DaVita PCT Study Guide Flashcards

Questions and Answers

What is the acceptable result for Chlorine/Chloramine testing?

Less than or equal to 0.1 mg/L (correct)

Equal to 0.5 mg/L

Greater than 0.1 mg/L

It varies by patient

What does AKI stand for?

Acute Kidney Injury

Give examples of pre-renal causes of AKI.

Obstruction, Volume Depletion, Impaired Cardiac Function

Give examples of intra-renal causes of AKI.

Ischemic ATN, Sepsis, SIRS, Septic Shock, Anaphylaxis Drugs, Goodpasture Syndrome, Acute Glomerulonephritis, Trauma, Open Heart Surgery Signup and view all the answers

Give examples of post-renal causes of AKI.

Obstruction, Oliguric, Bladder Rupture, Pregnancy Signup and view all the answers

How can you help restore kidney function?

Find the cause of the AKI Signup and view all the answers

How do you protect kidneys from further injury?

Avoid substances that may be toxic to the kidney Signup and view all the answers

What is important when monitoring weight and BP in AKI patients?

Keep a little extra fluid available for the kidneys Signup and view all the answers

What complications are AKI patients at increased risk for?

Hypovolemia, Hypotension Signup and view all the answers

What should you consider regarding vascular access for AKI patients?

They typically have a dialysis catheter Signup and view all the answers

Explain the difference between AKI and CKD.

AKI can sometimes be reversible, while CKD is often irreversible. Signup and view all the answers

Outline the treatment goals for a patient with CKD.

Slowing progression, managing comorbidities, controlling symptoms, minimizing lifestyle impacts, and educating on replacement therapy. Signup and view all the answers

What are the most common causes of CKD in the USA?

Diabetes Mellitus, Hypertension, Polycystic Kidney Disease Signup and view all the answers

Why is it important to know the cause of a patient's CKD?

To inquire about possible problems during data collection and assessment Signup and view all the answers

In Kt/V, what does 'K' represent?

Clearance of urea Signup and view all the answers

What treatment factors decrease 'K'?

Inadequate coagulation, Decreased BFR, Poor priming, Not following eP&P, Patient not adhering to treatment. Signup and view all the answers

What treatment factors increase 'K'?

Increased BFR, Correct DFR, Correct dialyzer, Correct target weight-amputation factor Signup and view all the answers

In Kt/V, what does 't' stand for?

Time of dialysis session Signup and view all the answers

What factors influence 't'?

Running prescribed treatment time, following physician orders, encouraging full treatment duration. Signup and view all the answers

In Kt/V, what does 'V' represent?

Volume of urea distribution Signup and view all the answers

What factors influence 'V'?

Amputation, Height, Sex, Age, Type of access Signup and view all the answers

What is the suggested BFR for 17 gauge needles?

200-250 Signup and view all the answers

What is the suggested BFR for 16 gauge needles?

250-350 Signup and view all the answers

What is the suggested BFR for 15 gauge needles?

350-450 Signup and view all the answers

What is the suggested BFR for 14 gauge needles?

450+ Signup and view all the answers

Match the procedure for post BUN lab draw with the steps:

<ol> <li>Turn off UFR or decrease it to 50 = Step 1</li> <li>Decrease DFR to 300 or put in bypass = Step 2</li> <li>Decrease BFR to 100 = Step 3</li> <li>Wait 15 seconds for all access types and draw post = Step 4</li> </ol> Signup and view all the answers

What lab draws mistakes would falsely increase Kt/V?

BFRs not reduced, waiting only 5 seconds, drawing post BUN from venous line Signup and view all the answers

What lab draws mistakes would falsely decrease Kt/V?

Accidentally diluting pre-treatment arterial BUN sample with saline, waiting longer than 15 seconds to draw Signup and view all the answers

Study Notes

Chlorine/Chloramine Testing

Conduct tests 15 minutes before each patient shift, every 4 hours.
Sample collected after the Primary carbon tank sample port.
Acceptable chlorine/chloramine level: ≤ 0.1 mg/L.
If levels exceed the acceptable limit, the test must be repeated.

Acute Kidney Injury (AKI)

AKI encompasses various kidney issues from mild function changes to acute kidney failure.
Dialysis may be required in outpatient settings until kidney function improves.

Pre-Renal Causes of AKI

Common causes include obstruction, volume depletion, and impaired cardiac function.

Intra-Renal Causes of AKI

Examples include:
- Ischemic Acute Tubular Necrosis (ATN)
- Sepsis
- Systemic Inflammatory Response Syndrome (SIRS)
- Septic shock
- Anaphylactic reactions to drugs
- Goodpasture syndrome
- Acute glomerulonephritis
- Trauma
- Open heart surgery

Post-Renal Causes of AKI

Common causes include obstruction, oliguria, bladder rupture, and complications from pregnancy.

Restoring Kidney Function

Identify and address the underlying cause of AKI for potential recovery of kidney function.

Protecting Kidneys from Further Injury

Avoid nephrotoxic substances, such as:
- Radiographic contrast
- Amphotericin B
- Low-dose aspirin
- Non-steroidal anti-inflammatory drugs (NSAIDs)

Monitoring Weight and Blood Pressure

Maintain slight fluid retention to support kidney function when they begin filtering again.

Complications in AKI Patients

Increased risk for hypovolemia and hypotension.

Vascular Access Considerations

Patients usually have dialysis catheters; risk of catheter-related infections must be minimized.

Differences Between AKI and Chronic Kidney Disease (CKD)

AKI may allow for recovery of kidney function if the cause is resolved, while CKD results from chronic conditions like hypertension and diabetes that cannot be eliminated.

Treatment Goals for CKD Patients

Slow CKD progression.
Manage comorbidities and complications.
Control symptoms.
Minimize lifestyle impacts.
Educate on kidney replacement therapy options.
Encourage active patient participation in healthcare.

Common Causes of CKD in the USA

Diabetes mellitus (DM).
Hypertension (HTN).
Polycystic kidney disease (PKD).

Importance of Identifying CKD Causes

Understanding the cause enables targeted inquiries and assessments during patient data collection.

Understanding Kt/V in Dialysis

'K' represents urea clearance.
't' indicates the duration of the dialysis session.
'V' is the volume of urea distribution within the patient’s body water.

Factors Affecting 'K'

Decrease in 'K' caused by:
- Inadequate coagulation.
- Low blood flow rate (BFR).
- Poor priming of dialyzer.
- Not adhering to established protocols.
- Patient non-compliance with treatment.

Factors Increasing 'K'

Higher 'K' can result from:
- Increased BFR.
- Correct dialysate flow rate (DFR).
- Correct dialyzer usage.
- Target weight considerations.

Influences on 't'

Follow physician directives to ensure prescribed treatment duration is met.
Patients must complete the entire treatment session; premature termination can adversely affect effectiveness.

Influences on 'V'

Factors affecting volume of urea distribution include:
- Amputation status.
- Patient height.
- Biological sex.
- Age considerations.
- Access type, where less efficient access may lower effective volume processing.

Blood Flow Rate (BFR) Guidelines

Suggested BFR for 17 gauge needles: 200-250 mL/min.
Suggested BFR for 16 gauge needles: 250-350 mL/min.
Suggested BFR for 15 gauge needles: 350-450 mL/min.
Suggested BFR for 14 gauge needles: 450+ mL/min.

Post BUN Lab Draw Procedure

Methods to follow:
- Turn off or reduce ultrafiltration (UFR) to 50 mL/min.
- Set DFR to 300 mL/min or bypass.
- Reduce BFR to 100 mL/min.
- Wait 15 seconds before drawing blood.

Mistakes Affecting Kt/V Accuracy

Factors that may falsely increase Kt/V:
- Not reducing BFR adequately.
- Insufficient wait time before sample collection.
- Collecting post BUN from the venous line.
Factors that may falsely decrease Kt/V:
- Diluting pre-treatment arterial BUN with saline.
- Overwaiting (> 15 seconds) before drawing blood.

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Description

This quiz provides essential flashcards for DaVita Patient Care Technicians (PCT) covering crucial topics such as chlorine/chloramine testing procedures and definitions of key medical terms like AKI. Enhance your knowledge and prepare for your patient care responsibilities effectively.