which space is fluid pulled from primarily during dialysis? ✔✔Intravascular What are the signs and symptoms of hypotension? ✔✔Experiencing yawning, dizziness, lightheadedness, n/v, and blurred vision. When using the sodium variation system (SVS), when must it be stopped prior to the end of treatment? ✔✔30-45 minutes prior to What is fever and chills potentially caused by? ✔✔Infection, contaminate dialyzer or lines, or too cold dialysate. What are the signs and symptoms of disequilibrium syndrome? ✔✔nausea, vomiting, headache, hypertension, confusion, and restlessness. What are the signs and symptoms of hemolysis? ✔✔SOB, CP, burning at venous needle, and bright red translucent blood in chamber. What causes hemoylsis? ✔✔Hypotonic dialysate, dialysate temp greater than 105 F, kinks in blood line, bleach, chlorine and chloramines, or arterial pressure greater than 250. What are the signs and symptoms of air embolism? ✔✔SOB, coughing, chest pain. What causes clotting in the ECC? ✔✔If BFR is too slow, blood pump stops, or air in the system. What are the indications of clotting? ✔✔20% decrease in KECN numbers, darkening of blood in the lines/chambers, increased VP What are clotting preventions? ✔✔run pump at BFR ordered, attend and correct machine alarms ASAP, prime lines correctly at 150 cc/min and ensure all air is removed prior to hooking up patient, and keep chambers 3/4 full. What does exsanguination mean? ✔✔bleeding out What are blood loss preventions? ✔✔Correct taping technique, DO NOT flip needles, rotate needle site for cannulation, and do no cannulate aneurysms or pseudoaneurysms. What leads to inadequate treatment? ✔✔Inadequate BFR and DFR, shortened treatment time, or using a smaller dialyzer than what was ordered. What is drawn monthly to determine adequacy? ✔✔BUN How many OLC test are performed during each treatment? ✔✔4-6 What are the complications that can occur with accesses? ✔✔Infection, aneurysms and pseudoaneursyms, thrombosis, and infiltration What is "one site-itis" ✔✔repeatedly cannulating the same area What is thrombosis? ✔✔clotted access What is sign and symptoms of thrombosis? ✔✔no bruit or thrill What are the rules for renal diet? ✔✔fluid restrictions, decreased K, decreased P, and decreased NA What does AAMI stand for? ✔✔The Association for the Advancement of Medical Instrumentation Where does city water initially enter through? ✔✔Water inlet valve What does the water flow through to prevent the water from flowing back to the city? ✔✔backflow preventors What is the ideal water temperature for the reverse osmosis (RO) filtering system? ✔✔77 degrees F What is the water treatment blending valve used for? ✔✔It is used to mix hot and cold water to an acceptable temperature What is added to the city water to kill bacteria? ✔✔Chlorine and chloramine. If not removed it will cause hemolysis What removes chlorine and chloramine from the water? ✔✔carbon tanks When should total chlorine be checked? ✔✔Before the 1st treatment of the day and every 4 hours afterwards. What does KECN stand for? ✔✔Clearance effective by conductivity Because we cannot replace endocrine function, what do we administer to the pt's? ✔✔Active Vitamin D (calcitrol) and erythropoietin What is the dialysate tested for prior to each treatment? ✔✔Total chlorine, bacteria, endotoxins, conductivity, and pH. What causes a high venous pressure? ✔✔Kink in lines, infiltration, clotted access, and clotting in chamber What must the level of total chlorine be for the treatment to begin? ✔✔< 0.1 ppm What is used to exchange calcium and magnesium for sodium? ✔✔water softeners What is the percent rejection the RO must have to be safe? ✔✔80/90% How long must the RO be running before testing? ✔✔15 minutes What function of the kidney corrects acidosis? ✔✔Acid-Base balance What tells the kidney to retain SODIUM? ✔✔Aldosterone What is renal osteodystrophy and what causes it? ✔✔It is when bones become weak due to the PTH signaling for bones to release calcium. Calcium then deposits in soft tissue. What is the amount of blood cleared of a solute in one minute of dialysis at a given BFR and DFR? ✔✔clearance What is the shriveling of RBC's due to exposure of blood to dialysate? ✔✔crenation What is the internal system that provides identification, communication, documentation, reporting and evaluation of clinical variances? ✔✔Adverse event Which DM type is resistance to insulin? ✔✔type 2 What does bio-compatible mean? ✔✔Not likely to cause an allergic reaction because it is compatible to our body What are the symptoms of hypoglycemia? ✔✔shaking, confusion, and diaphoresis What is an adverse event? ✔✔It is an internal system to provide identification, communication, documentation, reporting, and evaluation of clinical variances an medical device related events. What must foot checks include? ✔✔prevention, early detection, and timely referrals What is the average life of a transplanted kidney? ✔✔2 years What is the normal conductivity range? ✔✔13.5-14.5 What is the normal range of pH? ✔✔6.8-7.4 What is the normal range of temperature, as well as ideal? ✔✔range- 35-39 What must be performed before each patient treatment? ✔✔Pressure holding test (PHT) and alarm testing Is Heparin short or long acting? ✔✔short acting How many times a day is total hardness tested? ✔✔twice daily (once in am and in pm) What is a brine tank used for? ✔✔It is used to regenerate the water softeners Heparin doses need to be lower if what occurs? ✔✔prolonged bleeding after treatment, nosebleeds, heavy menstrual flow, surgery, or dental work. What may be administered for uncontrolled bleeding from administration from heparin? ✔✔protamine sulfate What is the minimum allowed rejection rate? ✔✔80% What is the solution delivery system used for? ✔✔used to mix bicarb and RO water. It sends bicarb and acid from header tanks via gravity to the wall boxes on the treatment floor What can elevated phosphorus levels in the blood cause? ✔✔itching, secondary hyperparathyroidism, and bone disease Does heparin pass through semi permeable membrane? ✔✔NO. It is a large molecule What is clearance and adequacy affected by? ✔✔BFR, DFR, type/size of dialyzer, length of treatment, size of patient, access function, heparinization, needle size, and patient compliance What two things allow the staff and patient to know the adequacy of each treatment? ✔✔OLC (on-line clearance) and AMP (adequacy monitoring program) What is projected spKt/V? ✔✔Calculation that projects the amount of dialysis the patient will receive if, and only if, the treatment is delivered as planned. What is delivered spKt/V? ✔✔The amount of dialysis that has occurred up to that point in time of the treatment. What is KECN estimating? ✔✔It is estimating the clearance of urea in ml/min at the time of the OLC test. What range should KECN be within? ✔✔200-300 What does OLC-V reflect? ✔✔The total body water content in which urea is contained What are signs of fluid overload? ✔✔SOB, jugular vein distention, edema, and elevated BP What does URR stand for? ✔✔urea reduction ratio What is the target goal for hemoglobin? ✔✔11-12 How long should you mix bicarbonate for? ✔✔10 minutes What is the buttonhole technique? ✔✔It is a method of constant site cannulation sometimes used by patients who have a fistula (sharp needle over 6-8 treatments) At what degrees angle should a fistula and graft be cannulated? ✔✔fistula - 20-30 degrees. graft - 45 degrees What does access flow testing used for? ✔✔To help identify the presence of stenosis/recirculation within an access What are the cause of recirculation? ✔✔stenosis, placing fistula needles to close together, or connecting the blood lines backwards. What are the two most life threatening complications during HD? ✔✔undetected blood loss and air embolism What are the causes of blood loss? ✔✔needle dislodgement, blood line separation, dialyzer rupture, defective blood lines. What are causes of an air embolism? ✔✔air in system, not enough saline to safely rinse back pt, not securing caps or clamps. What are the causes of hypotension? ✔✔pulling too much fluid large fluid gains, medications, incorrect UF goal, Perform COLT for air embolism. What does this mean? ✔✔C- clamp lines O - Turn off pump L - Left side T - Tredelenburg position What are the sxs of pyrogen reaction? ✔✔fever, chills, HA, hypotension What are the causes of pyrogen reaction? ✔✔bacteria in water or dialysate What happens if there is a power failure? ✔✔remove V line from line clamp. Hand crank clockwise 6-10 mins. What must you do to the machine if a code occurs? ✔✔pull it and tag it. Save dialzyer and lines When do you recirculate the pts blood? ✔✔Infiltration, remove air from system, or crenation