Final CCHT Exam 580 Questions with Verified Answers,100% CORRECT

Final CCHT Exam 580 Questions with Verified Answers Abscess - CORRECT ANSWER An abscess is an infection under the skin. It looks lika blister or pimple filled with fluid or pus. If needles are inserted into or near an ...

Final CCHT Exam 580 Questions with Verified Answers Abscess - CORRECT ANSWER An abscess is an infection under the skin. It looks lika blister or pimple filled with fluid or pus. If needles are inserted into or near an abscess, infection of a dialysis access or other tissues may occur. Access - CORRECT ANSWER An access -vascular access- is a route into the bloodstream that allows enough blood flow for hemodialysis. For permanent access, a surgeon connects a vein to an artery. This can be done directly - fistula- or with a piece of synthetic tubing - graft. For short term access, a catheter may be placed in a large central vein. - CORRECT ANSWER Acid - CORRECT ANSWER An acid is substance with a pH below 7.0 that can donate a hydrogen ion -H+. In the human body, acids form when protein and other foods are broken down by cell metabolism. Acquired Immunodeficiency Syndrome - AIDS - CORRECT ANSWER Acute Kidney Failure - CORRECT ANSWER Acute kidney failure has a sudden onset. It is most often caused by an illness, injury, or toxin that stresses the kidneys. Some patients who survive acute kidney failure can recover kidney function. Others die or go on to develop chronic kidney failure. Alum - CORRECT ANSWER Alum is an aluminum compound. It is often added to city water supplies to remove sediment and make the water clearer. Aluminum can build up in the bodies and brains of dialysis patients. Aluminum in dialysis water must be kept at low levels with water treatment. - CORRECT ANSWER Aluminum-Related Bone Disease - ARBD - CORRECT ANSWER ARBD is cause by long-term exposure to aluminum. Aluminum builds up in the tissues at the point where new bone forms and be seen on X-ray. Sources of aluminum include dialysis water, medications, and cookware. Phosphate binders with aluminum are also a source, but these are rarely used today. Symptoms of ARBD can include deep bone pain, muscle weakness, and fractures. - CORRECT ANSWER Amyloidosis - CORRECT ANSWER Amyloidosis occurs when aproteingcalled beta-2-microglobulin -B2M- builds up in soft tissues, bones, and joints. The deposits can cause joint and or bone pain. High-flux membranes and or noctournal hemodialysis remove more B2M, which may help prevent or treat this problem. Anaphylaxis - CORRECT ANSWER Anaphylaxis is a fast severe immune response to an allergen. Hives, itching, or wheezing may occur. Anaphylactic shock may cause blood pressure drop; change in heart rhythms or arrest; and swelling of the lips, tongue, and throat. This problem can be fatal. Anastomosis - CORRECT ANSWER An anastomosis is a surgical connection beteen two blood vessels. Dialysis needles should not be inserted into the area of the anastomosis in a fistual or graft. Adsorb - CORRECT ANSWER Adsorb means to attract and hold. The dialyzer membrane adsorbs blood proteins to the walls of the hollow fibers during a treatment. This can make reused dialyzers more biocompatible than new ones - if bleach is not used to remove the protein coating. - CORRECT ANSWER Advance Directives - CORRECT ANSWER Advance directives outline a patient's wishes for medical treatment in case he or she becomes too ill to make such choices. A living will is one type of advance directive. The patient's family and other members of the care team should be told of the patient's wishes when an advance directive is done and given a copy to keep. - CORRECT ANSWER Afferent - CORRECT ANSWER means toward an organ. Air Detector - CORRECT ANSWER The air - or foam detector checks blood in the venous line of the extracorporeal circuit for air. Air in a patient's bloodstream can stop the blood flow or heartbeat, causing death. If the detector finds air, an alarm will sound, the blood pump will stop, and the venous bloodline will clamp to keep air from reaching the patient. - CORRECT ANSWER Air Embolism - CORRECT ANSWER An air embolism occurs when air bubbles enter the bloodstream and flow into a vessel small enough to be blocked by the air. The air in the vessel acts like a clot, blocking the flow of blood. Dialysis machines have an air detector on the venous bloodline to help prevent this problem, which can be fatal. - CORRECT ANSWER Albumin - CORRECT ANSWER Albumin is a blood protein. Lo serum albumin levels -<3.5 g/dL- may mean a patient is undernourished. Malnutrition is a common in dialysis patients and raises their risk of death. Anemia - CORRECT ANSWER Anemia is a shortage of oxygen-carrying red blood cells. It causes sever fatigue, trouble with metal focus, reduced immune function, and many other problems. Anemia is common in kidney failure due to less erythropoietin, iron deficiency, and loss of blood through tests and dialysis itself. - CORRECT ANSWER Anesthetic - CORRECT ANSWER An anesthetic is a drug that numbs the body to reduce pain. Local anesthetics can be injected into a spot, such as the skin around a puncture site, before needle placement. Or, gels or creams can be put on the skin to prevent pain at that site. Aneurysm - CORRECT ANSWER An aneurysm is a ballooning or bulging of a weak spot in a blood vessel. Severe bleeding can occur if an anerurysm ruptures, so great care must be taken with a patient who has one. Aneurysms can occur if needles are placed too often into the small area of a fistula. Angioplasty - CORRECT ANSWER Angioplasty is a procedure to open a narrowed blood vessel - stenosis. It may be used for vascular access repair. A small balloon is threaded through the vessel into the access and gently inflated to push the walls of the vessel open. Anion - CORRECT ANSWER An anion is a negatively-charged ion. Antegrade - CORRECT ANSWER Antegrade means forward-moving. In dialysis, it means in the direction of blood flow. The venous needle should always be placed antegrade. The arterial needle is placed antegrade or retrograde, though there is some evidenc that antegrade is better. . Anticoagulant - CORRECT ANSWER An anticoagulant is a blood-thinning drug used to keep clots from forming. Anticoagulants, such as heperain, are used to prevent clotting in the extracorporeal circuit during hemodialysis. Antidiuretic Hormone- ADH - CORRECT ANSWER Antidiuretic hormone - ADH or vasopressin- is released by the pituitary gland in the brain. ADH helps prevent excess fluid loss by telling healthy kidneys to reabsorb water. ADH also tells the blood vessels to constrict - tighten. Apical Pulse - CORRECT ANSWER The apical pulse is felt on the chest wall over the heart. Apnea - CORRECT ANSWER Apnea is a period when breathing stops. Arterial Pressure - CORRECT ANSWER In hemodialysis, arterial pressure is measured in the extracorporeal circuit between the arterial needle and the dialyzer. Pre-pump arterial pressure is measured from the patient's access to the blood pump. Post-pump arterial pressure is measured after the blood pump, but before the dialyzer. - CORRECT ANSWER Arrhythmia - CORRECT ANSWER An arrhythmia is an irregular heartbeat. It may be felt as an extra pulse or heard over the heart. Arterial pressure Monitor - CORRECT ANSWER A pressure sensor monitors pre-pump arterial pressure in the extracorporeal circuit between the patient's access and the blood pump. A post-pump arterial pressure monitor measures pressure beten the blood pump and the dialyzer. If the pressure reading is outside of set limits, an alarm will sound and the blood pump will stop. - CORRECT ANSWER Arterialize - CORRECT ANSWER When a fistual is made, strong arterial blood flow causes the vein to arterialize - it dilates - widens, thickens and becomes more muscular, like an artery. Arteriovenous -AV-Fistula - CORRECT ANSWER In dialysis, an arteriovenous fistula is a link beteen an artery and a vein under the skin of an arm or leg to provide access to the blood. The force of blood from the artery makes the vein larger and thicker. After a fistual matures, it can be punctured with dialysis needles and will allo the blood flow rates needed for dialysis. - CORRECT ANSWER Arteriole - CORRECT ANSWER An arteriole is a small artery. Artery - CORRECT ANSWER A blood vessel that carries blood away from the heart at high pressure. Arteries bring oxygenated blood to each part of the body. Artificial - CORRECT ANSWER Artificial means man-made. The dialyzer is called an artificial kidney. A piece of artificial vein is used to create a dialysis graft. Ascites - CORRECT ANSWER Ascites is a build - up of fluid inthe abdomen caused by liver damage, heart failure, malnutrition, or infection. Special ultrafiltration and other methods - i.e. drainage may be needed to remove it. Asepsis - CORRECT ANSWER Asepsis is the absence of pathogens. Aseptic - CORRECT ANSWER Aseptic means sterile or germ-free. Aseptic technique - CORRECT ANSWER Aseptic technique is a series of steps used to maintain a germ-free environment. The steps include washing hands before touching things in sterile packages, touching sterile objects only to other sterile objects, cleaning blood ports or the patient's skin with disinfectant before placing a needle, and throwing out any sterile supplies in we, damaged, or torn packages. Peritoneal dialysis exchanges must be done using aseptic technique to prevent infection. - CORRECT ANSWER Association for the Advancement of Medical Instrumentation - AAMI - CORRECT ANSWER AAMI develops voluntary standards for dialysis water treatment and dialyzer reprocessing. TheAAMI guidelines have been adopted by CMS. Auscultate - CORRECT ANSWER Auscultate means to listen with a stethoscope. Auscultation is used to diagnose access problems like stenosis or thromboisis that can change the normal sound of the bruit. Backfiltration - CORRECT ANSWER Backfiltration occurs when dialysate crosses the dialyzer membrane into the patient's blood. It can be caused by a change in the presure or concentration gradient between the dialysate and blood. Back filtration may be more likely with high-flux dialyzer membranes, which have larger pores. Backfiltration can harm patients because endotoxin in the nonsterile dialysate can enter the bloodstream, causing infection and fever. - CORRECT ANSWER Backwashing - CORRECT ANSWER Backwashing means forcing water backwards through a filter. It can used to remove particles from clogged sediment filters in a water treatment system. Bacteria - CORRECT ANSWER Bacteria are microscopic, single-celled organisms that can cause disease. Bacteria are classified as Gram-positive or Gram-negative by the color they turn on a test called Gram's stain. Base - CORRECT ANSWER Bases are chemicals that can accept a hydrogen ion-H+. A ubstance with a pH of greater than 7.0 is a base, or alkaline. In the body, bicarbonate is a base. Bicarbonate - CORRECT ANSWER Bicarbonate is a buffer. It helpsneutralize acids that form when the body breaks down protein and other foods, and is reabsorbed by healthy kidneys. Dialysis patients often have low levels of bicarbonate because their kidneys do not reabsorb enough. Thus, they can't neutralize acids well. Bicarbonate is used in dialysate to help restore levels in the body, but it has two main drawbacks; it supports bacterial growth, and it needs two concentrates - acid and bicarbonate to keep scale from forming and harming equipment. - CORRECT ANSWER Biocompatible - CORRECT ANSWER Biocompatible means like the human body. A biocompatible membrane is less likely to cause patient symptoms or trigger immune responses caused by a foreign "invader." Blood leak - CORRECT ANSWER A blood leak occurs when the delicate semipermeable membrane of the dialyzer tears, letting blood leak into the dialysate. Severe blood leaks can cause major blood loss during treatment. Any blood leak will expose patients directly to the dialysate. Blood Leak Detector - CORRECT ANSWER The blood leak detector is an alarm system on the hemodialysis delivery system. It checks used dialysate for blood that would mean a leak in the membrane. The dector shines a beam of light through the dialysate and into a photocell. A break in the light beam caused by blood cells triggers and alarm that stops the blood pump and clamps the venous line. This prevents further blood loss and contamination of the patient's blood with dialysate. - CORRECT ANSWER Blood pump - CORRECT ANSWER The blood pump is part of the hemodialysis delivery system. It pushes the patient's blood through the extracorporeal circuit at a fixed rate of speed. During a treatment, the blood tubing is threaded beteen the pump head and rollers. the rollers move blood through the circuit and back to the patient. Blood Pump Segment - CORRECT ANSWER The blood pump segment is a durable, larger diameter section of the arterial blood tubing. It is a threaded through the roller mechanism of the blood pump. Blood tubing - CORRECT ANSWER Blood tubing is the part of the extracorporeal circuit that carries blood from the patient;s access, through the arterial needle, to the dialyzer, and back to the patient through the venous needle. There are two segments of blood tubing. The arterial segment is often color-coded red. The venous segment is often color - coded blue. Parts of the blood tubing include patient conncetors, dialyzer conncetors, drip chamber/bubble trap, blood pump segment, and heparin and saline infusion lines. - CORRECT ANSWER Blood Urea Nitrogen - BUN - CORRECT ANSWER Urea is a waste product of protein metabolism. It is measured as blood urea nitrogen - BUN. Failed kidneys cannot remove urea, which builds up in the body between treatments. BUN is easy and low cost to measure , so it is used as a stand - in for other wastes that are harder to identify or measure. BUN levels are the basis of the urea reduction ratio and urea kinetic modeling-methods used to assess the adequacy of dialysis. - CORRECT ANSWER Bolus - CORRECT ANSWER A bolus is a single, large amount of something. In dialysis, heparin can be given by bolus. The full prescribed dose is given all at once. Brachial pulse - CORRECT ANSWER The brachial pulse is the pulse felt in the crease of the elbow at the brachial artery. Brachiocephalic Fistula - CORRECT ANSWER A brachiocephalic fistula is the most common type of AV fistula of the upper arm. It is created by surgically joining the brachial artery to the cephalic vein. Brine - CORRECT ANSWER Brine is a concentrated saline solution. In dialysis water treatment, brine is used to flush the resinbed of a water softener. This recharges the softener with sodium chloride ions. These ions are then exchanged with calcium and magnesium to soften the water. Bruit - CORRECT ANSWER A Bruit is a buzzing or swooshing sound caused by the high-pressure flow of blood through a patient's fistula or graft. The bruit can be heard through a stethoscope at the anastomosis, and for some length along the access. A high-pitched bruit may mean there is stenosis of the access. Buffer - CORRECT ANSWER A buffer is a substance that keeps the pH of a solution at a constant level, even when an acid or base is added. Bicarbonate is the buffer used in dialysis to maintain the pH for dialysate. Buttonhole Technique - CORRECT ANSWER In the buttonhole technique, dialysis needles are placed in a fistula - not a graft- into the same holes at the same angle. Over 3 - 4 weeks, this creates pierced earring -like tracts that guide the needles to the right spots. The patient or the same staff person should place the needles. Once the tracts are formed, special blunt needles are used to avoid cutting new tracts. Buttonhole cannulation is quick to do, less likely to infiltrate, and largely painless for the patient. - CORRECT ANSWER Bypass - CORRECT ANSWER Bypass is a safety feature of the hemodialysis delivery system. It cuts off the flow of fresh dialysate to the dialyzer and shunts it to the drain. Bypass keeps unsafe dialysate -wrong conductivity, temperature, or pH- from reaching the patient and causing harm. Calcium - CORRECT ANSWER Calcium is an element that exists as a cation - positively-charge ion. In the body, calcium is an electrolyte needed for nerves and muscles to form normal bone. It is partly bound to protein in the blood. Too much or too little calcium in dialysate can cause sever health problems or death for patients. Patient blood levels of calcium are checked once a month. - CORRECT ANSWER Calcium in a dialysis feed water supply can combine with other substances to form scale that can clog equipment. Cannulate - CORRECT ANSWER Cannulate means to put dialysis needles into a fistual or graft. Capillaries - CORRECT ANSWER Capillaries are tiny blood vessels, where oxygenated blood crosses from arteries into veins. They are smaller than a human hair; blood cells must line up single file to pass through. Unlike arteries and veins, capillary walls are semipermeable. The walls let oxygen, nutrients, and waste products pass through. In the kidneys, each glomerulus is a ball of capillaries that filters out wastes from the blood. - CORRECT ANSWER Carbon tank - CORRECT ANSWER Carbon tanks are water treament devices. They contain granular, activated carbon that adsorbs low molecular weight particles from water. Carbon tanks are mainly used to remove chlorine, chloramines, pesticides, solvents, and some trace organic substances from water used for dialysis . Cardiac Arrest - CORRECT ANSWER Cardiac arrest occurs when the heart stops beating. Cardiac arrest can be a deadly side effect of some dialysiss problems, such as too-warm dialysate, wrong dialysate concentration, hemolysis, severe blood loss, or a large amount of air in the blood-stream. Hyperkalmia - high potassium levels- can also cause cardiac arrest. Cardiac Output - CORRECT ANSWER Cardiac output is the amount of blood passing through the heart in a certain period of time. Having an AV fistual or graft causes a 10% increase in cardiac output. This causes a 10% increase in the size of the heart. Patients who can't tolerate this increase in cardiac output cant's have AV fistulae or grafts. Catabolism - CORRECT ANSWER Catabolism is a chemical process that occurs in the body. Substances, such as proteins, are broken down, forming wastes. These wastes -e.g., urea- are removed by healthy kidneys. In dialysis patients, the wastes must be removed by the treatment. Catheter - CORRECT ANSWER A catheter is a plastic tube. In hemodialysis, a catheter can be placed in a large, central vein for short-term or long term access. In peritoneal dialysis, a catheter is placed in the abdoman or chest. It is used to infuse fresh dialysate into the periotoneum and drain used dialysate. Cation - CORRECT ANSWER A cation is a positively-charged ion. In water treatment, cations can be removed by ion exchange or reverse osmosis to ensure safe water for dialysate and dialyzer repr0cessing. Cellulose - CORRECT ANSWER Cellulose is a fiber that forms the cell walls of plants. Cellulose acetate was used as the first dialyzer membrane by Dr. Willem Kolff in 1942. It was also the first substance used to make reverse osmosis membranes for water treatment. To form a membrane, cellulose can be dissolved in a solution ith copper salts and ammonium, then spun into sheets or hollow fibers. Cellulose dialyzer membranes are the most likely to cause first - use syndrome, because they are not biocompatible. - CORRECT ANSWER Central Venous Stenosis - CORRECT ANSWER Central venous stenosis is narrowing of a central vein. It can damage vessels in the arm on the of affected side so a patient can't have a fistula or a graft. With only 10 access sites in the body, it is vital to preserve as many as possible. Due to the risk of stenosis, the KDOQI guidelines say the subclavian vein should not be used for a hemodialysis catheter site The internal jugular -IJ- vein should be used instead. - CORRECT ANSWER Certified Clinical Hemodialysis Technician - CCHT - CORRECT ANSWER The 2yr CCHT certification is offered by the Nephrology Nursing Certification Committee. Certified in Biomedical Nephrology Technology -CBNT - CORRECT ANSWER The CBNT certification is offered by the National Nephrology Certification Organization Inc. - NNCO. Certified in Clinical Nephrology Technology - CCNT - CORRECT ANSWER The CCNT certification is offered by the Natonal Nephrology Certification Organization, Inc - NNCO Chloramine - CORRECT ANSWER Chloramine is a mix of chlorine an ammonia. Ammonia may be added to city water to boost the germ-killing power of chlorine. Chloramine is an oxidant. It destroys microbes by breaking down their cell walls. Chloramines in dialysis water can cause a deadly health problem called hemolysis - rupture of red blood celles. Carbon tanks are used to remove chloramines from water used for dialysis. - CORRECT ANSWER Chloride - CORRECT ANSWER Chloride is a salt concentrate needed in dialystate and in the human body. Chloride combines with other elements to form sodium chloride, potassium chloride, magnesium chloride, and calcium chloride. Chlorine - CORRECT ANSWER The element chlorine is greenish yellow gas. It can cause severe lung irritation if inhaled. Chlorine is blended with other substances to disinfect surfaces. Chlorine may be added to city water to destroy micorbes. Carbon tanks are used to remove chlorine and chloramines from water used for hemodialysis and dialyzer reuse. - CORRECT ANSWER Chronic - CORRECT ANSWER means long-term Chronic Kidney Disease - CKD - CORRECT ANSWER CKD is a long , slow loss of nephrons - and thus kidney function. CKD can take many years to progress. It is divided into stages based on the glomerular filtration rate -GFR. Stage 1 CKD is mild kidney dysfunction. Stage 5 CKD is the most severe forms. Clearance - K - CORRECT ANSWER Clearance is the amount of blood - in mL- that is completely cleared of a solute in one minute of dialysis at a given blood and dialysate flow rate. Dialyzer clearance affects how much treatment a patient receives. Dialyzer makers test their products with fluids other than blood - in vitro. This means that clearance of a dialyzer during treatment - in vivio - can vary from the maker's stated clearance. - CORRECT ANSWER Clinical Practice Guidelines - CORRECT ANSWER Clinical practice guidelines are the suggestions of experst to improve patient outcomes. The National Kidney Foundation - NKF - DOQITM giudelines were written by expert panels who reviewed many research studies. CMS often adopts guidelines and turns them into rules that clinics must follow or benchmarks for good care. Coefficient of Ultrafiltration - CORRECT ANSWER T Kuf is the amount of water a dialyzer will remove from the patient's blood per hour at a certain pressure. Kuf is also called the ultrafiltraion factor -UFF or UR rate - UFR. It is stated in milliliters - mL per hour - hr of water removed for each millimeter - mm of mercury - Hg - of transmembrane pressure - TMP, or mL/hr/mmHg TMP. The higher the Kuf the more water per mL of pressure will be removed. High-flux and high-efficiency dialyzers has a higher Kuf than conventional dialyzers. Any Kuf above 8 requires volumetric control hemodialysis system to precisely control how much water is removed. - CORRECT ANSWER Colony-Forming Unit - CFU - CORRECT ANSWER The number of CFUs in a water or dialysate sample is a measure of the number of living bacteria. Complement Activation - CORRECT ANSWER Complement is a group of proteins in the blood serum that work to remove pathogens from the body. Complement activation occurs when this system is exposed to a pathogen. Concentrate - CORRECT ANSWER In dialysis, concentrate is one of two salt solutions - acid and bicarbonate - that are mixed together to form dialysate. Concentration - CORRECT ANSWER Concentration is the level of solute dissoved in a measure of fluid. A highly-concentrated solution has more solutes. A less -concentrated - more dilute solution has less solutes. One task of healthy kidneys is to control the concentration of urine so the right amounts of fluid and other substances stay in the body. In dialysis, the concentration of each of substance in dialysate must be correct to ensure a safe and effective treatment. - CORRECT ANSWER Conditions for Coverage - CORRECT ANSWER The Conditions for Coverage for ESRD facilities are Medicare rules for dialysis clinics to follow to receive federal dollars. In 2008, the conditions were updated for the first time in 29yrs. Medicare surveyors visit dialysis clinics to ensure that they are following the rules. Conductivity - CORRECT ANSWER Conductivity is how well a fluid will transfer an electrical charge. It is a measure of ions in solution. A conductivity meter measures the electrolyte level of dialysate to be sure it is within safe limits. Conductivity Monitor - CORRECT ANSWER This monitor checks the conductivity of dialysate to be sure it is correct. If the level is wrong, an alarm goes off and the machine goes into bypass mode so dialysate is sent to the drain. Congestive Heart Failure - CHF - CORRECT ANSWER CHF occurs when the heart can't pump out enough of the blood it receives. Excess fluid backs up into the lungs. Fluid overload from too much fluid intake or not enough fluid removal at dialysis may lead to CHF in dialysis patients. Contamination - CORRECT ANSWER means that something is impure due to the presence of dirt, blood, or micorbes. Continuous Ambulatory Peritoneal Dialysis -CAPD - CORRECT ANSWER CAPD is peritoneal dialysis with manual exchanges done four or five times each day. The exchanges can be done at home or ork while the patient goes about his or her day. Each one takes about 30 minutes. CAPD is continous, so large amounts of wastes do not build up beteen treatments. This means the diet and fluids tend to ble less restricted for CAPD than for standard in-center hemodialysis. Because the patient can dialyze on his or her own schedule, this treatment is work-friendly. - CORRECT ANSWER Continuous Cycling Peritoneal Dialysis - CCPD - CORRECT ANSWER CCPD, or automated peritoneal dialysis - APD, is PD using a cycler machine to do exchanges at night while the patient sleeps. Because the patients days are free, this treatment is work friendly. Some patients may use a cycler at night and do one exchange by hand at mid-day. Continuous Quality Improvement -CQI - CORRECT ANSWER CQI is a way to improve care by choosing an area that needs to be improved, analyzing the process of care, finding root causes of problems, and then making and using a plan of change. Continuous Renal Replacement Therapy - CRRT - CORRECT ANSWER CRRT is slow, ongoing form of dialysis. It uses the patient's heart or blood pump to move blood through an extracorporeal circuit. CRRT is most often done for may hours to gently remove extra fluid and some wastes in patients who are too ill or unstable for standard hemodialysis. A cartridge with a semipermeable membrane - like a dialyzer - is used. - CORRECT ANSWER Countercurrent flow - CORRECT ANSWER Countercurrent flow in a dialyzer occurs when blood moves one ay and dialysate flows the other way. This type of flow allows for the most efficient dialysis because it keeps the blood in constant contact with fresh dialysate. Creatinine - CORRECT ANSWER is a waste product of muscle use that healthy kidneys remove from the blood. Larger people with more muscle tend to have higher creatine levels in their blood. Higher-than-normal creatinine levels may be a sign of kidney disease. Creatinine Clearance - CORRECT ANSWER Creatinine clearance is a urine test that measures how well the kidneys remove creatinine from the blood in a certain amount of time . As kidney disease worsens, creatinine clearance will fall to 10% of normal or less. Crenation - CORRECT ANSWER Crenation is the shriveling of blood cells. This can occur if blood cells are exposed to dialysate that is more concentrated than blood - hypertonic. If crenation is present, the blood will look dark red. Crenation can be fatal. CROWNWeb - CORRECT ANSWER is Consolidated Renal Operations in a Web-enabled Network. It is a computer program that allows clinics to send their required data to the ESRD networks. Cuffed Tunneled Catheters - CORRECT ANSWER are placed into a large central blood vessel through a tunnel formed under the skin. Inside the tunnel, tissue grows into an attached cuff. The cuff makes the catheter more stable and is a physical barrier against bacteria. Cyanosis - CORRECT ANSWER is bluish-colored skin, lips, gums, and fingernil beds from lack of oxygen. It may be present in patients with methemoglobinemia, caused by exposure to dialysate made form water that contains high levels of nitrates. Dehydration - CORRECT ANSWER means the body does not have enough water. It may be caused by diarrhea, vomiting, heavy seating, or removingtoo much water at dialysis. A dehydrated patient may have low blood pressure, sunken eyes, be listless, and have poor skin tone. Deionization - DI - Tank - CORRECT ANSWER Part of a water treament systems, a DI tank uses beds of resin beads to remove unwatned ions from water used for dialysis. The unwanted ions are exchanged for hydrogen - H+ and Hydroxide -OH - ions to form pure water. Diabetes - CORRECT ANSWER There are 2 main types of diabetes, and both can harm the kidneys. In type 1, the immune system kills the pa ncreas cells that make insulin. In type 2 the pancreas does not make enough insulin, or the body can't use what it does make. Diabetic Nephropathy - CORRECT ANSWER is kidney disease that results from diabetes. Type 2 diabetes, a shortagle of or resistance to insulin, is the number one cause of kidney failure in the US. In type 1 diabetes, the immune system destroys the pancreas cells that make insulin. Diabetes is a disease of the blood vessels. It causes heart disease and nerve damage. Diabetes is also the leading cause of blindness and loss of limb in the US. - CORRECT ANSWER Dialysate - CORRECT ANSWER is a precise mixture of treated water and chemicals. It is used in dialysis to create a concentration gradient ot remove wastes from the blood. Sodium, calcium, magnesium, chloride, potassium, glucose, and bicarbonate are most often included, at levels like those ofnormal blood. Dialysate must be mixed properly or patients can be harmed. Dialysis - CORRECT ANSWER is a process of removing wastes and excess water from the blood of people whose kidneys have failed. It may be done using a dialyzer - hemodialysis - or the patient's own peritoneum - peritoneal dialysis - as a filter. Dialysis Outcomes and Practice Pattern Study - DOPPS - CORRECT ANSWER The DOPPS is a long-term study of patients in Australia, Belgium, Canada, France, Germany, Italy, Japan, Ne Zealand, Spain, Sweden, the United Kingdom, and the US> The goal of DOPPS is to help patients live longer by looking at practice patterns in centers. The data are used to help find practices that can be changed to improve patient outcomes. - CORRECT ANSWER Dialyzer - CORRECT ANSWER is a semipermeable membrane in a plastic cylinder. Dialyzers are used in hemodialysis to filter wastes and water out of the blood of patients with kidney failure. Ports on the cylinder let blood and dialysate flow in and out. The membrane keeps blood and dialysate apart, but allows an exchange of water and some solutes to occur. Diastolic - CORRECT ANSWER Diastolic blood pressure is the pressure of blood against the arteries when the heart rate is at rest - between beats. It is the bottom number of a blood pressure reading. Diffusion - CORRECT ANSWER is the principle on which dialysis is based. Dissolved particles will move across a semipermeable membrane for ma higher solute level to a lower one. The process will go on unitl both sides of the membrane have the same solute level. In dialysis, diffusion removes wastes form the blood. Dialsate has no wastes, so wastes in the blood diffuse across the dialyzer membrane into the dialysate. The rate of diffusion depends on the concentration gradient, temperature, and size of the wastes and the membrane pores. Diffusion is also called conductive solute transfer. - CORRECT ANSWER Disinfectant - CORRECT ANSWER A disinfectant is a chemical or process - e.g., heat - that destroys or slows the groth of harmful microbes. To work, disinfectants need time. They must stay moist and in contact with a surface. Some common equipment disinfectants are heat, bleach, formaldehyde, gluteraldehyde, renalin, citric acid, and amuchina. Disinfectnats are also used to clean water treatment ports before taking a water sample and to wipe off surfaces in the center. - CORRECT ANSWER Distal - CORRECT ANSWER Distal means far. In anatomy, distal is far from the center of the body. The hands and feet are distal extremities. Diuretic - CORRECT ANSWER is a drug that causes someone to make more urine. Some diuretics can cause hypokalemia because they promote the loss of potassium in the urine. Diuretics are the first line of treatment for high blood pressure. They may be used for kidney patients before they start dialysis. Once the kidneys stop making urine, diuretics no longer ork. Documentation - CORRECT ANSWER is information about a patients care entered in the permanent medical record or chart. It is vital to track the patient's progress, to provide a way to follow up on each patients response to treatment, and to ensure continuity of care. A patient's chart is legal evidence of the care he or she received. If a task wasn't charted, it wasn't done - CORRECT ANSWER Drip Chamber - CORRECT ANSWER An arterial or venous drip chamber checks arterial or venous pressure in the extracorporeal circuit. A bubble trap in the drip chamber collects any air that enters the blood tubing Dry weight - CORRECT ANSWER is the Patient's weight without excess fluid. When dry weight is reached, there are not signs of fluid overload or dehydration. Breathing is normal, with no signs of fluid in the lungs. And, blood pressure is normal for the patient - not too high or too low. "Target weight" is the goal wight for a given dialysis treatment and is most often determined by the dry weight. - CORRECT ANSWER Dwell Time - CORRECT ANSWER In hemodialysis, dwell time is the length of time a disinfectant must stay in a dialyzer while reprocessing. If a disinfectant is used on the hemodialysis delivery system, it must dwell in the fluid pathways long enough to kill microbes. Then, it is rinsed out. In peritoneal dialysis, dwell time is the length of time dialysate stays in the patient's abdomen before it is drained. - CORRECT ANSWER Dyspnea - CORRECT ANSWER Means trouble breathing or shortness of breath. It can be a symptom of fluid overload, anemia, or heart or lung disease. Dyspnea can also occur at dialysis due to problems such as an air embolism. Ecchymosis - CORRECT ANSWER is a bruise or bleeding under the skin. In dialysis patients, an ecchymosis can be a sign that too much heparin has been given. Or, it can mean that not enough pressure was placed on the needle sites after the needles were removed. Edema - CORRECT ANSWER is water retention with swelling in body tissues. It occurs as a result of fluid overload or other health problems, such as congestive heart failure. This swelling may be seen in the patient's eyelids, ankles, feet, hands, abdomen, or lower back area. "Pitting" edema is present when a finger pushed against the skin of the ankle leaves a dent. Report this to the nurse if you see it. - CORRECT ANSWER Efferent - CORRECT ANSWER means away from an organ Electrolyte - CORRECT ANSWER is a compound that breaks apart into ions when dissolved in water. Electrolytes send electrical signals along the nerves to the muscles, including the heart. In the body, healthy kidneys keep electrolytes in balance. Sodium, Potassium, magnesium, chloride, and calcium are electrolytes. Each is added to dialysate in precise amounts. - CORRECT ANSWER Empty Bed Contact Time - EBCT - CORRECT ANSWER is the amount of time that feed water must stay in contact with the charcoal bed in a carbon tank during water treatment to remove chlorine and chloramines. Encephalopathy - CORRECT ANSWER is a change in brain function that can be fatal. Patients may seem confused or may lose short-term memory. You may see a change in personality or speech. Muscle spasms, hallucinations, and seizures can also occur. Chronic exposure to high levels of aluminum can cause the problem. Aluminum can come from dialysate water, some antacids, and cookware. - CORRECT ANSWER Endocrine Function - CORRECT ANSWER - making hormones is one of the tasks of healthy kidneys. Kidneys maker hormones that control blood pressure and tell the bone marrow to make red blood cells. They also convert Vitamin D into an active form the body can use to absorb calcium. Endotoxin - CORRECT ANSWER -Lipopolysaccaride is a toxic part of the cell walls of some bacteria. Live bacteria can shed endotoxin, and it is released when they die. Wndotoxin is not alive, so it cant be killed. If endotoxin enters a patients body, it can cause pyrogenic reactions. Endotoxin is a concern in water treatment and dialyzer reprocessing. To control it, we reduce bacteria count of the water or remove it with an ultrafilter. - CORRECT ANSWER End-Stage Renal Disease - ERSD - CORRECT ANSWER is a legal term for complete and permanent loss of kidney funtion. This occurs during the last state - stage 5- of chronic kidney disease, when dialysis or a transplant is needed for the patient to live. Patients have ERSD when their glomerular filtration rate has dropped less that 15. Equilibrium - CORRECT ANSWER is a state of balance. Diffusion and osmosis both go on until equilibrium has been reached the levels of solutes or fluid are equal on both sides of a semipermeable membrane. Erythropoietin - EPO - CORRECT ANSWER is a hormone made by healthy kidneys that tell the bone marrow to make red blood cells. ERSD Networks - CORRECT ANSWER were formed by the US Congress in 1978. Their job is to oversee dialysis centers and make sure patients receive high-quality care. The Networks collect data, take steps to improve quality, and promote rehabilitation. They also handle patient grievances and give resources to ESRD staff and patients. There are 18 regional ERSD Networks in the US. - CORRECT ANSWER Ethylene Oxide - ETO - CORRECT ANSWER is a gas used by some manufacturers to sterilize new dialyzers. Patients who are hypersensitive to ETO may have first-use syndrome if a new dialyzer is properly rinsed. Exchange - CORRECT ANSWER In peritoneal dialysis, an exchange occurs each time used dialysate is drained and replaced with fresh after a dwell time. Exchanges may be done by hand or with a cycler machine. Excretory Function - CORRECT ANSWER To excrete means to eliminate from the body. The excretory function of healthy kidneys is to remove wastes and excess water as urine. Exsanguination - CORRECT ANSWER is a severe loss of blood that can be fatal. At dialysis, this can occur if a needle is dislodged, a bloodline seperates, an access ruptures, or there is a crack in a dialyzer casing. All of these problems can be prevented. Extracellular - CORRECT ANSWER means outside the cells. About one-third of the water in the body is extracellur, between the cells and in the blood vessels. Water must move into the blood vessels for dialysis to remove it. The sodium in dialysate helps draw water into the blood vessels so it can be removed. - CORRECT ANSWER Extracorporeal - CORRECT ANSWER means outside the body. Hemodialysis is an extracorporeal therapy; it takes place outside the body Extracorporeal Circuit - CORRECT ANSWER Is the arterial bloodline, dilyzer, venous blooline and extracorporeal circuit monitors. It is an extension of the patients blood vessels outside of the body, bringing blood from the access to the dialyzer and then back to the patient. Extracorporeal Circuit Monitors - CORRECT ANSWER include a blood flow monitor, arterial or venous pressure monitors - measured at drip chambers-, an air dectector, and a blood leak detector. Each will shut off the blood pump and clamp the venous bloodline if the pressure is too high, aire gets in the venous blooline, or there is blood in the used dialysate. Extraskeletal Calcification - CORRECT ANSWER occurs when calcium phosphate crystals form in blood vessels or soft tissues. Though rate, it can cause gangrene, loss of limb, and death. Patients with high blood -serum-levels of calcium and phosphorus are at a higher risk for the problem. If you see that a patient has mottled, painful, purplish skin - often in the same place on both sides of the body - tell the nurse or nephrologist right away. - CORRECT ANSWER Feed water - CORRECT ANSWER is untreated tap water before it passes through a water treatment system. Feed water must pass through all of the parts of a water treatment system before it is used for dialysis. Femoral Catheter - CORRECT ANSWER is a short-term vascular access placed in the femoral vein in the groin. This vein is easy to reach and leaves blood vessels in the upper body to be used for a fistula or graft. But, the groin is quite prone to infection. It is most often used for critically ill or bedridden patients. Ferritin - CORRECT ANSWER is an iron storage protein. It is measured with a blood test. Ferritin stores are needed as a building block for red blood cells. KDOQI anemia guidelines say dialysis patients ferritin levels should be greater than 200ng/mL. Most patients need intravenous iron to keep their ferritin levels at this level. Fiber Bundle Volume -FBV - CORRECT ANSWER or total cell volume - TCV s a measure of the volume of fluid the hollow fibers in a dialyzer can hold. FBV is checked before a dialyzer is used again after each reprocessing. Reprocessing a dialyzer can reduce its FBV. Fibrin Sheath - CORRECT ANSWER is a cluster of blood clotting fibers that build up on the outside of a catheter lumen. The fibers can form a cap that blocks the end of a catheter and reduces blood flow. Fibrosis - CORRECT ANSWER is overgrowth of scar tissue. Fibrosis can develop in a fistula due to needle punctures for dialysis. Scar tissue builds up, narrowing the lumen of the vessel and reducing blood flow. Filters - CORRECT ANSWER are devices that remove particles, solutes, and other substances by passing solutions that contain them through membranes that have holes of various sizes. Filtration - CORRECT ANSWER is the process of passing a fluid through a filter. In dialysis, filtration forces water out of the patient's blood and across the dialyzer membrane by using pressure. First-Use Syndrome - CORRECT ANSWER is a reaction to a new dialyzer. Shortly after a treatment starts, patients may feel nervous, have itching, chest or back pain, or palpitations - skipped or missed heartbeats. First-use syndrome may be caused by ethylene oxide gas or manufacturing residues. Preprocessing a dialyzer may help remove some of these substances. - CORRECT ANSWER Flocculant - CORRECT ANSWER is a chemical added to drinking water to remove solid particles from the water to make it clearer. Flow - CORRECT ANSWER is a stream. Blood flow to each organ in the body is based on the amount and pressure of blood delivered by the heart, and the resistance the blood meets in the blood vessels. Blood flow in the extracorporeal circuit is based on the blood pump setting, resistance in the extracorporeal circuit, and the access. - CORRECT ANSWER Flow rate - CORRECT ANSWER is the amount of fluid that flows through the tubing in a given period of time. Flow velocity - CORRECT ANSWER is the speed at which the fluid moves through a give length of tubing. FDA - CORRECT ANSWER is a federal agency. It makes rules that cover the release and marketing of drugs and medical devices, such as dialyzers and repr0cessing machines. Formalin - CORRECT ANSWER is the trademark name for a 37% solution of formaldehyde. Formaldehyde - CORRECT ANSWER is a poisonous, clear, strong-smelling gas. Formalin is a germicide used to disinfect dialysate delivery systems or reprocess dialyzers. The liquid form is volatile. It changes into a vapor that can penetrate and disinfect even small spaces. Formaldehyde is a known cancer-causing agent. Centers must follow OSHA safety rues to keep patients and staff safe. - CORRECT ANSWER Free Chlorine - CORRECT ANSWER is chlorine that is not chemically bound to other substances. Gauge - CORRECT ANSWER is a standard of measurement for needle sizes. Glomerular Filtration Rate -GFR - CORRECT ANSWER is the volume of blood filtered by the glomeruli each minute, in mL/min. A normal GFR is about 120 to 130 mL/min. Chronic kidney diseae is divided into stages based on the level of GFR. Glomerulonephritis - CORRECT ANSWER is an inflammation that damages the glomeruli. It can be slow and progressive or rapid in onset. It may occur as an immune response to a strep infection. Hypertension often occurs with it. Glomerulosclerosis - CORRECT ANSWER is hardening of the glomeruli Glomerulus - CORRECT ANSWER is a tangled ball of capillaries in each nephron. It is held together by a membrane called a Bowman's capsule. Water and small solutes are forced through filtration slits in each glomerulus by the presure of the beating heart. The fluid that results is called glomerular filtrate. Hemodialysis Adequacy - CORRECT ANSWER is the least amount of treatment patients need to live. It is measured with urea kinetic modeling - Kt/V or the urea reduction ratio - URR. KDOQI guidelines say the delivered Kt/V must be at least 1.2 - with a prescribed Kt/V of 1.4. A minimum delivered URR must be about 65% - with a prescribed URR of about 70%. - CORRECT ANSWER Gradient - CORRECT ANSWER is a difference. A concentration gradient is a difference in the level of solutes between to fluids kept apart by a semipermeable membrane. In dialysis, the fluids are blood and dialysate. Graft - CORRECT ANSWER is to join one thing surgically to another. In hemodialysis, a graft is a piece of man-made vessel that is used to create a vascular access. One end of the graft is connected to the patients artery, the other to the vein. Gram-Negative - CORRECT ANSWER Gram-negative bacteria live in water and form an electrically charged biofile - slime- that lets them cling to surfaces like dialysate jugs or hoses. Biofilm protects the bacteria from disinfectants, and is very hard to remove. For example, Achromobacter is a Gram-negative bacteria that can contaminate dialysis water or dialysate. Acinetobacter, Aeromaonas, Alcaigenes, Flavobacterium, Moraxella, Pseudomonas, and Serratia are toerh types of Gram-Negative Bacteria. - CORRECT ANSWER Gram-Positive - CORRECT ANSWER bacteria turn purple with a Gram's stain. Staphylococcia are Gram-Positive bacteria that cause most access infections. Heat Disinfection - CORRECT ANSWER Heat can be used instead of chemicals to disinfect some types of dialyzers and equipment. The use of heat prevents patient and staff exposure to chemicals. Cellulose dialyzer membranes degrade in heat and cannot be disinfected in this way. Hemastix - CORRECT ANSWER is a regent strip that reacts to blood. When the blood leak dector shows that there is blood in the used dialysate - but the blood cant be seen - a Hemastix strip is used to check the extent of the leak. Hematocrit - CORRECT ANSWER Hct - is a measure of red cells in the blood. It is stated as percentage of red blood cells per total blood volume. Routing checks of Hct levels were used to assess anemia in the past. Hematoma - CORRECT ANSWER is a painful, hard, black and blue mass of blood under the skin. It caused by blood leaking out of a vessel into the tissues. Hematomas can form when dialysis needles are placed, infiltrated, or taken out. A hematoma can compress the access, making a clot more likely. Hemoconcentration - CORRECT ANSWER is dehydration of the blood. This can occur in the extracorporeal circuit if ultrafiltration goes on after the blood pump is turned off. Recirculation can also lead to this problem. Hemoconcentration can lead to blood clotting, which can harm the patients access. Hemodialysis - CORRECT ANSWER removes excess water and wastes from the blood by passing it through a dialyzer. Blood goes to the dialyzer and back to the patients body through tubing connected to needles that are placed in a cascular access. Water and wastes pass through the semipermeable dialyzer membrane and into the dialysate. Alarms and monitors help ensure a safe treatment. Treatments can be done in a center or at home,during the day or at night while the patient sleeps. - CORRECT ANSWER Hemoglobin - Hgb - CORRECT ANSWER is the red, oxygen-carrying pigment of red blood cells. Routinely checking Hgb levels lets the care team follow the patients response to anemia treatment and alerts them to any chronic blood loss. Hemodialysis Delivery System - CORRECT ANSWER The delivery system is a machine hat has a blood pump, dialysate delivery system, and safety monitors. The blood pump moves blood from the patients access through the dialyzer and back to the patient. The machine makes dialsate by mixing treated water with two types of concentrate. Safety alarms check blood and dialysate flow, dialysate temperature, conductivity, venous and arterial pressure, blood in dialysate leaks, and often, the patients blood pressure. - CORRECT ANSWER Hemodialysis Reliable Outflow - HeRO - CORRECT ANSWER is a type of dialysis graft. It can be used ofr patients whos only access choice was a catheter due to central venous stenosis and blockages. The HeRO is a 6mm ePTFE graft with an arterial anastomosis on one side. Onthe other side, it has a 5 mm silicone outflow into a central vein, with the tip placed in the right atrium of the heart. The HeRO is completely under the skin. It has continuous flow from the graft into the outflow component. It is FDA-approved as a graft, and needles are placed in it just like any other graft. - CORRECT ANSWER Hemolysis - CORRECT ANSWER is red blood cell rupture. It is a life threatening problem that needs urgent care from a doctor. Hemolysis may be caused by hyponatremia - low blood sodium; dialysate that is too hot or too dilute - hypotonic; chloramines, copper, or nitrates in dialysate water; formaldehyde or bleach in the dialysate; low dialysate conductivity; too-high pre-pump arterial pressure; transfusions with the wrong blood type; kinked blood tubing; some drugs; ande certain diseases. - CORRECT ANSWER Hemolytic Anemia - CORRECT ANSWER is a shortage of red blood cells due to hemolysis Hemothorax - CORRECT ANSWER is a collection of blood in the chest that keeps the lungs from fully expanding. This causes trouble breathing. The problem can occur if a blood vessel is punctured when a hemodialysis catheter is placed. High-Output Cardiac Failure - CORRECT ANSWER occurs when the patients heart cannot work hard enough to pump out the extra blood sent to it by an AV fistual or graft. Heparin - CORRECT ANSWER is a blood thinner used during dialysis so blood will flow freely through the extracorporeal circuit. It can be given as a bolus - single does, intermittently - on and off, or continuously. Continuous infusion uses a pump to slowly inject heparin onto the circuit at a prescribed rate during a treatment. Heparin Infusion Line - CORRECT ANSWER The heparin infusion line is a small tube that extends from the blood tubing. It allows heparin to be given during dialysis. The line is most often found on the arterial blood tubing segment just before the dialzyer. Heparin Infusion Pump - CORRECT ANSWER consists of a syring holder, a piston, and an electric motor. It is used to deliver precise amounts of heparin during dialysis. The heparin pump is connected to the heparin infusion line, which is part of the extracorporeal blood tubing. Most dialysis machines have a heparin delivery system, although stand-alone heparin pumps are still used in some settings. - CORRECT ANSWER Hepatitis - CORRECT ANSWER inflammation of the liver. It can be caused by one of three viruses - A, B, or C. Hepatitis B and C are spread through contact with infected blood or other body fluids, and a concern for dialysis patients and staff. Hepatitis can cause permanent liver damage or death. Vaccination against the hep B virus should be offered to all staff and patients - CORRECT ANSWER Infection control is used to prevent the spread of hepatitis and other diseases. High-Efficiency Dialysis - CORRECT ANSWER uses dialyzers that can remove more small solutes- e. g. urea than conventional ones. Larger-guage needles and blood flow rates from 300-500 mL/min are most often used. The US government requires ultrafiltration control when a dialyzer with a Kur above 8 is used. High-Flux Dialysis - CORRECT ANSWER uses a dialyzer with a Kuf value higher than 8. Ultrafiltration control must be used. High-flux dialyzers can remove more fluid and large wastes, such as beta-2microglobulin. HIPAA - CORRECT ANSWER is the Health Insurance Portability and Accountability Act. This Act requires that patients personal health information be kept confidential. Hydrophobic - CORRECT ANSWER means water-repellent. Hollow Fiber Dialyzer - CORRECT ANSWER Thousands of tiny hollow fibers form the membrane of this dialyzer. The fibers are held in place at each end by a plastic potting material. Both the fibers and the potting material are encased in a hard plastic cylinder. During dialysis, blood flows through the hollow tubes, while dialysate flows around them. This type of dialyzer allows for well-controlled and predictable diffusion and ultrafiltration. It is the only type of dialyzer on the market in the US. - CORRECT ANSWER Homeostasis - CORRECT ANSWER is a constant internal balance in the body. Healthy kidneys help maintain fluid balance, acid/base balance, hormone balance, and electrolyte balance. All of these are key aspects of homeostasis. Hormones - CORRECT ANSWER are chemical messages made in one organ or gland that act on another part of the body. Healthy kidneys make a hormone - erythropoietin - that tells the bone marrow to make red blood cells and other hormones that control blood pressure and use of calcium in the body. Human Immunodeficiency Virus - HIV - CORRECT ANSWER is a virus that attacks the immune system. It destroys the white blood cells that fight disease - T-lymphocytes. HIV is spread through blood, semen, vaginal secretions, peritoneal fluids, and breast mile. Over time people who have HIV can develop AIDS. Damage to the immune system caused by AIDs leaves the body open to infections and cancers that rarely occur in people with healthy immune systems. There are treatments, but it is best to prevent the spread of HIV with infection control. - CORRECT ANSWER Hydraulic Pressure - CORRECT ANSWER is water pressure. It can be created naturally - such as form gravity - or artificially - such as from a pump. Hydraulic pressure affects the amount of water that is removed from the patient during dialysis. Hyper- - CORRECT ANSWER The prefix "Hyper" means beyond, above, more, or too much. For example, hyperactivity is an above normal activity level. Hyperplasia - CORRECT ANSWER is overgrowth of cells. Clotting in the middle of vascular access graft is often caused by clumps of platelets that build up on areas of hyperplasia. Hypercalcemia - CORRECT ANSWER means toos much calcium - electrolyte in the blood. Patients with this problem may have muscle weakness, fatigue, constipation, loss of appetite, abdominal cramps, nausea and vomiting, and coma. Hyperglycemia - CORRECT ANSWER means high blood sugar levels. Thirst may be a symptom of hyperglycemia in a patient who has diabetes. Hyperkalemia - CORRECT ANSWER means too much potassium - an electrolyte - in the blood. Patients with this problem may have muscle weakness, heart arrhythmia, cardiac arrest, or may die. Hyperkalemia can occur if a patient eats too may high-potassium foods or if dialysate with too much potassium is used. Bleeding, hemolysis, surgery, or fever can also cause this problem because as tissue breaks down potassium is released from cells into the blood stream. - CORRECT ANSWER Hypermagnesemia - CORRECT ANSWER means too much magnesium - an electrolyte in the blood. Magnesium is needed for muscle and nerve funciton. patients with hypermagnesemia may feel sleepy or have nerve problems, low blood pressure, and slower breathing. In sever cases, cardiac arrest may occur. Hypernatremia - CORRECT ANSWER means too much sodium - an electrolyte- in the blood. Excess sodium in the blood causes water to move out of the cells - including red blood cells. It can cause headaches, high blood pressure, and crenation. Hyperphoshatemia - CORRECT ANSWER means too much phosphorus in the blood. It is most often found in patients wh0 eat a lot of protein or dairy foods and dont take enough phosphate binders. Phosphorus is a component of bones. It is key to energy transfer between cells. Hyperphospatemia can cause sever itching in the short term and bone damage in the long term. When it occurs with hypercalcemia, hypercalcemia can cause fractures, bone pain, and sharp calcium phosphate crystals in the soft tissues. - CORRECT ANSWER Infection - CORRECT ANSWER is an invasion of the body by a pathogen. Hypersensitivity - CORRECT ANSWER is above-normal sensitivity or allergy. Hypersensitivity reactiosn occur most often with cellulose dialyzers. This can cause anaphylaxis in some patients. Hypertension - CORRECT ANSWER is high blood pressure. It can be a cause or result of kidney failure and is the second most common cause of kidney disease in the US. High blood pressure can raise the risk of a stroke and damage the kidneys, heart, blood vessels, eyes, and other organs. Patients on standard in-center hemodialysis often take more than one blood pressure drug to control hypertension. Hypertonic - CORRECT ANSWER A hypertonic solution has a higher osmotic concentration than another solution. Use of hypertonic saline - more concentrated than the blood - can draw more water into the blood if a patient feels dizzy or faint. Since its use leaves cause excess sodium in the blood, this practice has fallen out of favor. Hypo - CORRECT ANSWER - means below, beneath, or too little. Fox example, a hypodermic needle is a needle that is inserted beneath the skin. Hypocalcemia - CORRECT ANSWER means not enough calcium in the blood. Hypocalcemia can cause tetany-spasms and twitching of the muscles - or seizures. Low blood calcium can occur in kidney disease due to the loss of calcitriol production by the failing kidneys. Calcitriol lets the body absorb calcium from the diet. Hypoglycemia - CORRECT ANSWER means below-normal levels of sugar in the blood. In a patient with diabetes, this can cause hunger, nervousness, shaking, weakness, sweating, dizziness, sleepiness, confusion, or trouble speaking. The treatment is a fast-acting carbohydrate, like juice. Hypokalemia - CORRECT ANSWER means below-normal levels of potassium in the blood. This is rare in dialysis patients. It can occur if there is too little potassium in the diet or in the dialysate. Hypokalemia can also be caused by a loss of potassium due to vomiting, diarrhea, use of potassium exhange resins, and use of diuretics that increase the loss of potassium in the urine - if the Patient makes urine. Hyponatremia - CORRECT ANSWER means below-normal levels of sodium in the blood. Without enough sodium, water moves out of the extracellular space and into the cells. This can cause low blood pressure and hemolysis. Symptoms can include muscle cramping, restlessness, anxiety, access pain, headaches, and nausea. Hypophosphatemia - CORRECT ANSWER means below-normal levels of phosphorus in the blood. This is rare in dialysis patients, as phosphorus is found in most foods. It may occur if a patient has a poor diet and takes too many phosphate binders, or in patients who do nocturnal HD. Low levels of phosphorus can suggest malnutrition. Hypophosphatemia can cause heart arrhythmias or muscle weakness - CORRECT ANSWER Hypotension - CORRECT ANSWER is low blood pressure. In dialysis patients, low blood pressure occurs most often when too much fluid is removed during dialysis or when patients take too many blood pressure drugs. Symptoms include sever muscle cramps; headaches; feeling warm, restless, dizzy, faint, or nauseated; or having visual disturbances. The trendelenburg position - raising the feet higher than the heart - and giving fluids help return blood pressure to normal. - CORRECT ANSWER Hypotonic - CORRECT ANSWER A hypotonic solution has a lower osmotic concentration than another solution. Use of hypotonic dialysate - more dilute than the blood - can lead to hemolysis - bursting of red blood cells. Interdialytic - CORRECT ANSWER means between dialysis treatments. Infection Conctrol - CORRECT ANSWER is a series of steps taken to prevent the spread of infection. The steps include washing hands, using aseptic technique for invasive procedures, disinfecting and cleaning, and wearing protective gear. Infiltration - CORRECT ANSWER is a leakage of a substance into body tissues. In dialysis patients, infiltration of blood into the tissues around the access can occur if the needle punctures the back of the vessel wall. To prevent infiltration, place needles with great care. Use of the buttonhole for cannulation can reduce the risk of infiltration. - CORRECT ANSWER Instill - CORRECT ANSWER To instill is to place into or cause to enter. Heparin is instilled into each lumen of a dialysis catheter to prevent clotting in a catheter between treatments. Dialysate is instilled into the peritoneum for peritoneal dialysis. Interstitial Space - CORRECT ANSWER is between the cells or organ tissues. Intermittent - CORRECT ANSWER means periodically or not continuously. Heparin can be given intermittently during dialysis. Internal Jugular - IJ - Catheter - CORRECT ANSWER Dialysis catheters may be placed in the internal jugular vein in the neck. This site is less likely to cause central venous stenosis than placement in the subclavian vein. Intima - CORRECT ANSWER is the smooth lining of the inner surfaces of arteries and veins. The intima is covered with a thin, fragile layer of cells that allows blood to flow through the vessel easily. In a fistual or graft, hyperplasia of the intima cells at the anastomosis can cause stenosis - narrowing, which makes blood clots more likely. - CORRECT ANSWER Intracellular - CORRECT ANSWER means within the cells. Two-thirds of fluid in the body is inside the cells. Sodium causes fluid to move accross cell membranes between the intracellular and extracellular spaces. Intradermal - CORRECT ANSWER means within the skin. Local anesthetics may be injected intradermally. Intramuscular - CORRECT ANSWER means within a muscle Intravacular - CORRECT ANSWER means within a blood vessel. Intravenous - IV - CORRECT ANSWER means within a vein. Many medications are injected intravenously. Ion - CORRECT ANSWER is an electrically-charged particle. Ions can carry a positive charge - cation - or a negative charge - anion. Ion Exchange - CORRECT ANSWER Occurs inside a deionizer for water treatment. Unwanted ions are traded for hydrogen and hydroxyl ions to create pure water. Isotonic - CORRECT ANSWER An is0tonic solution has the same osmotic concentration as another solution. Normal saline is isotonic; it has the same level of sodium as the blood. Iron Deficiency - CORRECT ANSWER is a lack of iron in the body to make red blood cells. Without iron, the bone marrow cant make red blood cells, even if erythropoietin is present. Low levels of iron can cause a form of anemia. Ischemia - CORRECT ANSWER is a lack of oxygen in the tissues due to reduced blood flow. It can be painful. Ischemia of the heart can cause angina pain. Steal syndrome - ischemia of the hand - may cause hand pain; a cold, clammy feeling; and, in extreme cases, painful, non-healing skin ulcers. Isolated Ultrafiltration - IU - CORRECT ANSWER IU removes water, but not solutes. It uses the extracorporeal circuit and dialyzer - without dialysate. IU is also called dry ultrafiltration, sequential ultrafiltration, or pure ultrafiltration. IU can be done before, after, or without dialysis. Its main advantage is that fluid removal is better tolerated than with standard dialysis. . - CORRECT ANSWER Kidney Transplant - CORRECT ANSWER replaces the failed kidneys with a healthy kidney from a donor. It is possible to receive a living donor kidney from a relative, spouse, friend, or unrelated person. Deceased donor kidneys come form people who have had died. Blood type and other tissue factors are used to match a recipient after a medical work-up has been done. - CORRECT ANSWER Local Infection - CORRECT ANSWER is an infection only in one area- such as in a fistula or graft and the tissues around it. Leach - CORRECT ANSWER Leaching occurs when water passes through a substance and dissolves part of it. In water treatment, copper, lead or galvanized steel should not be used after the blending valve because water can leach copper or zinc from the pipes. Loading Dose - CORRECT ANSWER is a dose of medication that creates a certain blood level in the body. A loading dose of heparin may be given after both needles are in place, but before a treatment begins. This lets the heparin glow through the patient's bloodstream. Lumen - CORRECT ANSWER is the inside diameter of a blood vessel or a tube, such as a catheter or needle. In stenosis, the lumen of the vascular access becomes narrower, which limits blood flow Lyse - CORRECT ANSWER To lyse is to dissolve. One option for treating a blood clot in a vascular access is to use a drug that will lyse the clot. Membrane Compliance - CORRECT ANSWER is a measure of the ability of a membrane to change shape or volume due to pressure. Magnesium - CORRECT ANSWER is a metallic mineral. It is found in the body as an electrolyte in the intracellular fluid. A small trace of magnesium in body fluids is vital to the nervous system. Malnutrition - CORRECT ANSWER is a lack of proper nutrition. Many people on dialysis dont get enough protein, which is a risk factor for death. Protein levels are checked with a blood test for serum albumin. This should be 4.0 g/dL or higher. Membrane Filters - CORRECT ANSWER are water treatment cartridges. They contain thin membranes with pores of a specified size. Membrane filters remove small particles and some solutes. Metablic Acidosis - CORRECT ANSWER occurs when the acid/base balance of body fluid and tissues shifts towards acid due to a build-up of acid in the body. This problem is common indialysis patients. Their kidneys no longer reabsorb as much bicarbonate - a buffer that keeps blood pH stable. Metabolism - CORRECT ANSWER is the sum of chemical processes that occurs when some substances are broken down and others are formed. Metabolize - CORRECT ANSWER is to break down into a simpler substance. Methemoglobinemia - CORRECT ANSWER is the loss of the oxygen-carrying ability of red blood cells. Microalbuminuria - CORRECT ANSWER means there are small amounts of albumin -protein- in the urine. Albumin is a large molecule. It does not pass through the cell walls of healthy glomeruli. So microalbuminuria can be an early sign of chronic kidney disease. Blood pressure drugs in the ACE inhibitor or ARB class can slow the rate of kidney disease in some people with microalbuminuria. - CORRECT ANSWER Microbe - CORRECT ANSWER is a microscopic living organism, such as bacteria, virus, fungus, or algae. Microns - CORRECT ANSWER are a unit of measure for filter pores. Filters with high micron sizes trap larger particles and let smaller ones flow through. A submiron filter may be needed to capture very small particles. Microorganism - CORRECT ANSWER is a microscopic living organism, such as bacteria, virus, fungus, or algae. Modality - CORRECT ANSWER is a type of treatment, such a hemodialysis, peritoneal dialysis, or transplant. Molecular Weight - CORRECT ANSWER is a measure of molecule size in Daltons -Dz. The sum of the atomic wights of all elements in a molecule of a substance is it molecular weight. Larger moleucules -likeB2M- have higher molecular weights. Molecular Weight Cutoff - CORRECT ANSWER is the argest solute size that can pass through a given semipermeable membrane. Molecule - CORRECT ANSWER is the smallest complete unit of a substance that has that substance's identity. Morbidity - CORRECT ANSWER is illness and may be measured as days of hospitalization. It is used as one measure of patient outcomes. Myocardial Infarction - MI - CORRECT ANSWER is blockage of a heart artery. It can lead to death of part of the heart muscle. The Patient may feel severe or crushing chest pain - "a heart attack" Myalgia - CORRECT ANSWER Muscle pain Nasogastric - NG - Tube - CORRECT ANSWER is a tube that is inserted through the nose into the stomach. Patients who are malnourished may need to be fed through an NG tube. Needle Site Rotation - CORRECT ANSWER is used with fistulae and grafts. Its aim to prevent damage that can occur when needles are placed many times in the same small area. Needles are always placed tat least 1.5in away for the anastomosis and away from the sites used at the last treatment. Negative pressure - CORRECT ANSWER is pressure less than 0 mmhg. Negative pressure plus positive pressure equals transmembrane pressure - TMP Neointimal Hyperplasia - CORRECT ANSWER occurs when smooth muscle cells at the venous anastomosis grow many extra layers of cells. These cells fill up the graft lumen, which means less blood can flow through the graft. Nephrologist - CORRECT ANSWER is a licensed doctor who specializes in kidney diseases. Nephrology - CORRECT ANSWER is the study of kidneys Nephron - CORRECT ANSWER is a tiny blood purification filter in the kidney. It is made up of a glomerulus and a tubule. Nephrons filter wastes from the body and keep electrolyte and fluid balance. Each Kidney has about a million nephrons. Nocturnal Home Hemodialysis - NHHD - CORRECT ANSWER NHHD treatments are done for 8 hours at night, while the patient sleeps at home, 3 to 6 nights per week. NHHD is work friendly. Studies show that survival with this treatment is about the same as with deceased donor transplant. Nocturnal In-Center Heomodialysis - CORRECT ANSWER treatments are done for 8 hours a night while the patient sleeps at the center. Normal Saline - CORRECT ANSWER is a sterile salt water solution with 0.9% sodium chloride. This level is equal to the concentration of sodium chloride found in the blood. In hemodialysis, normal saline is used ot prime and prepare the extracorporeal circuit. It may also be used for fluid replacement during the treatment. Nosocmial - CORRECT ANSWER means hospital-acquired. The term is used for infections or illnesses patients get during the course of their medical treatment. Opportunistic Illness - CORRECT ANSWER is one that tends to occur only when a patient's immune system is impaired. Patients with AIDS, for example, are prone to these illnesses because their immune systems are weakened. Orthostatic Hypotension - CORRECT ANSWER is a drop in blood pressure of 15 mmHg or more that occurs when a person rises from sitting to standing Osmosis - CORRECT ANSWER is movement of water across a semipermable membrane from a lower solute concentration to a higher one, until the water level is the same on both sides. Osmosis is too slow to remove enough water for hemodialysis. So water movement is aided by a hydraulic pressure gradient. Osmotic Gradient - CORRECT ANSWER is a difference in the concentration of solutes on each side of a semipermeable membrane. Osmotic Pressure - CORRECT ANSWER is a gradient created by using dialysate that has substances, like glucose, that cause fluid to move out of the blood and into the dialysate. Palpate - CORRECT ANSWER is to examine by touching. Palpating the thrill over a vascular access is one way to know if the access is working. Palpitations - CORRECT ANSWER are occasional, strong heartbeats. They can be a symptom of cardiac arrhythmia. Parathyroid Hormone - PTH - CORRECT ANSWER is a hormone produced by the four parathyorid glands in the neck. PTH is released into the bloodstream in large amounts when calcium levels are low or phosphorus levels are high. Too much PTH can cause bone disease. Patent - CORRECT ANSWER means open or not blocked. Before each dialysis treatment, patency of the patient's access is checked by listening for the bruit and feeling for the thrill. Pathogen - CORRECT ANSWER is an agent - such as bacterial that causes disease in humans. Patient outcomes - CORRECT ANSWER are the results of care. Morbidity and mortality are common measures of outcomes. Others such as the patient's self-rate physical and mental health, are important as well. Percutaneous - CORRECT ANSWER means through the skin Pericardial Effusion - CORRECT ANSWER is a build-up of fluid in the pericardium, or sac around the heart. In severe cases, it can lead to cardiac tamponade, a life-threatening problem that occurs when fluid pressure makes it hard or even impossible for the heart to beat. Pericarditis - CORRECT ANSWER inflammation of the pericadium, that sac around the heart. Peripheral - CORRECT ANSWER means away for the center of the body. Fox example, peripheral vascular disease affects the limbs, not the core, of the body. Periphreal Neuropathy - CORRECT ANSWER is nerves damage in the hands and feet. It can cause numbness, tingling, burning, pain, and weakness. Diabetes is a common cause of neuropathy. In dialysis patients, neuropathy may be caused by uremic toxins that are not well removed by standard in-center hemodialysis. Peripheral Vascular Resistance - CORRECT ANSWER is a measure of how well blood can flow through the blood vessels. A drop in resistance - the blood vessels relax - will lower blood pressure if the heart can't make up for it. A rise in resistance - the blood vessels narrow - will raise blood pressure. Peritoneal Dialysis - PD - CORRECT ANSWER use the peritoneum as a semipermeable membrane ot clean the blood. Peritoneal Dialysis Adequacy - CORRECT ANSWER PD adequacy is a measure of the treatment dose. The intent is to ensure that PD patients receive at least the minimum amount of treatment they need to live. The KDOQI guidelines set standards for adequacy and give tips for attaining them. Pertoneum - CORRECT ANSWER is smooth, thin layer of blood-vessel-rich tissue that covers the inside of the abdominal walls. The peritoneum forms a closed sac. Thus, it can be used as a semipermeable membrane and container for dialysate in PD. Peritonitis - CORRECT ANSWER is an infection of the peritoneum. It can occur when aspetic technique is not used during a PD exchange. Peritonitis may cause scarring that can make further PD impossible. Permeable - CORRECT ANSWER means allowing substances to pass through. Cell membranes in the body are freely permeable to water, letting it pass in and out. Dialyzer membranes are semipermeable. They let some substances through, but keep others out. pH - CORRECT ANSWER refers to the hydrogen ion concentration of a solution Phosphate Binders - CORRECT ANSWER are drugs that bind with phosphorous in food. They keep phosphorus from being absorbed in the gut. Thus eliminated in the stool. Phosphorus - CORRECT ANSWER is a non-metallic element. It is found in dairy products, meat, poultry, fish, nuts, chocolate, and colas - so many foods that it is hard to avoid. Too much phosphorus in the blood can cause itching, secondary hyperparathyroidism, and bone disease. Plasticizer - CORRECT ANSWER is a chemical that makes plastic flexible. Priming the dialyzer and blood tubing before use with saline helps remove plasticizers that could harm patients. Platelets - CORRECT ANSWER are blood cells that promote clotting by clumping together when "activate" by signals sent by injured cells. Pneumothorax - CORRECT ANSWER is air in the chest cavity that keeps the lungs from expanding. Polycysitic Kidney Disease - PKD - CORRECT ANSWER is a genetic disease that causes large, fluid filled cysts to grow in the kidneys, liver, and sometimes the brain. - this can cause kidney failure. Pores - CORRECT ANSWER are holes. In a semipermeable dialyzer membrane, membrane filter, or reverse osmosis unit, the pores allow solutes of a certain size range to pass through, but trap larger ones. Positional - CORRECT ANSWER means affected by the patient's body position. Positive Pressure - CORRECT ANSWER is pressure greater than 0 mmHg. Post- - CORRECT ANSWER After - A post test is taken after a lesson Potassium - CORRECT ANSWER is a metallic, element and an electrolyte in the body. Levels of potassium that are too high or too low can cause illness or death. Pro - - CORRECT ANSWER Before Predialyzer Pressure - CORRECT ANSWER is the positive pressure after the blood pump and before the dialyzer. It is also called post-pump pressure or post-pump arterial pressure. Preprocessing - CORRECT ANSWER means putting a new dialyzer through all of the reprocessing steps before it is used for the first time. This helps remove substances used in manufacturing that might cause allergic reactions. Pre-Pump Arterial Pressure - CORRECT ANSWER is measured between the patient's arterial needle and the blood pump. It represents the negative pressure created by the blood pump. Arterial pressure monitoring guards against too much suction on the vascular access. Pressure - CORRECT ANSWER is force applied by something that comes in contact with an object. In the body, blood pressure is the force from the heart and resistance in the blood vessels. In hemodialysis, pressure is the flow form the blood pump and resistance in the dialyzer and extracorporeal circuit. Pressure testing - CORRECT ANSWER or leak testing, ensures that a dialyzer membrane is intact and not blood loss will occur during the next use. Pressure testing must be part of the reuse process. Presternal Catheter - CORRECT ANSWER used in peritoneal dialysis, is placed in the patient's chest wall with the tip in the abdomen. Priming - CORRECT ANSWER is getting the bloodlines and dialyzer ready for use by flushing them with normal saline. Product Water - CORRECT ANSWER is that water that has been forced through a revers osmosis membrane. Proportioning system - CORRECT ANSWER is a type of dialysate delivery system. This system mixes liquid concentrate with measured amounts of treated water to form dialysate and send it to the dialyzer. There are two types: fixed-ratio and servo-controlled. Both use dual conductivity meters to check the mixed dialysate and support the system, should one meter fail. Prospective Payment System -PPS - CORRECT ANSWER A system for calculating Medicare reimbursement rates, the PPS "bundles" what was in the old composite rate plus lab tests, some drugs, and home training into one payment. Proteinuria - CORRECT ANSWER means protein in the urine. Proximal - CORRECT ANSWER means near. In anatomy, proximal is near the center of the body, e.g, the should is proximal to the hand. Pruitus - CORRECT ANSWER is itching Pseudoaneurysm - CORRECT ANSWER is a false aneruysm. Pulmonary Edema - CORRECT ANSWER is fluid build-up in the lungs. Pump Occlusion - CORRECT ANSWER is the space between the blood pump rollers and the pump housing. Purpura - CORRECT ANSWER is bleeding under the skin which may be a symptom of too much heparin or a platelet dysfunction. Pyrogen - CORRECT ANSWER is a fever-producing substance, such as endotoxin. Pyrogenic Reaction - CORRECT ANSWER A Pyrogenic - fever - reaction is caused by pyrogens. Quality Assurance - QA - CORRECT ANSWER is a way to monitor, evaluate, and improve care. Radial Pulse - CORRECT ANSWER is the pulse felt on the thumb side of the wrist. Radiocephalic Fistula - CORRECT ANSWER connects the radial artery and cephalic vein in the forearm. This is the most common type of AVE fistula. Reagent - CORRECT ANSWER is a substance that reacts when a certain chemical is present. Reagentstrips are used to be sure that all chemical residues are gone from a reprocessed dialyzer or the dialysis delivery system. Recirculation - CORRECT ANSWER occurs when dialyzed blood mixes with undialyzed blood in the patient's access. Rejection - CORRECT ANSWER occurs when the immune system of a transplant patient attacks the new organ, which is foreign to the body. Reject Water - CORRECT ANSWER is the waste or reject stream that is sent to the drain, along with any solutes removed by reverse osmosis. Renal Osteodystrophy - CORRECT ANSWER is bone disease that is caused by too-high or too-low levels of PTH. Renin-Angiotensin System - CORRECT ANSWER helps control blood pressure. Renin is an enzyme mady by healthy kidneys during stress. Reprocessing - CORRECT ANSWER is cleaning and disinfecting a dialyzer to be used again by the same patient to save money. Resistance - CORRECT ANSWER is created by any factor that partly obstructs flow. Resistivity - CORRECT ANSWER is the measure of the forces that oppose the flow of electricity through a fluid. Retrograde - CORRECT ANSWER means against the direction of blood flow. Reverse Osmosis - RO - CORRECT ANSWER is a membrane separation process that removes solutes from water. Rinseback - CORRECT ANSWER means using saline to flush the patients blood back into the body after dialysis to minimize blood loss. Roller Pump - CORRECT ANSWER is the most common type of blood pump. A motor turns the roller head, pushing blood through the extracorporeal circuit. Rule of Sixes - CORRECT ANSWER The DKOQI guidelines say the "Rule of 6" is a good way to tell if a fistula is a success; It is less than 0.6 cm below the surface of the skin - about 1/5 of an inch. It is at least 0.6cm wide. And, ultrasound shows a blood flow rate of 600 mL/min or more. Saline Infusion Line - CORRECT ANSWER allows saline to be given to the patient during dialysis. Scale - CORRECT ANSWER or precipitate, is solid particles that settle out of a solution and can clog pipes or harm parts of the water treatment system. Hard water, which has more minerals and salts, can form scale. Secondary Hyperparathyroidism - CORRECT ANSWER is the release of too much parathyroid hormone -PTH. It can lead to bone disease. Seizures - CORRECT ANSWER are involuntary muscle spasms and loss of consciousness. Self-Care Hemodialysis - CORRECT ANSWER is done in-center. Patients do most or all of their own care with little staff assustance. Semipermeable Membrane - CORRECT ANSWER has microscopic pores. The pores let some substances pass through freely, but hold others - such as red blood cells back. The membranes pore size affects dialysis efficiency. Sepsis/Septicemia - CORRECT ANSWER is a life-threatening blood infection caused by bacteria that enter the bloodstream. It is also called septicemia or bacteremia. Serum - CORRECT ANSWER is the clear liquid that can be separated from blood. Short Daily Home Hemodialysis - CORRECT ANSWER is 2.5 - 4 hour treatments done at home 5-7days per week Shunt - CORRECT ANSWER is a tube that is inserted into the body. A shunt was the fist permanent vascular access used for dialysis in 1960 by Drs. Scribner and Quinton. Sieving Coefficient - SC - CORRECT ANSWER is the amount of solute removed from a solution by convection - solvent drag Sodium - CORRECT ANSWER is an element and an electrolyte in the body. It causes fluid to move across the cell membranes between the intracellular and extracellular spaces. Sodium Modeling - CORRECT ANSWER is changing the level of sodium in the dialysate during the treatment to remove more water. Solute - CORRECT ANSWER is a particle dissolved in fluid. Solution - CORRECT ANSWER is a combination of solvent - fluid and solute. Solvent - CORRECT ANSWER is a fluid in which substances are dissolved, e.g., water Solvent drag - CORRECT ANSWER occurs when molecules of a dissolved substance are dragged along in a solvent that passes through a semipermeable membrane. Sorbent Dialysis Systems - CORRECT ANSWER uses a cartridge with layers of chemicals to mae and then regenerate dialysate. Spore - CORRECT ANSWER are the reproductive form of bacteria, fungi, andalgae. They are very resistant to heat. Bleach can kill many types of spores. Standard In-Center Hemodialysis - CORRECT ANSWER Done in a center 3 times a week. at least 4 hours long Standard Home Hemodialysis - CORRECT ANSWER treatments are done 3 days a week or every other day by the patient and a partner at home. Standing Orders - CORRECT ANSWER are orders that stay the same. They are written by the doctor to meet patients common treatment needs. Steal Syndrome - CORRECT ANSWER occurs when a fistula or graft "steals" too much blood away from the distal part of the limb. Stenosis - CORRECT ANSWER is narrowing of a blood vessel. Stenosis slows the flow of blood and causes turbulence inside the vessel. Stents - CORRECT ANSWER are small. expanding metal rings that can be placed in a blood vessels to hep keep the lumen open. Sterile - CORRECT ANSWER means free of all living organisms, bacterial, viruses, microorganisms. Sterilant - CORRECT ANSWER is a germ-killing solution Sterlization - CORRECT ANSWER destroys bacteria with chemicals. Subclavian Catheter - CORRECT ANSWER is placed in the subclavian vein. Subcutaneous - CORRECT ANSWER means under the skin. aka - lido Surface Area - CORRECT ANSWER in hemodialysis is the amount of membrane in direct contact with blood and dialysate. Systemic - CORRECT ANSWER means affecting the entire body. Systolic - CORRECT ANSWER is the pressure inside the arteries during a heart beat. It is the top number of a blood pressure reading. Temperature Alarm - CORRECT ANSWER tells you that the dialysate temperature is too high or too low. Dialysate that is too hot can cause hemolysis. Too-cool dialysate can cause patient discomfort and reduce the efficiency of the treatment. Temporary Catheters - CORRECT ANSWER is a central venous catheter that is used for short-term vascular access, for example, when a fistula has not matured. Thrill - CORRECT ANSWER is the vibration of blood flowing through the patients fistual or graft. Thrombectomy - CORRECT ANSWER is surgery or drug treatment - I.e, with a clot-dissolving drug to remove a thrombus, or blood clot. Thrombosis - CORRECT ANSWER formation of a thrombus, or blood clot Thrombus - CORRECT ANSWER is a clot formed in a blood vessel or a blood passage. Total Pareteral Nutrition -TPN - CORRECT ANSWER is a form of intravenous feeding Transducer Protectors - CORRECT ANSWER are small plastic caps with filters inside. Transmembrane Pressure - TMP - CORRECT ANSWER is blood side pressure plus dialysate side pressure across the dialyzer membrane. Trandelenburg Position - CORRECT ANSWER puts the head at a 45 degree incline, with the legs up. Ultrafilter - CORRECT ANSWER is a fine membrane filter that removes very small particles. Ultrafiltration - UF - CORRECT ANSWER In hemodialysis, UF is filtration caused by a pressure gradient between two sides of a filter. Ultrafiltration Rate - UFR - CORRECT ANSWER is a rate at which fluid moves from the blood into the dialysate through the membrane. Ultraviolet - UV light - CORRECT ANSWER is a form of invisible radiation. Urea Kinetic Modeling - UKM - CORRECT ANSWER is used to assess if a patient's dialysis is adequate, based on change in the level of urea in the blood. Urea Reduction Ratio - URR - CORRECT ANSWER is a way to estimate the delivered dose of dialysis by comparing urea levels before and after a treatment. Uremia - CORRECT ANSWER is a build-up of wastes in the blood. Vascular Access - CORRECT ANSWER is a way to gain repeated entry to the patients bloodstream for hemodialysis. Vasoconstrict - CORRECT ANSWER meant to tightentheblood vessels. Vasoconstrictor - CORRECT ANSWER is a drug that causes the blood vessels to constrict. Vein - CORRECT ANSWER is a blood vessel that carries blood back to the heart Venipuncture - CORRECT ANSWER is inserting a needle into a blood vessel. Venous Pressure - CORRECT ANSWER is the measurement of the extracorporeal blood circuit pressure after the dialyzer and before the blood goes back into the patients body. It may also be called postdialyzer pressure. Venous Pressure High/Low Alarm - CORRECT ANSWER monitors pressure from the monitoring site to the patients venous puncture site. Virus - CORRECT ANSWER is a microorganism that must obtain energy and food from other living cells. Water Softener - CORRECT ANSWER is used in water treatment to reduce the level of calcium and magnesium that form scale. The venous needle is always placed antegrage - in the direction of the blood flow. - CORRECT ANSWER The Arterial needle is placed closes to the arterial anastomosis. It receives blood from the artery. The arterial needle can be placed antegrade or retrograde - against the blood flow; most often towards the hand. - CORRECT ANSWER When an antegrade needle comes out, the blood flow will hold the flap closed. But when a needle is retrograde, the blood flow will hold the flap open. - CORRECT ANSWER Draw blood samples from the arterial bloodline injection port or arterial needle tubing. Heparin bolus/load given 5 minutes before treatment starts - CORRECT ANSWER Air Embolism: 1. Place Patient in trendlelenburg position on LEFT side to trap air in the right ventricle of the heart. Disconnect Patients from machine in this order when emergency: - CORRECT ANSWER 1. Patients who can walk without help. 2. Patients who can walk with help. 3. Patients who CANT walk and need staff to help to do so. 4. Leave the premises using the safest and closest exit. In case of fire remember R.A.C.E. R = rescue A = Activate Alarm C = Contain fire - if small E = Evacuate - CORRECT ANSWER You can check for amount of swelling by gently pressing your thumb over the foot, ankle, or shin with slow steady pressure. If a dent stays in the patients skin, this is called pitting edema and is more serious. B/P cuffs to small = will cause higher blood pressure - CORRECT ANSWER B/P cuffs to big will cause lower readings. B/P cuffs wrapped too loose or uneven will also cause higher readings. - CORRECT ANSWER Arterial Low Pressure Alarms: 1. Blockage of arterial blood flow from the patients access. 2. Wrong position in infiltration of Arterial Needle. 3. Compression Kink in the arterial bloodline. 4. Hypotension 5. Vasonstriction - tightening of the patients blood vessels. 6. Poorly working central catheter - CORRECT ANSWER Arterial High Pressure Alarms: 1. A bloodline separation - if the upper limit is set below zero. 2.A leak between the patient and the monitoring site 3. A drop in the blood pump speed. 4. Infusion of saline or medications. Venous Low Pressure Alarms: 1. Blood tubing separation for the venous needle or catheter. 2. A drop in the blood flow rate. 3. Blockage in the blood tubing before the monitoring site. 4. A badly clotted dialyzer - CORRECT ANSWER Venous High Pressure Alarms: 1. Blood tubing is blocked between the monitoring site and the venous needle. 2. Poor position or infiltration of the venous needle. 3. Poorly working central catheter 4. Clotting in the access. What are 2 main types of dialysis? - CORRECT ANSWER Hemodialysis and peritoneal dialysis How are dialysis clinics paid by Medicare? - CORRECT ANSWER Prospective payment system bundles What does "Pay for performance" mean - CORRECT ANSWER Clinics that dont meet certain quality standards will have their payments cut Which of the following are dialysis clinics required to work with - CORRECT ANSWER ESRDS networks Which of the following is a responsibility of the ERDS networks? - CORRECT ANSWER 1. Collect and report data about dialysis 2. Handle Patient grievances 3. Help clinics deal with conflict 4. Promote rehabilitation What are clinical practice guidelines - CORRECT ANSWER Efforts to improve patient outcomes by finding best practices Which of these is a step of the CQI process - CORRECT ANSWER Implement the PDCA cycle Which of the following actions shows that you are behaving as a professional - CORRECT ANSWER Getting to work on time Which of the following is an example of a boundary that should be kept between you and your patients - CORRECT ANSWER You should not invite patients to your home How do you become certified dialysis technician - CORRECT ANSWER Take a test given by an approved program What is a nephron made up of - CORRECT ANSWER A glomerulus and a tubule What is the most common cause of kidney failure for US Adults - CORRECT ANSWER Diabetes Which of these is a problem of kidney failure caused by build-up of wastes in the blood - CORRECT ANSWER uremia What causes secondary hyperparathyroidism in people with kidney failure - CORRECT ANSWER The kidneys no longer make active Vitamin D Which of these substances are electrolytes - CORRECT ANSWER Calcium and Sodium Which word means too much potassium - CORRECT ANSWER Hyhperkalemia What is the patients dry weight - CORRECT ANSWER The weight after a treatment when all or most excess water is gone What should you do if a patient asks you a question you dont know the answer to - CORRECT ANSWER Refer patient to a member of the care team that can answer the question. The dialysis team member with special training in helping people cope with the changes caused by kidney disease is the - CORRECT ANSWER social worker What is a solution made up of - CORRECT ANSWER Solvent and solute A semipermeable membrane is a filter that - CORRECT ANSWER Allows only certain sized particles pass through What happens in diffusion - CORRECT ANSWER Solutes move through a membrane from an area of higher concentration to a lower one Which of these would lead to fastest diffusion - CORRECT ANSWER Small particles, warm solution, large pores Which of these best describe osmosis - CORRECT ANSWER Water moves through a membrane from a lower solute concentration a higher one What role does ultrafiltration play in dialysis - CORRECT ANSWER removes water from the patients blood Which of these is the intravascular fluid compartment - CORRECT ANSWER Blood inside the blood vessels During dialysis, levels of waste in the blood can be expected to - CORRECT ANSWER decrease What type of pressure is applied when the blood pump pulls blood through a needle - CORRECT ANSWER Negative pressure What is a gradient - CORRECT ANSWER A difference Why are synthetic dialysis membranes more biocampatible - CORRECT ANSWER They adsorb more proteins from the blood Which of these is a way to remove solutes - CORRECT ANSWER convection What are the two compartments of the dialyzer - CORRECT ANSWER Blood and dialysate Which of these substances might be included in a dialysate prescription - CORRECT ANSWER Bicarbonate, sodium, potassium What is the purpose of a proportioning system - CORRECT ANSWER Make dialysate by mixing fresh concentrate with fixed amounts of treated water Where is conductivity most often checked - CORRECT ANSWER Dialysate mixing and before dialysate enters the dialyzer What condition occurs due to dialysate that is too hot - CORRECT ANSWER Hemolysis What are two types of ultrafiltration systems - CORRECT ANSWER Volumetric and Flow Control Which of these best describes the transducer protector - CORRECT ANSWER A mechanical device in the machine that converts air pressure into an electronic signal Which group contains the dialyste delivery system monitors - CORRECT ANSWER Conductivity, pH, flow rate When assessing a fistula or graft, which of these do you listen for before starting dialysis - CORRECT ANSWER Stenosis Which of these can happen when the needle is flipped during cannulation - CORRECT ANSWER infiltration, stretch the needle hole, tear the lining of the vessel Why do we rotate needle sites on a fistula - CORRECT ANSWER to prevent aneurysms What is the buttonhole technique - CORRECT ANSWER placing needles in the same spot at the same angle to form tunnel tracts What is an infiltration - CORRECT ANSWER A needle tip that goes into a fistual or graft and out the other side. Which of these is a long-term complication of a fistual - CORRECT ANSWER stenosis What is the biggest risk of one site itis in a graft - CORRECT ANSWER Graft rupture and exsanguination Which of these steps will help prevent infection in catheters - CORRECT ANSWER wash hands and change gloves before touching the patient and equipment What is aseptic - CORRECT ANSWER free from disease-causing germs What is the most important step you can take to prevent the spread of infection - CORRECT ANSWER wash your hands A pulse of 104 beats/min would suggest the patient has - CORRECT ANSWER tachycardia The normal range of resting respirations in adult is - CORRECT ANSWER 12 to 16 breaths/min For whom would you use the stand and pivot technique to transfer from a wheelchair or dialysis chair - CORRECT ANSWER A patient who can bear his or her weight once standing What is the purpose of priming bloodlines and the dialyzer - CORRECT ANSWER To remove air and germicide from the blood lines and dialyzer 1kg = 1000mL - CORRECT ANSWER Which of the following is a cause of hypotension during and after dialysis - CORRECT ANSWER removing too much fluid What is the main reason that dialyzers are reprocessed - CORRECT ANSWER cost saving measures Which organizations sets the standards for dialyzer processing - CORRECT ANSWER AAMI Which test needs to be done on new dialyzers - CORRECT ANSWER TCV - Total cell volume What are the steps for dialyzer reprocessing after a dialysis treatment - CORRECT ANSWER precleaning, performance tests, dialyzer rejection and disinfection Which of these is a germicide used for dialyzer reprocessing - CORRECT ANSWER peracetic acid Which of these is a definition of contact time - CORRECT ANSWER How long the germicide must stay in the dialyzer to work Who must check a reprocessed dialyzer to verify the quality control information - CORRECT ANSWER two people, one of whom should be the patient Which of these problem that could cause bacteria or endotoxin to be in a reprocessed dialyzer - CORRECT ANSWER Wrongly mixed or outdated germicide Which of these best describes the dialyzer reprocessing manuals - CORRECT ANSWER A summary of all reuse specifications, policies, procedures, training material, manuals and methods, and samples of forms and labels For which of these reasons would we reject a reprocessed dialyzer - CORRECT ANSWER cracks or leaks in the plastic housing, labels cant be read Why must water used for dialysate be treated - CORRECT ANSWER because patients are exposed to large volumes of water during dialysis which of these substances may be added to city drinking water - CORRECT ANSWER alum what does a water softener do - CORRECT ANSWER removes calcium and magnesium which of these is a limitation of a reverse osmosis - RO system - CORRECT ANSWER Thin film composite membranes break down when exposed to chlorine and chloramines which is the most common way that water treatment systems are disinfected - CORRECT ANSWER using chemicals what type of patient reactions may occur if dialysis water contains bacteria or endotoxin - CORRECT ANSWER pyrogenic how often should the RO operating parameters be checked - CORRECT ANSWER daily Per AAMI standards, how often should dialysis water be tested for bacteria - CORRECT ANSWER monthly per AAMI standards, the total microbial count of dialysate shall not exceed - CORRECT ANSWER 200 CFU/mL What problem could large amounts of aluminum in dialysis water cause for patients - CORRECT ANSWER bone disease During a hemodialysis treatments, a patient complains of feeling chilled. In addition to getting the patient a blanket, what do you do - CORRECT ANSWER take the patients tempature During the set up of a hemodialysis machine, the alarm test for conductivity fails. what do you do - CORRECT ANSWER notify the equipment technician The technician observes that the hardness reading after the water softner is above the acceptable limit the technician should check the brine tanks level of - CORRECT ANSWER salt The venous pressure alarms sounds during a patients hemodialysis treatment after muting the alarm the tech actions should begin with - CORRECT ANSWER inspecting the extracorporeal circuit The following method should be used to calculate the ultrafiltration rate per hour of treatment: 72 kg predialysis weight minus 70 kg target weight equals 2 kg to be removed over 4 hours. - CORRECT ANSWER Two kg equals 2,000mL. Thus, 2,000 mL divided by 4 hours equals 500 mL per hour. Please note: This example does not include prime or rinseback volumes. A patient who is blind needs to be oriented to equipment and activities in the immediate environment. It is not necessary to avoid phrases that refer to sight, such as "I see..." or "it looks like..." - CORRECT ANSWER The technician should speak to the patient before touching to avoid startling the patient. As with all patients, instructions should be given directly to the patient, although the spouse or significant other may be included. During a hemodialysis treatment, a technician notices that the blood in the extracorporeal circuit is translucent and cherry red colored. The most likely cause - CORRECT ANSWER hemolysis A conductivity alarm sounds during a hemodialysis treatment. The tech should expect what - CORRECT ANSWER the dialyzer was bypassed The following formula is used to calculate total fluid removal: 1. Subtract target weight from predialysis weight; 2. Convert kilograms to mL; 3. Add rinseback in mL; 4. Seven 100 mL normal saline flushes - at 30 min., 1 hr, 1.5 hrs, 2 hrs, 2.5 hrs, 3 hrs, and 3.5 hrs.) - CORRECT ANSWER In this example: Predialysis weight (73.8 kg) - Target weight (71.5 kg) = 2.3 kg; 1 kg = 1,000 mL; 2.3 kg X 1,000 = 2,300 mL; add 400 mL rinseback = 2,700 mL; add 700 mL (100 mL flushes x 7 = 700 mL) = 3,400 mL When preparing a bleach solution for cleaning and their is a spill. which resource do you read to properly clean it up - CORRECT ANSWER Material Safety Data Sheet - MSDS when does a blood pump stop? - CORRECT ANSWER Low arterial pressure alarm. The venous needle is always placed antegrade - in the direction of the blood flow. - CORRECT ANSWER This helps prevent turbulence when blood returns to the patient. Be sure this needle is downstream - most often closer to the patients heart - from the arterial needle to keep newly dialyzed blood from recirculating. The arterial needle is placed closest to the arterial anastomosis. - CORRECT ANSWER It receives blood from the artery. The arterial needle can be placed antegrade or retrograde - against the blood flow; most often toward the hand. - CORRECT ANSWER When an antegrage needle comes out, the blood flow will hold the flap closed. But when the needle is retrograde, the blood flow will hold the flap open. 9 main pieces of equipment found in a hemodialysis water room and their purpose: - CORRECT ANSWER Temperature Blending valve: Mixes hot and cold water in order to maintain a water temperature between 55-85 degrees F. Carbon tanks - removes chlorine and chloramines from the water. Each tank contains 3.6 cubic feet of carbon. - CORRECT ANSWER Provides greater than 10 minutes of empty bed contact time - EBCT. Under no circumstances may the carbon tanks be bypassed! Brine Tank and Softener - Brine tank prepares sodium pellets and water to be used by the softener - CORRECT ANSWER Softener removes calcium and magnesium from the water and exchanges it for sodium. Protects the RO membranes. Feed Water Cartridge Filter - Sediment filter: Filets off large particles such a dirt, silt and colloidal matter - suspended particles. - CORRECT ANSWER 5 microns or larger. Measure pressures above and below each set of filters. Pressure drop must be less than 15 PSI. Reverse Osmosis - RO Membrane. The heart of the water system - CORRECT ANSWER Produces purified water by revers osmosis. Removes contaminants such as inorganic salts, organic matter, and bacteria from the municipal water supply. Dionizing - DI Tanks: Polishes the RO water. Can be used if RO needs to be bypassed to purify the feed water. - CORRECT ANSWER Ultrafilters: Removes bacteria and endotoxins 0.05 microns and larger from the product water. Measure pressure before and after the filter. Pressure drop must be less than 25 psi. - CORRECT ANSWER Product water storage tank: Is a reservoir for RO water used for dialysis treatment. Distribution Pump: Circulates the RO water from the storage tank, through the loop, and back to the storage tank. - CORRECT ANSWER What 2 water tests need to be done each day and when are they due? Total Chlorine Test: Test for chlorine and chloramines in feed water after the first carbon tank. Performed prior to initial patient hookup and at a minimum of every 4 hours thereafter. - CORRECT ANSWER If results of Total chlorine are >/=0.1ppm repeat the test. If results of Total chlorine are >/=0.1ppm a 2nd time, refer to facility policy and what to do next. You MUST discontinue all hemodialysis treatments immediately if your total Chlorine level is above the standards at your last carbon tank test port. DO NOT rinseback the Patients blood. - CORRECT ANSWER Hardness Test: Test the feed water level of hardness prior to initial patient hookup, at a minimum of every 4 hours thereafter, and at the end of the day. It IS SAFE to continue hemodialysis treatment with hard water. Make sure the Brine Tank is at least 1/2 full of salt at the end of the day so the softener may regenerate and soften any hard water during non-operational hours. - CORRECT ANSWER Monthly Waters Tests: Bacterial Cultures - Start of Loop -SOL End of Loop -EOL Dialysate from hemodialysis machines Endotoxin/Pyrogen Tests - Start of Loop (SOL) End of Loop (EOL) Dialysate from hemodialysis machine Quarterly Water Tests Months 1, 4, 7, 10 Water Analysis/Metals End of Loop -EOL - CORRECT ANSWER Yearly Water Tests Month 7 -July Water Analysis/Metals Pre RO Post RO Low Water Level Alarm RO Alarm Resistivity Alarms Good Quality Water - CORRECT ANSWER Green light means good quality water is being produced. It is safe to continue hemodialysis treatments. Low Water Level Alarm - CORRECT ANSWER Sensors located in the product water storage tank alarm when water falls below a certain level and the RO does not turn on to produce more product water to fill the tank. Low Water Level Alarm Action Press the red button on top of the RO monitor to manually trigger the RO to start. Notify RN and BioMed. - CORRECT ANSWER RO Alarm: The RO machine is not functioning properly. Bypass the RO and run on the DI tanks. RO Alarm Action: Make sure the DI tanks are on-line and working. Follow your facility specific policy on how to turn off the Distribution pump and close the valves to the RO Machine. Hang a sign to notify others that the RO is bypassed. - CORRECT ANSWER Resistivity Alarm: Resistivity readings should be in the range of 5-20 megohms. If Resistivity reading is <5 megohms, notify Charge Nurse and contact BioMed. Resistivity Alarm Actions: Follow facility policy on how to bypass the DI tanks when the resistivity meter is alarming at <5 Megohms/cm. Bypass the DI Tanks - CORRECT ANSWER