Dialysis Procedures and Complications: A Comprehensive Guide, Exams of Nursing

Download Dialysis Procedures and Complications: A Comprehensive Guide and more Exams Nursing in PDF only on Docsity! 1 FRESENIUS PCT EXAM 2023-2024 ACTUAL EXAM 200 QUESTIONS AND CORRECT ANSWERS|ALREADY GRADED A+ 2 FRESENIUS EXAM ALREADY GRADED A+ 2023 What is a pre-dialysis evaluation? - Answer 1) Review of the patient's health. 2) Compares current health status to previous evaluations. Why is pre-dialysis evaluations needed? - Answer 1) To determine if the patient is stable to receive treatment 2) Determine if there has been a change in health status. 3) Provides a baseline date to plan for a safe treatment. Describe Universal precautions - Answer Steps we take with all patient contact to decrease the risk of spreading infection to protect our patient and ourselves What are the 3 C's? - Answer 1) Condition (objective) 2) Complaints (subjective) 3) Changes (objective) What should you look for with Ambulation - Answer Gait changes, use of assistive devices, ROM, energy level. What should you look for with Mental status and mood - Answer A&O x 3, any changes in usual mood (Alert and orientation) Person, place, time (situation) A&Ox4 What should you look for with Skin - Answer Color, integrity, temperature, edema What should you look for with Vital signs - Answer Weight, BP, HR, respiration's, temperature What is EDW? Estimated Dry weight - Answer A patient's wt with excess fluid removed When is a RN required to assess a pre-treatment wt? - Answer If the patient pre- treatment wt is >4 kg above EDW What does a blood pressure measure? - Answer Measurement of the pressure of 5 4) Alarm & pressure holding test passed 5) Final check on blood circuit What is a priority and major reason why we monitor our patients? - Answer Patient safety As fluid shifts during dialysis what changes can occur? - Answer Blood pressure, fluid and electrolyte shifts Who is responsible for monitoring patients? - Answer Everyone! 6 5) Temperature >or = to 100 degress 4) Irregular heart rate The PCT must take what action when he or she identifies a potential problem? - Answer Immeddiate The RN must respond to what from patients and the PCT? - Answer Complaints or PCT notifications to assess the patien Why does a pateint's face and vascular access need to be visible at all times? (3) - Answer 1) It is a CMS requirement 2) Identify any changes in the patient's awareness 3) A covered access can result in major blood loss What are "Red Flags" to report to the RN? (5) - Answer 1) Severe hypertesnion (SBP >200) 2) Severe hypotension (SBP <80) 3) New onset of pulse <60 or >100 What should the RN do when notified about "red Flags" - Answer 1) Assess the patient 2) Provide intervention 3) Report to the physician based on clinical judgmen Name 4 non-verbal behaviors that may indicate a change in the patient status or discomfort: - Answer 1) Restlessness 2) Grimacing 3) Excessive yawning 4) Is patient alert, drowsy,sleepy Name 5 changes you should educate your patient to report immediately? - Answer 1) Discomfort at needle site 2) Muscle cramps 3) Headaches, dizziness, blurred vision 4) Nausea, vomiting 5) Fever, chills, chest pain, and SOB Name 4 machine reading we verify at every safety check? - Answer 1) BFR 2) DFR 3) AP (not more than-250) 4) VP (not more that 1/2 the bfr rate) 7 ss or dialyzer 5) clotting in the acce 4) poor CVC function Describe what the arterial pressure reading reflect? - Answer Refers to the pressure in the system from the patient;s vascular access to the blood pump What are the potential compliactions of a high arterial pressure? (2) - Answer Inadequate dialysis and hemolysis Name 5 reasons for a high arterial pressure? - Answer 1) A kink in the arterial line 2) Poor cardiac status 3) Blood pump speed to much for vascular access 4) High hematocrit / increase blood viscosity 5) High BFR through a small needle gauge What can a low arterial pressure indicate? - Answer 1) A line separation 2) Air 3) A decrease blood pump speed 4) A wet transducer Describe what the venous pressure reading reflects? - Answer The pressure in the circuit after the dialyzer and before it re-enter the patient Name 5 causes for low venous pressure? - Answer 1) Blood line separation 2) Needle dislodgemen 3) Decrease BFR 4) Clotting before the monitoring site 5) Wet transduce What can cause high venous pressure? (5) - Answer 1) occlusion in the lines between the monitoring site and venous needle, 2) poor position 3) an infiltration of venous needle What is the most important function of the dialysis treatment? - Answer Fluid removal How can fluid removal be monitored? - Answer Critline monitor or CLM Describe the 3 profiles that the CLM provides? - Answer 1) Profile A 2) Profile B 3) Profile C What does profile A look like? - Answer Profile shows a flat or a positive slope 10 6) needle size 7 anticoagulation 5) dialysate composition 4) dialysate flow rate 3) blood flow rate Identify five factors that affect dialyzer clearance? - Answer 1) BFR What are the goals of hemodialysis? (3) - Answer 1) removal of waste products 2) regulation of fluid balance 3) correction of electrolyte and acid/base imbalance Identify seven components of the hemodialysis prescription - Answer 1) treatment time 2) type of dialyzer Identify four components of the extra-corporeal circuit. - Answer 1) Arterial line 2) Venous line 3) Needles 4) Dialyzer Biocompatibility is? - Answer a term to describe a dialyzer membrane that is more like the human body and less likey to cause an immune response Dialyzers with more surface area allows? - Answer More removal of solutes. Transmembranes pressure affects? - Answer Fluid removal Pressure on the blood side is positive Pressure on the dialysate side is negative Define countercurrent flow? - Answer Blood flows one way while the dialysate flows the opposite wasy What is the advantages of countecurrent? - Answer Allows more net diffusion. Dialyzer clearance is the amount of what? - Answer Blood cleared of a given solute in one minute at agiven BFR and DFR 11 5) chloride 4) magnesium 2) DFR 3) Dialyzer characteristics 4) Treatment time and frequency 5) Anticoagulation Dialysate is composed of - Answer 1) Treated water 2) acidified concentrate (acid) 3) bicarbonate concentrate Is dialysate clean or sterile - Answer Clean identify five electrolytes in the acid concentrate? - Answer 1) sodium 2) potassium 3) calcium Kidney failure causes what to build up and leads to what? - Answer 1) acid 2) metabolic acidosis What componet of the dialysate treats metabolic acidosis? - Answer bicarbonate Identify the two sources of the bicarbonate in final dialysate? - Answer 1) bicarbonate concentrate 2) Acetate in the acide concentration Two electrolytes that are part of the doctor's dialysate and are highlighted on the acid concentrate label are? - Answer Potassium and calicum Alarms to monitor the dialysate to ensure it is safe to use: - Answer 1) conductivity alarm 2) temperature alarm What is conductivity? - Answer a measure of the ability of a solution to conduct an electrical charge Is verification of the conducitivy and pH required? - Answer Yes, before initiating treatment using a independent meter What verifies the conductivity and and pH? 12 3) Excessive bruising 2) Bleeding >20 mins from access post treatment insertion site during tx Three signs of excessive heparinization? - Answer 1) Bleeding at the needle (2) - Answer 1) Phoenix meter 2) Precision PH control paper When does the phoenix meter need to be calibrated and verified? - Answer At the start of every treatment day What is an acceptable pH range on a phoenix meter? - Answer 6.9-7.6 What is an acceptable pH range when using a pH test strip? - Answer 7.0-7.4 What are the two autoflow setting? - Answer 1) A 1.5 2) A 2.0 What is the purpose of a dialysafe filter? - Answer It removes endotoxins and other impurities from dialysate. For a prime dialyzer that has been set up for greater than 2 hours what MUST be done prior to initiating the treatment? - Answer Recirculating using ultrafiltration for 5 minutes. Heparin is given 5 minutes before treatment is started to allow for what? - Answer Systemic anticoagulation Heparin loading (bolus) dose is given in what port? - Answer Venous When opening a new vial of heparin what three things are recorded on the label? - Answer 1) Date 2) Time 3) Initials When is heparin held? What can you use instead? - Answer 1) If the patient fell or hit their head 2) if the patient has a headache 3) if the patient is scheduled for surgery 4) if patient C/O bleeding N/S flushes is one method to use during heparin free dialysis to prevent clotting 15 What do the Red Hanson's do? - Answer dialysate flows out of the dialyzer-blood flows into the dialyzer What do the Blue Hanson's do? - Answer dialysate flows into the dialyzer- blood flows out of the dialyzer What is counter current flow and why is it important? - Answer dialysate flows in the opposite direction from the blood Blood is always being exposed to fresh dialysate, allowing for optimum clearance. When examining the blood lines what should you be looking for? (4) - Answer 1) Check the expiration date 2) Packaging intact What is a transducer and how do you ensure it is working properly? - Answer They monitor both the arterial and venous pressures in the blood circuits If they are not working properly they will not measure AP and VP accurately. If they are wet, they need to be replaced immediately, if both sides of the transducers are wet or impinged with blood remove the machine AFTER the patients treatment and notified BIO MED. When and how do you test for residual chlorine bleach? - Answer This is required when the inside of the machine has been exposed to bleach Bleach can result in hemolysis Step -put on PPE -check expiration date on the bottle -obtain one test strip from a vial of test strips -access the machine rinse water -hold the test strip in a steam of water for 10 seconds -compare test strips results to the color scale on the side of the vial used dialysate (effluent flows into the drain) 4) Caps and clamps are intact 3) No visible defects 16 5) Caps are intact 4) No visible defects 3) Packaging intact to a GFCI out 3) Ftr safety reasons, it is imperative the dialysis machine power cord is plugged in let 4) Heater and Power switches on the back of the machine are turned "on" 5) Acid and bicarb lines are secured into machine ports 6) Verify date of last disinfection 7) Dialyzer supply lines and diaylzer return line are connected to the machine shunt 8) Emergency hand crank availa When inspecting the dialyzer what are you looking for? (5) - Answer 1) Type and Size ordered 2) Expiration date How is the correct dialysate prescription entered into the dialysis machine? - Answer -concentrate icon 2251-0 ,2 K, 2.5 Ca++ and 100 dextros -enter formula for the prescribed concentrate -Verifiy the potassium and Ca++ match the order Enter base sodium and Bicarb levels Explain theoretical conductivity (TCD)? - Answer a setting in the dialysis machine for each dialysate concentrate. To ensure delivery of safe dialysate, the conductivity default alarm limits. This must be maintained at +/- 0.5S/cm of the TCD What is the temperature icon on the machine represents? - Answer The dialysate temperate is part of the Doctor's orders The typical range is 35.5-37 When are the safety check completed? - Answer Theses are required before starting each patient treatment What are the pre-treatment safety checks? - Answer Alarm and Pressure test How do you know if the test passed or failed? - Answer Alarm screen will indicate if the pressure test failed with an audible and visual alarm A red "X" will appear next to the test that has failed What are the required step to turn on the dialysis machine on in the morning? (9) - Answer 1) Water supply line is connected to machine 2) Drain line inserted into drain receptacle behind the machine 17 What do you do if your machine fails a test? - Answer 1) Retest 2) If the failure repeats, inform the nurse 3) remove the machine from the treatment area 4) Label to identify which test failed 5) Notify Bio Med Explain pH testing? - Answer -pH measures the acidity or alkalinity of a solution -Verify the dialysate pH using a Phoenix meter or pH strip - pH range must be 609-7.6 - If pH is out of range, re-calibrate the meter and retes - If retest fails, remove machine from floor (report and tag - Document pH results in chairside How is a second signature obtained? (Double) - Answer - A second person MUST witness the machine and meter testing for conductivity and pH -Independent meter and machine conductivity must be between +/- 0.3 mS/cm Why is circulating important? - Answer -It helps to clear dialyzer and bloodline of any sterilants or residue. -Removes any remaining air in lines. -BFR should be 300-400m;/min and dialysate flow rate should be 500ml/min until air is purged from lines What should be done if the extracorporeal circuit is up for 2 hours? - Answer Dialyzer primed for more than 2 hours must be recirculated using an increased ultrafiltration rate 5 minutes before use At what time should primed lines be discarded? - Answer If the lines have not been used within 4 hours What must be done with a machine that is not working properly? - Answer -Do not use a machine that is out of range or failed an Alarm/Pressure test -Machine should be removed from treatment floor and "yellow tag" should be completed. -Biomed notified How is the arterial bloodline returned? - Answer - Make sure saline bag has at least 300 ml's -reduce the BFR to minimum and stop 20 5) 2 year life expectancy 4) Easy to implant, construct, and repair 4) Morbidity & mortality decreased 5) Increased life of access, good blood flow Disadvantages to an AVF (4) - Answer 1) Increased maturation time 2) Vein may fail to enlarge 3) Difficult cannulation 4) Enlarged vein perceived as unattractive What are Expert cannulators only allowed to do? - Answer Place needles in a New AVF How long does it take a AVF to mature? - Answer 4 weeks When can a CVC be removed after consecutive cannulation with 2 needles and the prescribed BFR? - Answer 6 weeks What is an AVG? - Answer It is an artificial tubing connected on one end to a patient's vein and on the other end to the patient's artery Disadvantages to an AVG? (5) - Answer 1) Increased risk of infection 2) Increased risk of thrombosis 3) Increased risk of stenosis 4) Increased pain with creation AVG considerations: - Answer -site rotation is essential and prevents (one-site-itis) which will decreased the AVG life -Never place needles in a Psuedoanurysm. Advantages to an AVG? (4) - Answer 1) Large surface to cannulate 2) Easy to cannulate 3) Healing time short Patient education for AVF and AVG includes 12: - Answer 1) Protect access from injury 2) report S/S if infection 3) Feel for thrill daily and report changes 4) Keep clean and dry 21 4) Palpation (feel) 3) Auscultation (listen) 3) Medication changes (7) - Answer 1) S/S of infection 2) changes in extremity 5) bruising may occur 6) AVF &Avg are for dialysis use only 7) No b/p in access arm 8) Do not cover access during treatment 9) Apply gentle pressure post treatment 10) Notify staff of bleeding-line separation 11) Pain 12) Perform exercises for AVF maturation What do you wear when cannulating? - Answer Full PPE What is the #1 infection control practice for reducing the transmission of disease? - Answer Hand washing Can patients was their own access? How long? - Answer Yes! Wash for 1 minute prior to dialysis What are the four components of vascular access assessment? - Answer 1) Patient interview 2) Inspection (look) 4) Checking thrill daily? Any changes Name at least 3 things the DPC staff would look for during the evaluation of an AVF or AVG? (5) - Answer 1) Skin color 2) Incision clean, dry, intact 3) Absence of infection 4) Prior to cannulation site problems free 5) Compare to other arm, limb Give some examples of abnormal AVG, AVF findings? AVF and AVG patient interview questions? (4) - Answer 1) Pain or bleeding g 2) Numbness or tinglin 22 3) Aneurysm/Psuedoaneurysm 4) Bruising/Hemotoma 5) Skin integrity issues 6) Collaterall vein distension 7) Steal syndrome Normal bruit sound? - Answer Low pitched, and has a continuous whooshing sound Abnormal bruit sound? - Answer High pitched or no sound, and or decreased whooshing How do you determine the direction of the blood flow? - Answer _compress the middle section of the vessel or graft and assess for a bruit and thrill -The bruit and thrill are on the ARTERIAL side and sound and feel stronger. What is a thrill? - Answer A vibrating senestion What does an abnormal thrill feel like? - Answer Pounding choppy pulse or completely absent. What are the AVF/AVG RED FLAGS? (4) - Answer 1) S/S of infection 2) Absence of thril 3) Bruising/Hematoma 4) Skin integrity issues What is cannulation? - Answer -Insertion of a needle into a vascular access What does an invasive procedure require strict of? - Answer -infection control practices, including aseptic technique, hand hygiene and new gloves What needle size (gauge) is required for a BFR: < 300 mL/min - Answer 17 gauge What needle size (gauge) is required for a BFR: 300-350 mL/min - Answer 16 gauge What needle size (gauge) is required for a BFR: >350-450 ml/min - Answer 15 gauge 25 container Arterial pressures that are > -260 are unacceptable! List at least 2 causes of negative arterial pressure less than (-250) (6) - Answer 1) hypotension 2) spasm or vasoconstriction 3) blood pump speed > the body supply 4) poor cardiac status 5) clotting in access or poor needle placement 6) kink in arterial bloodline What are at least 2 causes of a high venous pressure? (4) - Answer 1) Kink in the venous bloodline 2) Clot in venous chamber 3) Stenosis of vascular access 4) Poor venous needle placement, infiltration what PPE is required when removing needles? - Answer Full PPE (If a family member is holding the site they must wear full PPE as well) (if patient is holding thier own site all they need is gloves) List ways to reduce a needle stick? (4) - Answer 1) remove arterial needle first 2) Do Not leave the patient after removing tape from the needles 3) Place gauze without pressure over insertion site while the needle is being removed at the same angle of insertion 4) Engage the needle guard immediately upon removal and place in sharps Do fistula clamps require a doctors order? - Answer YES! One clamp may be used at a time You must check for a thrill every 10 minutes when the clamps are being used. Patient must be able to recognize bleeding 26 er policy Flush unaffected needled with saline (needle not infiltrated) Do not remove infiltrated needle unless causing pain or infiltration is enlarging 5) Cannulate access to replace infiltrated needle 2) Disconnect blood-lines and recirculate blood p - Answer 1) Stop blood pump and clamp lines 5) Evaluation arterial and venous pressures 6) Tape needles securley 7) Avoid tension on lines-clip to clothing 4) Ask for help with a difficult access 8) Keep access uncovered at ALL Times infiltrated- cannulate above or below si 6) Venous infiltrated -cannulate downstream from the infiltrated site; Arterial 3) Hardness 5) Pulling or tension of needles How can one achieve hemostasis post treatment? - Answer -Use compressed gauze over the needle site with 2 fingers - Check above and below the site to ensure the access is not occluded - Pressure should be continuous for 5-10 minutes What causes an infiltration & hematomas? - Answer -puncturing through a vessel or graft wall leading to blood leaking into the surrounding tissue causing swelling and hardness What are at least 3 signs and symptoms of an infiltration? 4) High venous pressure (venous needle infiltrated) 5) More negative (lower) arterial pressure (arterial needle infiltrated) What are at least 4 causes of infiltration? - Answer 1) Improper cannulation technique 2) Immature access 3) Patient movement ccess 6) Incorrect taping of needles 7) Flipping or rotatingneedles 8) Compression of needle site prior to needle removal What are some interventions for a needle infiltration? (8) te 7) Rest fistula for 1 treatment if possible 8) Patient education List 10 ways to prevent infiltration of the vascular access: - Answer 1) Avoid premature cannulation 2) Use tourniquet with AVF 3) Expert cannulator for NEW AVF/AVG or difficult access (5) - Answer 1) pain 2) Swelling 4) BFR too high for a 27 5) using sharp needles in an established buttonhole access 6) over anticoagulation 4) needle placement in aneurysm or psuedoaneurysm 3) repeated cannu 6) shock 7) seizure 8) cardiac arrest 5) hypotension 4) machine pressure alarms (may or may not occur) 3) obvious bleeding source (5) - Answer 1) regular assessment Preventions of bleeding from access 9) Do not put pressure on needled insertions site until needle completely removed 10) Do not flip or rotate needles When does the RN report to the Physican following adverse event related to infiltration (2) - Answer 1) Infiltration extend to upper trunk or limb 2) Inability to re-cannulate and continue treatmen List 3 causes of bleeding from a vascular access? (6) - Answer 1) access infiltration 2) flipping needles lation in same site (not rotating sites) 2) rotate needle sticks 3) review anticoagulation 4) use only buttonhole needles in established buttonholes 5) DO NOT CANNULATE into an aneurysm or psuedoaneursyms 3 things a PCT MUST REPORT TO AN RN REGARDING BLEEDING OF THE ACCESS - Answer 1) Any bleeding during dialysis 2) Bleeding > 20 minutes post dialysis 3) Visible break in skin near access Exsanguination is? - Answer an extensive blood loss and may cause death. List 8 symptoms of needle dislodgment. - Answer 1) blood saturating the underpad or patient's clothing 2) blood visible in the chair or pooled on the floor List 4 causes of dislodgment - Answer 1) improper taping technique- must do a 6 inch chevron taping 2) using old tape after re-positioning a needle 30 -VP and TMP alarms -clotted venous drip chamber or dialyzer -dark blood in venous line (>250) causes a more negative arterial pressure -occurs when there is resistance in pulling blood out of the patient into the machine -measured between the patient and the blood pump -BFR too high, -clotting of the vascular access- -access stenosis -dialysis machine malfunction (prevent increase pressure by monitoring patient and responding to alarms STAT -intervention will be required to resolve the pressure issue) What is AP? - Answer -pressure in the lines that carries blood from the patient to the machine -expressed as a negative number -needle placement, -clotting/stenosis, vessel spasm -poor cardiac status - hypotension, -high hematocrit -CVC issues (prevent by monitoring patient and responding to alarms stat, Interventions will be required to resolve increased pressure) What can cause a clotted dialyzer? - Answer -decrease surface area due to clots which results in inadequate dialysis and blood loss what are causes, s/s and interventions of a clotted dialyzer? - Answer s/s -increased tmp, -increased VP causes- improper priming, air in lines, inadequate heparinization, obstruction of blood flow, poor functioning vascular access interventions Cauese of AP increased pressure - Answer -causes or occlusions in line -kinks, clamls. 31 6) Hemolysis, dialysate, dialyzer or water prep errors 5) reaction to rapid infusion of IV medications 4) Bleeding or systemic infection 3) Diabetes or eating <1 hr before or during treatment -herparin per policy, saline flushes (heparin free pt.) -proper set up and monitoring, safety checks and limit interruptions. (notify RN and change lines and or dialyzer) Blood leaks are? - Answer -These are tears in the dialzyer membranes that allows blood to leak into the dialysate Blood leak s/s causes interventions - Answer S/S -blood leak alarm (major leak will make dialysate pink in dialysate path or red Hansen -minor will test positive with blood test strip but will not be evident to the naked eye causes- faulty or damaged dialyzer, improper priming, improper or inadequate heparinization, clotting, and blood line kink interventions- inspect dialyzer prior to use, do not use dropped or damaged dialyzer, prime properly, complete pressure testing, avoid clotting and kinking, inspect and test dialysate fro presence of blood (if confirmed blood leak, STOP treatment and DO NO RETURN BLOOD, if tes negative, reset alarm and retest in 5 min, if still negative remove machine and tag for service) What is the target range for blood pressure - Answer 140/90mmHG At what minimum should the blood pressure be checked? - Answer 30 minutes What are 6 s/s of hypotension? - Answer 1) Tachycardia or yawning 2) Complaint of feeling hot or muscle cramps 3) Anxiety and restlessness 4) More negative AP, which may trigger a high AP alarm List at least 6 potential causes of hypotension - Answer 1) Hypovolemia or incorrect EDW 2) Anti hypertensive medication or dehydration 32 List in order the interventions for hypotension (8) - Answer 1) Call for help 2) Modified trendelenburg 3) decrease UFR to 300mL/hr 4) administer saline (100-200) 5) recheck b/p and pulse 6) give more saline and medication if prescribed 7) repeat b/p q 5 min until stable 8) EMS if determined by RN Orthrostatic hypotension is? - Answer This is a blood pressure that falls equal to or greater than 15mmHG or 10mmHG diastolic upon standing -This can put the patient at risk for falls and fainting -A sudden drop in BP upon standing, rapid pulse, confusion dizziness, shaking nausea and blurred vision Causes of orthrostatic hypotension and interventions - Answer causes- hypovolemia, inaccurate EDW, overeating before dialysis, other medical conditions -medications for a high b/p and heart disease -long periods of immobility -assist patient to stand after treatment, saline bolus, recheck sitting and standing b/p -notify the RN if 200mL's are given -notify if a total of 500 mL's doesn't stabilize the pt per policy Hypertension is? - Answer This is a high blood pressure and is a SYMPTOM and a cause of kidney disease -80-90% of hypertension in patients on dialysis is fluid related -Action threshold bp equal to or > than 200/100 mmHG hypertension causes, s/s, prevention and interventions - Answer S/S b/p above patients normal, headache, and hypervolemia (fluid overload) -causes- fluid and sodium overload, missed/short treatment, incorrect, EDW/ unrecognized wt loss/obesity, nonadherence to order medication, smoking and anxiety/pain preventon- include fluid and dietary, counseling, adherence to antihypertensive, smoking, cessation and therapeutic life style and routine EDW reassessment and saftey checks 35 causes s/s - Answer -blood glucose > 70 check cbg, treat with oral or IV glucose and collaborate with dietitian causes- removal of glucose during tx, decreased food intake or absorption, delayed eating after medication, incorrect dose of med, n/v, medication s/s mental status change, shakiness, irritability, sudden mood change, sweating, paleness, lightheartedness, severe confusion, combativeness, seizure List 3 routine measures for the prevention of injury to blood loss - Answer 1) rinse back dialyzer per policy 2) secure line connections 3) hold pressure on cannulations for 5 minutes Air embolism is? Causes s/s prevention interventions - Answer a large quantity of air into the bloodstream - causes -an empty saline bag, disarmed air detector, loose arterial connection, dialyzer leak s/s- air in line, coughing, visual disturbances, hypotension, anxiety ensure venous line is threaded through clamp, maintain >300ml in Saline bag, double clamp NS. never leave machine when rinsing pt back, return blood with saline and not air Interventions- COLT Clamp lines, turn off blood pump, place patient on left side, trendelenburg Hemolysis is? 36 Causes s/s prevention interventions - Answer a rupture of blood cells and release of cell contents a temp >40, failure of conductivity meter, knks, Ap > -250, small needle, sterilant, hypotonic inadeuately treated water, RX to blood transfusion or medication s/s- cherry colored blood, burning at access, nauseas, dizzy, chest pain, back pain -preventions- monitor ECC, complete all test and checks, use appropriate BFR for needle gauge, monitor AP, complete water checks per policy, do not disinfect during dialysis treatment interventions- call for help, notify RN, turn off blood pump, clamp lines, turn off UF, do not return blood, O2, vs, and emergency protocol if needed Crenation is? Causes s/s prevention interventions - Answer - the shrinking of blood cells when exposed to a concentrated solution (hypertonic) causes- conductivity alarm failure, proportioning system malfunction, improper mixing of dialysate -s/s- dark blood and thrist prevention- varify dialysate conductivty with independent meter, perform pre tx machine tests, ensure bypass is functiongs, regular machine maintenance, 30 min safety checks interventions- turn off pump, clamp line, turn off UFR, notify RN, do not return blood 37 2) uremic encephalopathy 3) persistent hypertension 4) drug toxicity 5) pre-existing-seizures disorders 6) stroke 7) sever anemia 8) return blood and d/c treatment 6) administer o2/suction as needed 7) protect from injury, move objects Seizures are? - Answer a violent spasm of jerking of the face, trunck, or extremities: -uncommone and occurs in <10% of adult hemodialysis patients -may occur during the treatment, immediately after, or up to 12-24 hrs after treatment List 7 s/s of a seizure - Answer 1) Jerking motion of limbs 2) decreased level of consciousness 3) hypotension 4) clenching jaws, frothing of the mouth, fluttering eyelids 5) cyanosis 6) incontinence 7) complaint of headache, vision changes List 7 dialysis related causes of seizures - Answer 1) severe hypotension 2) electrolyte imbalance 3) air embolism 4) hemolysis 5) disequlilbrium syndrome 6) ESA therapy 7) worsening intracranial bleed List 7 disease related causes of seizures - Answer 1) hypoglycemia Prevention of seizures (8) - Answer 1) call for help and institute emergency protocol 2) turn UF off/ assess for air in ECC 3) turn patient to the left in modified trendelenburg with head to the left 4) protect airway and secure vascular access 5) check b/p Seizure documentation - Answer documentation should include -duration, b/p, interventions, md conversations, orders, and patient outcome, 40 causes prevention and intervention - Answer -an excessive increased in blood volume s/s- excessive wt gain, hypertension, sob, dyspnea, edema, and neck vein distension causes- related to dialysis are excessive fluid intake, inaccurate EDW, improper calculation of UFR, and use of high UFR and use of high sodium dialysate. Other medical causes are pre-exsisting HTN or decreased residual urine output Prurtitis is? s/s causes prevention/interventions - Answer -known as itching, common in patients on dialysis s/s- hives, redness, or crusty lesions, causes are sudden onset (could be a reaction to dialysis circuit.) - Chronic itching could be due to inadequare dialysis -ca++ and phos4 imbalance, hyperparathyrois disease or skin infection Infection is s/s causes prevention and intervention - Answer -is an invasion of the body by a pathogen that has the potential to cause disease. (bacteria, viruses, fungi,parasites s/s- fever, chills, warm, pain and or swelling, redness/damage, n/v, muscle or body aches, joint pain or elevated wbc levels causes- kidney disease suppresses the patient's immune system, repeated dialysis procedures, poor hand hygiene or patient hygiene, breaks infection control, improper disinfection of equipment ( diabetics have a higher risk of infections) preventions & inervetions- good hand hygiene, disinfect between patients, aseptic techniques, cover coughs, sneezes, stay home when sick (obtain cultures, obtain fluids, check labs, meds, and abx) 41 What is the single most important measure for preventing the spread of infection? - Answer HAND HYGIENE! Pyrogenic reaction s/s causes prevention/interventions documentation - Answer - caused by toxins coming from dead bacteria - a febrile response to bacteria or bacterial breakdown products (associated with equipment, water, dialysate) s/s-chills, n/v, anxiety, low b/p, fever, feeling cold, dizziness, light headed, headache, and or muscle pain, cause- poor infection control, dialysate pyrogens/endotoxins, ECC prepared more than 4 hrs ahead, contaminated concentrate containers prevention & intervention- follow infection control policy, do not recirculate ECC for more than 4 hrs, disinfect all equipmen -obtain cultures of dialysate and remove equipmen -documentation- notify MD, medical director, TOM, RQM, CQM, QAI and adverse event form Fever is Chills are s/s causes prevention and intervention - Answer - body temperature >100 f or 2 degree above baseline FEVER and CHILLS IN DIALYSATE NEEDS IMMEDIATE ACTIONS s/s- chils, cold/achy, vomiting, coughing, sputum production, redness, swelling or 42 causes- high temperature setting machine, pyrogenic reaction of access, blood, respiratory, urinary tract, wound -prevention& intervention- proper disinfection of equipment, used primed ECC within 4 hrs and proper aspectic technique, monitor s/s of patient, proper hand hygiene Notify RN for assessment, machine temp should be checked and evaluate fo pyrogenic reaction. CULTURE THE DIALYSATE! Dialyzer membrane reaction is s/s causes interventions - Answer -also known as "FIRST USE SYNDROME" VERY RARE -s/s occurs within a few minutes of a dialyzer membrane reaction: SOB, wheezing or coughing, facial edema, flushing, hive like rash, watery eyes, nausea, anxiety, uneasy, fear, tightness in the chest or throat, (nack and or chest pain, warm feeling or hyper/hypotension) causes- sensitivity, or allergy to dialzyer, membrane material. Reactions to ethylene oxide or improper priming of the dialyzer -intervention- notify the RN, stop treatment, turn off and clamp the line, administer o2, call the MD, (SAVE ALL DIALYZER, BLOODLINES) DOCUMENT INTERVENTIONS AND COMPLETE AND ADVERSE EVENT FORM Allergic reactions s/s - Answer an over reaction of the immune system to a substance itching, hives, pruritis, red/irritated skin, restlessness, facial/neck, swelling, fever, sudden onset of chilling, watery eyes, mild cough, difficulty breathing, anxious nausea, abdominal cramping, muscle pain and or chest or back pain anaphylaxis is - Answer a severe, potentially life threatening reaction Severe allergic reactions is - Answer this can be caused by medications, blood draining "cold", hypotension