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180 terms

Dialysis Technician Exam Study Guide

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What foods are high in phosphorus
Dairy, Meats, Nuts, Peanuts, Dried Beans & Peas, Whole Grains, Chocolate, Colas
What foods are high in potassium
Avocados, Mangos, Bananas, Orange Juice, Dried Fruit, Cantaloupe, Dried Peas, Beans, Tomato Sauce, & Potatoes
What are the two hemodialysis delivery systems?
Extracorpeal (blood) & Dialysate
During dialysis, ultrfiltration occurs when:
Water is removed from blood because there is a pressure gradient across a membrane
What are the hemodialysis treatment options?
In-Center, Nocturnal, Short Daily
What development in dialysis came first?
Dr. Kolff's rotating drum
What is the definition for dry-weight?
Post-dialysis weight at which all or most excess fluid has been removed
How are clinics paid by Medicare for dialysis?
Composite Rate
The primary cause of the anemia of ESRD is:
Erythropoietin Deficiency
What isn't a component of the Extracorpeal Circuit?
Blood Leak Detector
What waste product of muscle metabolism is removed by healthy kidneys?
Creatinine
What line is a negative pressure?
Arterial
What is the leading cause of chronic kidney disease for adults in the U.S.?
Diabetes
What are the symptoms of puritis?
Itching
Why must water used for dialysate be treated?
Dialysis patients are exposed to large volumes of water during dialysis
What is the U.V. light and what does it do?
Invisible radiation that destroys microorganisms
Which patients may benefit from an increased bicarbonate concentration?
Poorly compliant with regards to fluid intake
If an air embolism occurs, how should a patient be placed?
Trendelenberg on the left side
What symptom is "cherry pop" colored blood?
Hemolysis
When does first-use syndrome usually appear?
15-30 minutes of starting treatment
What are the two main types of dialysis?
Hemodialysis & Peritoneal Dialysis
What is the functional unit of the kidney, or the structure in the kidney that does the work?
Nephron
Severe chest pain and dyspnea are symptoms of what?
Air Embolism
What are the symptoms of first use syndrome?
Back pain 15 minutes into treatment
What are symptoms of anemia?
Weak, Syanotic, Dizzy
What are three signs or symptoms of an access infection?
Drainage, Fever, Swelling
What is the pressure across the dialyzer membrane?
TMP -Transmembrane Pressure
What are the symptoms of an air embolism?
Shortness of breath, Coughing, Confusion
What is a long-term complications of a fistulae?
Thrombosis
What are the symptoms of a pyrogen reaction?
Fever, Chills
What are the symptoms of disequilibrium syndrome?
Headache
What would a rapid pulse of 104 beats per minute indicate?
Tachycardia
What does infiltration mean?
A needle tip that punctures a vessel and goes out the other side, so blood escapes into the tissues
According to AAMI standards, when should bacteriologic testing for water and dialysate take place?
Monthly
What is the first step in the port/catheter pre-dialysis assessment?
Assessing the ease of heparin removal and saline flushing before connecting bloodlines
What would be a cause of hypotension during and after dialysis?
Removing too much fluid
How frequently should the carbon tanks be checked for chlorine and chloramines?
Each shift
What complication can happen to grafts if the needle sites are not rotated?
Pseudoaneurysm
What can cause a dialyzer membrane leak?
Any damage to the dialyzer
What is included in the dialysate delivery system monitors?
Conductivity, pH, Flow Rate
What is the measurement of ions or particles that carry an electrical charge known as?
Conductivity
Who must check the dialyzer to verify quality control information?
Two people, one of whom should be the charge nurse
What symptom occurs due to dialysate that is too hot?
Hemolysis
What activity does the water softener perform?
Removes calcium and magnesium from water
What is a way to prevent infection in catheters?
Wash hands and change gloves prior to touching the catheter
Which organization sets the standards and recommendations for dialyzer reprocessing?
AAMI
What substance may be added to municipal drinking water supplied to make the water cleaner?
Bleach
What is dialysate a mixture of?
Acid, Bicarbonate, Water
Why should you rotate needle sites on a fistula?
To prevent aneurysms
What is the most likely source of staphylococcus aureus?
Nasal drainage or Discharge
What could large amounts of aluminum in water used for dialysate cause?
Bone Disease
What are sign and symptoms of Steal Syndrome?
Pale, Bluish nail beds of the access hand. Cold feeling in access limb. Pain in access limb (hand or fingers)
What are symptoms of hemolysis?
Bright red colored blood
What are some complications of "flipping" the needle in AVF cannulation?
Infiltration, Stretching the needle hole, Tearing the lining of the vessel
What is the condition that can develop from using the subclavian vein for catheter placement?
Central Venous Stenosis
When assessing a fistula or graft, what needs to be felt prior to starting dialysis?
Pulse and Thrill
Contamination of water by bacteria endotoxins may cause what reaction?
Pyrogenic
When drawing a blood specimen from a double lumen catheter, what should the clinician always do?
Discard the first 4-5 ml of blood before obtaining the sample
What medication is used to prevent blood from clotting in the extracorporeal circuit?
Heparin
What is oxygen carrying red pigment of red blood cells?
Hemoglobin
What is a severe loss of blood?
Exsanguination
What is low blood sugar?
Hypoglycemia
What can misuse of mishandling result in?
Illness, Injury, Death
What is a symptom of Hypotension?
Yawning
How far should needle insertion be done from the anastomosis in a fistula or graft?
One inch
What is high phosphorous?
Hyperphosphatemia
To determine the amount of urea removed from a patient during a specific dialysis treatment, what tests are needed?
Pre-BUN, Post-BUN, URR
What is a symptom of Disequilibrium Syndrome?
Headache, Restlessness
What can the development of bacteria in bicarbonate concentrate lead to?
Pyrogen Reactions and Innfections
What is the normal range of resting respirations in an adult?
12-20 breaths per minute
What happens when molecules of dissolved solute are dragged along?
Convection
What is high potassium?
Hyperkalemia
What is the breakdown of red blood cells with a concurrent loss or liberation of hemoglobin and large amounts of potassium?
Hemolysis
When assessing a fistula or graft, what needs to be listened for prior to starting?
Bruit
What is Hypoglycemia?
High Blood Sugar
How long can Hepatitis B Virus survive on surfaces?
One Week
What should be done to prevent needle sticks?
Throwing used needles into puncture-resistant, color coded containers
If the dialysate conductivity moves outside the pre-set limits, what will occur within the dialysate delivery system?
Dialysate will bypass to drain. Audio and visual alarms
How often should the RO operating parameters be checked?
Daily
What is low calcium?
Hyocalcemia
What is the most common way that water treatment systems are disinfected?
Chemical
What is the most important activity that you can perform to prevent the spread of infectious diseases?
Hand Washing
What is Hyponatremia?
Low Sodium
What method kills bacteria, but will not destroy all of them completely?
Dissinfection
Why are dialyzers mainly reprocessed?
Reprocessing reduces the cost of dialysis treatments
What is the empty bed contact time of chlorine tanks?
5 minute/tank
What is low phosphorous?
Hypophospatemia
What is molecular weight?
How big the holes are
Blending valve keeps water at what temperature?
77 Degrees
What is Hypercalcemia?
High Calcium
What prevents water from going back out?
Backflow Prevention Valve
What is dialysate buffered to?
Helps regulate the patients pH
What is a step of the CQI process?
Implement the PDCA Style
What is high sodium?
Hypernatremia
What is the most common cause of pruritus in patients?
Hyperphosphatemia or Uremia
What is a transducer protector?
A device inside the machine that converts air pressure into an electronic signal
T or F: Double acid hook-ups for a dialysis treatment is potentially lethal.
True
T or F: Steal Syndrome may occur with AV fistulas or AV Grafts.
True
What is low potassium?
Hypokalemia
Which ion doesn't dialyze easy?
Protein, Phosphorous
Higher bicarbonate concentration in dialysate are needed when plasma bicarbonate levels drop below:
22 mEq/L
Where is the heparin pump infusion line located?
On the arterial tubing before the dialyzer
Muscle cramps are primarily caused by the shifting of what ion during treatment?
Sodium
What is the Health Insurance Portability & Accountability?
A law that created national rules about the security and privacy of health data
What does intravascular mean?
Inside the blood vessels
During dialysis, levels of waste in the blood should:
Decrease
What is one way to remove solutes?
Convection
What is not a dialyzer characteristic?
Capacity
A nephron is made up of:
Glomerulus, Tubule
What isa solution a mixture of?
A Solvent and a Solute
A semipermeable is a filter that:
Allows only certain sized particles to cross
Diffusion is movement of particles .....
From an area of higher concentration to an area of lower concentration
What does AAMI stand for?
Association for the Advancement of Medical Instrumentation
What is covered by the standardsof AAMI?
Dialyzer Reprocessing
Whatare symptoms of pericarditis?
Chest pain relieved after sitting upright
What is a Chief iron-storage protein in the body?
Serum Ferritin
How can you prevent a patient from having a dialyzer reaction?
Use cellulose acetate dialyzer membrane
What does the conductivity of dialysate reflect?
Electrolyte levels of the dialysate bath
What is the syndrome that cerebral edema can cause by the too rapid removal of urea nitrogen from the blood?
Dialysis Disequilibrium Syndrome
How much blood is outside the patients body at any time during dialysis?
150-250 ml
What factor affects the rate of diffusion?
Surface area of the membrane
What are symptoms of a dialyzer reaction?
Back Pain
What are the steps for dialyzer reprocessing after a dialysis treatment?
Pre-Cleaning, Performance Tests, Dialyzer Rejection, Disinfection
What are symptoms of anaphylaxis?
Hives, Trouble Breathing, Hypotension, Anxiety
What is the length of dialysis treatments based on?
Clearance, Blood Flow Rate, Fluid Gains, Patients Health
What is Pressure Gradient or TMP?
Difference between blood and dialysate pressure
A patient who is fluid overloaded will probably have which symptoms?
Tachycardia, Hypertension, Dyspnea
What conditions could alter or affect dialysate flow rates?
Low water pressure, Dialysate pump failure, Obstruction in dialysate flow path
What are the symptoms of Hypotension?
Dizziness, Tachycardia
What level of calcium concentration usually at?
2.5-3.5 mEq
What medical problems may occur due to chronic kidney disease?
Anemia, Sleeping Problems, Pericarditis
What are the steps for reprocessing the first time?
Dialyzer labeling, Total Cell Volume, Reprocessing
What will increase the amount of solutes that will diffuse across the semi-permeable membrane?
High Concentration Gradient
What are symptoms to Hyperkalemia?
Muscle Weakness
What is ETD?
Germicide in dialyzer
How much iron is in the body?
Transferrin Saturation (TSAT)
What is the condition that renal patient develop due to kidney inability to reabsorb enough bicarbonate?
Metabolic Acidosis
An AV Fistula can routinely be used for cannulation within how many weeks of being created?
2 Weeks
What is the target lab value for Serum Ferritin?
>200 ng/mL
What is the target lab value for BUN?
5-25 mg/dL
What is the target lab for Magnesium?
1.7-2.5 mg/dL
What is the target lab for Sodium?
135-146 mEq/L
What is the target lab for Creatinine?
10-18 mg/dL
.4-1.4
What is the lab value for Albumin?
>4.0 g/dL
What is the target lab value for Phosphorous?
3.5-5.5 mg/dL
What is the target lab value for Calcium?
8.4-9.5 mg/dL
The endocrine functions of the kidney include what?
Making erythropoietin and the active form of Vitamin D
What is the target lab value for Potassium?
3.5-5.5 mEq/L
Negative pressure is pressure created when...
Fluid is pulled through a restriction
What is the definition of contact time?
Amount of time the germicide remains in the dialyzer
What is the purpose of a proportioning system?
Make dialysate by mixing fresh concentrate with fixed amounts of treated water
What is an acceptable level of post softner hardness?
0.8 grain/gallon
A dialysate that contains too much potassium causes hyperkalemia. What are the signs and symptoms?
Muscle weakness, Cardiac Arrhythmia, Cardiac Arrest
What is the instrument used for measuring blood pressure called?
Sphygomanometer
What is the build-up of waxy proteins in soft tissues, bones, and joints?
Amyloidosis
Which direction should the venous be placed?
Antegrade
What does ETO stand for?
Ethylene Oxide
What is the normal pH for a patient?
7.35-7.45
What test must be performed on new dialyzers?
TCV (Total Cell Volume)
According to AAMI standards, the total endotoxin count of dialysate shall not exceed what ?
2 EU/ml
What does dialysate conductivity measure?
the total electrical charge of a solution
What are two criteria for rejecting a reprocessed dialyzer?
Less than 80% of original fiber bundle volume aesthetic apperance
What is a problem in dialyzer reprocessing that may cause bacteria or endotoxin contamination of the dialyzer?
Improperly prepared germicide
What germicide is used for dialyzer reprocessing?
Peracetic Acid
What is the target lab value for Transferrin Saturation?
20%
What is the target lab value for Hemoglobin?
>11 g/dL
What is a limitation of a reverse osmosis system?
Thin film composite membranes break down when exposed to chlorine and chloramines
What is the normal GFR?
125 mL/min
Stage 1 kidney disease is at what GFR?
>90
Stage 5 kidney disease is at what GFR?
<14
Stage 3 kidney disease is at what GFR?
30-59
What labeling must be on reuse dialyzers?
Patient Name, Color Code, Medical Record #, Warning if 2 Patients have same name, Must say re-use on dialyzer
What means you have had the vaccine. You want this to be positive.
Antibody
What means you have the actual disease. You want this to be negative.
Antigen
Stage 4 kidney disease is what GFR?
15-29
Name 2 compartment of the dialyzer.
Blood
Dialysate
According to AAMI standards, the total microbial count of dialysate shall not exceed...
200 CFU/mL
What are 2 types of ultrafiltration systems?
Volumetric UF control and flow control
What are the 3 main ways to remove solutes?
Diffusion, Convection, Absorption
Shriveling of red blood cells and may be caused by hypertonic
Crenation