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Laboratory Specimen Collection, Handling

Terms in this set (33)

PPE Requirements
Gowns, gloves, face shield are required when drawing pre dialysis labs through the VA needle; if CVC add mask to tm and pt
Successful lab draws
Know the 20 tips— instructors give the current handout- available on the Davita intranet- (remind them not handwritten or double label-will be rejected) order of lab draws important to follow because of additives in the tubes that will effect other tubes.
Processing
• Clotting time: follow requisition label
• Rules for spinning samples: follow requisition- must balance centrifuge
• When to refrigerate: follow requisition(some are immediate and not spun)
• When not to refrigerate: cultrettes/swabs/ occult stool-follow directions
• Training requirements for shipping IATA
What are the signs and symptoms of fluid imbalance?
Edema, hypertension, shortness of breath
What does hypertension lead to?
LVH= Left Ventricular hypertrophy
Why is sodium balance important?
Leads to volume expansion— increased CO— increased peripheral vascular resistance—increased BP
Signs and symptoms of hyper- and hypokalemia
•Hyperkalemia: Extreme muscle weakness, abnormal heart rhythm
• Hypokalemia: Fatigue, muscle weakness, paralysis, resp, failure, cardiac instability, arrhythmias, cardiac arrest.
Why are patient anemic?
• Patient cause: Lack of Erythropoietin(EPO)
• Secondary causes: Blood loss during treatment
How can you prevent contributing to blood loss?
Ensure Epogen dose is correct and administered, good rinse back, avoid repeat lab draws
What is pericarditis?
inflammation around the heart(Pericardial sac)
What is included in it treatment?
Decrease or stop Heparin, give more frequent dialysis
Systemic effects of CKD-what would you advise for a patient who complains of dry, itchy skin:
Use hyper-fatty soaps and lotions caution pt re: safety at home, provide emotional support, control diabetes and phos.
• Peripheral Neuropathy: intake
• GI problems: Inform RN& MD of any bleeding problems/constipation/diarrhea/ER visits, take meds as ordered... ie... stools softeners/immodium
• Psychological problems: verbalize struggles to IDT( core team) Esp. The social worker.
What are the four key elements affected in CKD-MBD?
1. CA 2. Phos 3. PTH. Vit D( calcitriol)—all leads to CKD-MBD when they are abnormal.
What are symptoms of CKD-MBD in addition to bone disease?
Soft tissue calcification, itching, muscle weakness, pathological fractures, tendon ruptures, compression of vertebrae, atherosclerosis, heart disease.
What is your role in CKD-MBD management?
report symptoms urge patients to take meds(home&treatment)
* report noncompliance problems related to non adherence
How much of normal Kidney function is replaced by HD?
15%
What does the acronym DARN stand for?
• Desire
• Ability
• Reason
• Need
When should the communication style Directing be used?
When training to perform procedures
When should the communication style following be used?
Allow time to digest bad news and impact on patient's life.
When should the communication style Guiding be used?
This helps resolve or change behavior problems.
What are the three core communication skills to be used within the communication styles?
Asking, listening, informing
What does the R in RULE stand for?
Resist Righting Reflex/Recognize
What does the U Rule stand for?
Understand
What does the L Rule stand for?
Listen
What does the E in Rule stand for?
Empower
Reflective Listening— define the three skills
Restating/rephrasing: provides a short summary of what the listener heard the patient say at the moment.
Deducing: reflects what the patient feels and what they mean
Summarizing: provides summary of the entire conversation and includes main aspect of what the pt said.
The 5 stages of grief what are they?
•Denial
• Anger
• Bargaining
• Depression
• Acceptance
Is there an order to work through them?
No right or wrong way, some people get stuck
Can one experience them more than once?
Yes
KDQOL 36. What is it.
36 items questionnaire- CMS requirement to be administered annually to all dialysis patients.
What is it used for?
It measures physical health, mental health, burden of Kidney disease, symptoms/problems, effects of Kidney disease on daily life
Social workers compile results and develop plans/interventions with patient.
Role of Social Worker
• Counselor
• Educator
• Advocate
• Coach
And what nurses and PCTs can do to assist
• Actively listen
• Acknowledge feelings
• Inform SW
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