Module 1 study (1).docx

Ultrafiltration- Fluid pushed through the semipermeable membrane using pressure Convection- Solutes dragged across the semipermeable membrane along with fluid Diffusion- Particles moved from an area of high concentration to low concentration Osmosis- Fluid moves from an area of low concentration...

Ultrafiltration- Fluid pushed through the semipermeable membrane using pressure Convection- Solutes dragged across the semipermeable membrane along with fluid Diffusion- Particles moved from an area of high concentration to low concentration Osmosis- Fluid moves from an area of low concentration to high concentration The kidneys' excretory functions are to normalize electrolytes, remove wastes, provide fluid and acid base balance Normal excretory functions are replaced through the use of acid concentrate and providing fluid balance through ultrafiltration Acid concentrate provides the concentration gradient for diffusion and helps normalize electrolytes Bicarbonate buffers the acid concentrate in the dialysate solution Bicarbonate normalizes body pH once it diffuses in patients' blood Hyperkalemia is when K is \> 5.5 and s/s include muscle weakness, abnormal heart rhythm, or cardiac arrest Hypokalemia is when K is \< 3.5 and s/s include fatigue, muscle weakness, paralysis, respiratory failure, arrythmia. Or cardiac arrest Endocrine functions of kidneys include renin secretion, erythropoietin secretion, vitamin D activation Normal endocrine functions are replaced with medications Only 15% of normal kidney function is replaced through hemodialysis Uremia is a buildup of waste in the blood due to kidney failure Most common causes of CKD are Diabetes, hypertension and Polycystic kidney disease S/S of fluid imbalance include hypertension, edema, and SOB Sodium balance leads to volume expansion, increased cardiac output, increased peripheral vascular resistance, increased BP Patients with dry, itchy skin should be advised to use hyper-fatted soaps and lotion Patients with peripheral neuropathy should be advised to not walk barefoot Prolonged fluid overload and hypertension leads to Left Ventricular Hypertrophy Pericarditis is inflammation of the membrane around the heart Pericarditis is treated with a decrease of heparin and an increase in dialysis Hypertension is most commonly caused by fluid overload Left ventricular Hypertrophy leads to ischemic heart disease, arrythmia, heart attack or death Dialysis patients are anemic because the life span of their RBC is 60 days, half of the normal 120 days Primary cause of anemia is lack of erythropoietin Blood loss and low hemoglobin can be avoided by proper Erythropoietin dosage and rinsing back until blood line is pink Four key elements of CKD-Mineral Bone Disorder are calcium, phosphorus, PTH, and Vitamin D S/S of CKD-MBD include soft tissue calcification, itching, muscle weakness, pathological fractures, tendon ruptures, vertebrae compression, atherosclerosis, heart disease AKI (Acute Kidney Injury) incorporates many kidney issues such as acute kidney failure and other kidney function changes Pre-renal causes of AKI include Obstruction, volume depletion and impaired cardiac function Intra-renal causes of AKI include Ischemic ATN, sepsis, acute interstitial nephritis, septic shock, anaphylaxis, drugs, goodpasture syndrome, glomerulonephritis, trauma, open heart surgery Post-renal causes of AKI include obstruction, bladder rupture, pregnancy Eliminating cause of AKI can often lead to return of kidney function meanwhile you cannot eliminate the cause of CKD which is HTN, Diabetes, genetic disorders Patients with dialysis catheters need extra care to avoid catheter related infection Kidneys can be protected from further injury by avoiding substances toxic to the kidney such as radiographic contrast, amphotericin B, aspirin and NSAIDS When monitoring weight and BP, extra fluid should be kept on the patient for kidney use when they begin filtering on their own AKI patients are at an increased risk for both hypovolemia and hypotension OSHA requires employers to provide workers with safe working conditions CMS is concerned with patient care and safety V-Tags state specific regulations within conditions such as infection control, providing guidance for each regulation and citing deficiencies by tag \# The only acceptable hand hygiene method when treating C diff patients is using soap and water Bacterial vascular access infections are the most common infectious complication MRSA causes the most common infection in hemodialysis patients Strikethrough of an external pressure transducer is when fluid has entered the machine and contaminated the internal pressure transducer providing a reservoir for microorganisms and causing blood infections in patients HBsAG- Hep B surface antigen (tested monthly for susceptible pts and non-responders HBsAB- Hep B Surface antibody HBcAb- Hep B core antibody Total proportion of dialysate used is 45X The two most frequent prescribed potassium strengths of dialysate concentrate are 2.0 K+ and 3.0 K+ The glomerulus functions similarly to the dialyzer's semipermeable membrane The two waste products removed and monitored with monthly labs are Blood Urea Nitrogen (BUN) and Creatinine The dialysis machine alarm tests are performed before each treatment The dialysate pH should be between 6.9 and 7.6 The manual conductivity value on the machine must be no less and no greater than 0.4 Dialyzer and blood lines can be set up no more than 2 hours due to the potential of bacteria growth Residual bleach testing should be done after bleach disinfection and before equipment use