Dialysis Test Review

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BP cuff too biglower bpHR of <60 BPM or >100 BPMrequire RN assessment prior to tx initiationWhat is the good BP range prior to tx?90-180/ 100-purpose of DQIassessing facility performance and improving the lives of patients to encourage continuous improvement across a broad range of disease management processespurpose of documentation1. proof that care was rendered 2. provides data continuity 3. permanent legal record 4. communication toolwhen to chart1. change from baseline assessment 2. change in pt condition 3. medication given and pt response 4. change in procedure/tx 5. patient teaching 6. care plan review and interventionswhat to chart1. what you see, hear, do 2. pertinent observations 3. unusual occurrences 4. lab results 5. teaching evaluation/results 6. physician visits and instructions 7. medications admin and pt response 8. precautionary or protective measures 9. allergieslegal precautions about charting- avoid generalizations, vague or speculative comments - do not chart something before it has happenedSMARTS = simple M = meaningful A = actual R = read T = teachFailure to use SMART comms- exposes you and DVA to liability - makes you a "star" at a deposition or trial - reputational injury - jeopardizes the recipient - potentially career threateningconductivity and pH monitors- measure the conductivity of dialysate solution - pH measures acid/base balance of dialysate - only Phoenix machines measure pHconductivity range13.0 - 15.5pH range6.9 - 7.6What causes a blood leak?damaged fibersPossible complications of a blood leak1. dialysate getting into blood 2. blood loss 3. must adjust timeHow do you determine a blood leak?blood stickfollowing standard of caremakes the care given defensible and avoids negligencewhen supervising non-licensed, assistive personnelit is the responsibility of the nurse to make sure standard of care is metWhy can't I do it my way?can lead to civil liabilityElements of liability- negligence - proximate cause - damagesMost important route of HAIscontactsymptoms of BSI- fever - chills - fatigue - altered mental status - hypotensionMRSA bacteria can remain on surfaces fordays with plastic and vinyl being most favorable for their survivalsymptoms of peritonitis- cloudy effluent - abdominal pain - fever - N/VWhy is wearing gloves so important in preventing the spread of infections?- barrier - reduces riskWhen must hands be washed with soap an water?when visibly soiled. includes the hands of patients and their care partnersuremiapt doesn't make enough erythropoeitinhemodialysis replaces15% of normal kidney functionkey elements in CKD-MBD1. calcium 2. phosphorous 3. PTH 4. calcitriolWhat does DARN stand for?D = Desire A = Ability R = Reason N = NeedWhat are the 3 core communication skills?1. Asking 2. Listening 3. InformingWhat are the 4 guiding principles of MIR - Resist the righting reflex U - Understand your pt motivations L - listen to pt E - empower your ptfiltrationfluid passing through a semipermeable membrane - controlled by hydrostatic pressureultrafiltrationcontrolled fluid removal by manipulation of hydrostatic pressureWhat is dialysis in regards to filtration?ultrafiltrationconvectionsolutes are dragged across the semipermeable membrane along with fluiddiffusionparticles move from an area of higher solute concentration to an area of lower solute concentrationchronic in-center acid concentrate formularyK: 2.0, 3.0 Ca: 2.0, 2.25, 2.5, 3.0 contains : sodium, magnesium, chloride, glucosefactors that effect diffusion rate1. molecule size 2. membrane surface area 3. membrane permeability 4. solution temperature 5. concentration gradients 6. solute dragosmosisfluid moves from lower solute concentration to higher solute concentrationBUNblood urea nitrogen which is a waste product from protein metabolismcreatininewaste product from muscle metaboloismerythropoiesisdecreased oxygen in renal blood supply -> erythropoietin is released -> stimulates bone marrow to produce RBC'sactivation of vitamin D3 and serum Ca regulationdecreased serum Ca levels -> kidneys convert vit D3 into its active form: Calcitriol -> Calcitriol stimulates absorption of dietary calcium and phosphorus from the gutnormal potassium3.5-5.5feverany temp greater than 100F or increase over baseline of 2F with symptomsWhat's the most common cause of seizures?hypotensionWhat makes are pt more likely to get dialysis disequilibrium syndrome?missing tx3 underlying assumptions1. regardless of condition, ppl have similar challenges w/ self-management 2. ppl can learn skills needed to better manage their diseases day by day 3. ppl who understand and take control of their condition will be happier and healthier3 basic principles1. dealing with consequences of illness 2. focusing on problem-solving, decision-making and patient confidence 3. placing patients and care providers in partnerships w/ specific responsibilities for eachhealth literacydegree which ppl can process and understand basic health info2-4-8 ruleno more than 2 hrs instruction at a time no more than 4 hrs instruction a day 8 days of trainingbeginner cannulator<6 mo exp <10 successful cannulations on established fistulaeintermediate cannulatorat least 6mo AVF cannulation exp at least 10 successful cannulations on established fistulaeadvanced cannulatorcompleted all competencies on NFACT skills checklist expert assessment and cannulation skills documentedrule of 6'sdepth below skin <0.6 cm 6-8 week post op check access blood flow >600 ml/min diameter of vessel >0.6 cmplace venous needlewith the flow of bloodkeep tips of needles1.5 inches aparthow many days to heal?14 daysnon-tunneled CVCtemporary and high risk for infectiontunneled CVCintended to be permanent/long-termcalcium range8.4-10.2PTH range150-600phosphorus range3-5.5Why water treatment?patient safety and prevent equipment damageWhen do we test for hardness?end of the dayWhen do we perform chlorine test?prior to first pt and every 4 hrs