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80 Cards in this Set
- Front
- Back
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What are some general symptoms of CKD?
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Proteinurea
Nocturia Hypertension Na retention Anemia Dyspnea Uremic symptoms N/v |
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What are two universal complications of uremia?
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Anemia
Renal osteodystrophy |
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Whqt are some common complications of CKD?
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Pericarditis
Electrolyte imbalance Neuropathy Amyloidosis b/c kidneys secrete amyloid Carpal tunnel b/c of amyloid build up Itching Sleep problems due to sob Bleeding abnormalities b/c Ca has to do with clotting factors |
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Whqt effect dos CKD have on the nervous system?
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Uremia damages the nerves.
Neuropathy and restless legs syndrome |
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What can cause bone and joint pain in CKD?
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Calciphylaxis and amyloidosis
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How does CKD affect the skin?
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Itchy, bruised, uremic frost, bleed easily
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What are some symptoms of fluid overload?
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HTN, fluid in the lungs, Jvd, edema
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What is the typical fluid restriction for a CKD pt?
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1500cc/day
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Whqt are some symptoms of metabolic acidosis?
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Increased rate and rhythm of RESPIRATIONS, altered mental status, decreased BP, increed hr in mild acidosis or decreased hr in severe acidosis
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How often do we do a potassium lab for a pt OB a 3k bath?
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Q week
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What addictive substance contains potassium?
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Chewing tobacco
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How is epo titrated?
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According to HgB.
HgB should be 10-11. |
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Why are ckd pts not typically give iron po?
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It is poorly tolerated and absorbed.
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What OTC meds do we avoid in CKD pts?
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Alka seltzer because it is Na
Pepto because of the ASA MOM Mg Citrate Enemas/laxatives Herbal remedies |
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If the pt has ammonia on their breath, a metallic taste in their mouth, and oral ulcerations, what do we do?
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Tell the to brush their teeth regularly, use mouthwash, chewing gum, and lemon juice...use a dilute vinegar mouthwash to neutralize ammonia breath
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How long do we have to do an assessment if the pt has no complaints?
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1hour
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What two medications do we use for nausea?
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Benedryl and Dramamine
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What causes diarrhea in the CKD pt?
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Intestinal irritation, medicatins, fluid balance
Give Immodium |
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What causes constipation in the CKD pt?
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Less bulk in diet, medications, fluid balance
Tell them to take stool softeners and to always consult with their doctor about OTC meds |
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Wht sexual side fx does CKD have?
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Erectile dysfunction, decreased sensation and libido for both sexes due to nerve damage
May decrease heparin during the menstrual cycle |
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What is it called when the pt has mental status changes, decreased alertness/concentration and possibly dementia/hallucinations?
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Uremic encephalopathy
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What are four affects uremia has on the nervous system?
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Restless legs, burning feet, asterixis, tremors
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What drug has been associated with high risk of infection?
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Hgh dose IV iron
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What hormones do the kidneys secrete?
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Renin, ADH, epo, and calcitriol (activated vit D)
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What three things make up the extra corporeal circuit?
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Blood lines, dialyzer, needles
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What can happen to the pt if there is a blood leak the dialyzer?
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Sepsis.
Dialysate is not sterile |
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Which Hanson is the dirty Hanson?
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Red one
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What could cause the arterial pressure alarm to ring?
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Clots/kinks in the tubing
Improper needle placement Wet transducer Central line pressures are naturally higher |
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What could cause the vinous pressure alarm to ring?
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Clots in dialyzer
Improperly placed venous needle |
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Is the TMP positive or negative?
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Positive
Negative means dialysate is flowing back in to the blood |
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What could cause the dialysate flow rate to be inadequate (and the bell go off)?
Name four. |
Not enough water
Dialysate pump failure Power failure Drained water storage tank Kink in the line |
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Why is the Pheonix meter so important?
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Checks how much Na is in dialysate.
Too much Na = crenation (RBC shrinkage) Too little Na = hemolysis (RBC blow up) |
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What happens if the dialysate is too hot?
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Hemolysis
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What are the safe limits for pH?
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6.9-7.5
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What are the three components of the hemodialysis system?
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1. The delivery system (machine and dialysate)
2. The extracorporeal circuit (needles, bloodlines, and dialyzer) 3. Vascular access |
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What is the movement of fluid called?
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Osmosis
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Whqt is the movement of salutes called?
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Diffusion
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Name 4 HD drugs that won't dialyzer off.
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Heparin
Epo Venefer Zemplar |
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What is the measurement of how well the HD tx removes fluid, toxins, and electrolytes?
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Adequacy
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What factors affect adequacy?
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Dialysate temp
BFR DFR Countercurrent flow |
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What kind of dialyzers do we use?
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High flux. The best out there.
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How does BFR affect adequacy?
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Higher speeds = higher adequacy
BFR can be 200-600, but higher speeds are not always attainable. If you can't attain the higher speed, document it. |
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How does DFR affect adequacy?
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Higher DFR = other adequacy
DFR can be 300-800 but not all machines have the capacity for higher flows |
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What happens at arterial pressures >-250?
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Hemolysis
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What is fluid removal under pressure called?
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Ultrafiltration
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Who is the most important team member in the HD setting?
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The patient
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What is the RN's job in the HD setting?
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Educate, advocate, and treat
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When is the Pheonix meter calibrated?
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Q am by the tech and prn
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Wht is the purpose of the Pheonix meter?
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To measure the final pH and conductivity of the dialysate before the pt receives tx.
Is the Na level correct?? |
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How much can the Pheonix meter differ from the machine?
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+ or - 0.2
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When should the conductivity be verified by the Pheonix?
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Before the Hansens are attached to the dialyzer
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Shat is a safe pH for dialysate?
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6.9-7.5
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How long is the pH buffer solution used to calibrate the Pheonix good for?
What about the conductivity calibrator solution? |
90 days
30 days |
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When do you rinse and wipe the Pheonix meter?
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Rinse with RO water every 2-3 uses and wipe with a bleach rag when you are done with it.
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What is the albumin level used to dx?
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Malnutrition. Levels less than 4 increase pt risk of death.
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What should the albumin level be?
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>4
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What is the RDA for protein?
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1g per 1kg body weight
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What could we do for a pt with an albumin less than 4?
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Give them a protein bar.
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Why does malnutrition increase a pt's risk for death?
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Because the body can't repair it's cells and fight infection
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How much potassium can an ESRD pt consume?
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2-3 grams per day or 5 1/2c servings of certain fruits and veggies per day
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How can ESRD pts eat potatoes?
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Soak them overnight to reduce the K
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Why are we concerned if a pt has had n/v/diarrhea?
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They may have low K and need their bath changed.
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What fruit should HD pts never EVER eat?
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Star fruit because the neurotoxins build up in their systems.
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What see some good protein sources for HD pts?
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Turkey, beef, eggs, chicken
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What foods contain phosphorus?
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Nuts, seeds, dairy, chocolate, dark colas except root beer
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What electrolyte is most poorly dialyzer off?
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Phosphorus.
It dialyzes off in the last half hour, so pts that leave early don't get their phosphorus removed. |
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What should the phosphorus level be in HD pts?
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3.5-5.5
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What do phosphate binders NOT bind to?
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Phosphorus in liquids like dark colas.
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If we see a pt eating in the clinic, what should we do?
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Ask them if they took their phosphate binder.
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What kind of bread should HD pts eat?
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White bread because whet brad contains phosphorus.
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How can one limit phosphorus intake?
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Limit dairy to 1/2c/day
Limit processed foods. |
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What are some good foods for Hd pts to eat?
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Apple
Pineapple Grapes Berries Cabbage Green beans Fish CornflakesLettuce Pasta Saltine crackers White rice Chicken Hamburger |
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How much sodium can a HD pt have?
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2g/day
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Can we dialyzer off that route 44 drink our pt came in with?
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No. We can try to compensate, but they have a higher risk of cramps and hypotension
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How much fluids can most HD pts consume?
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1000-1500cc
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Where could we look for edema on a pt with amputated legs?
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Sacrum
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Whqt are the signs of fluid overload?
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HTN
Pulmonary edema Headache Enlarged heart Diminished lung sounds Edema |
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What is the safest way to add calories to an underweight pt's diet without increasing electrolytes?
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Sugar and fat
We don't want them breaking down muscle or protein for energy because of the metabolic wastes from that. |
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What are some general nutritional guidelines for HD pts?
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Take medication to replace fiber intake
Take a multivitamin for HD pts |
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Why do we NOT want HD pts eating restaurant fried chicken?
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Because it is injected with phosphorus as a preservative
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