Exam (elaborations)
Bonent exam
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- BONENT - Reviewer
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- BONENT - Reviewer
Exam of 28 pages for the course BONENT - Reviewer at BONENT - Reviewer (Bonent exam)
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Bonent examIn center hemo must be done - ANS-3x a week for about 4 hours
Cons of in center HD - ANS-Most limitation on Diet, fluid than other modalities
Requires the most medication
Most symptoms
Patients who run 4 hour tx - ANS-Are 30% less likely to die than pts who run shorter
times
Each 30 mins extra of tx increase life by 7%
Patients are 50% more likely to die after - ANS-2 day no treatment weekend, the last 12
hours of the 2 days the risk of death triples
diastolic blood pressure - ANS-When the heart is at rest.
Benefits of nocturnal in center - ANS-You get 2x as many txs as standard because it is
longer and more gentle with fluid removal
Rarely cramp
Easy on heart
Fewer limitations on food and drink
Free days
72% better survival rate than standard in center
You check blood pressure with - ANS-Stethoscope and sphygmomanometer
Nocturnal in center hemo must be done - ANS-3x a weeks about 8 hours per tx
If BP site is below the heart.... - ANS-The reading will be to high
Benefits of nocturnal home hemo - ANS-Better protein level
Don't need binders
No fluid limits
Fewer symptoms
Less heart damage
Live as long as people who get a deceased kidney transplant
,If BP site is above the heart.... - ANS-The reading will be to low
Home hemo must be done - ANS-3x a week 4-6 hours per tx
Benefits of PD - ANS-Can do alone at home or work
Only need 1-2weeks of training
Allows for a more normal diet
Allows pt to feel more normal
peritonitis - ANS-inflammation of the peritoneum, this can scar the peritoneum and
make PD no longer possible, can be avoided by doing a sterile exchange
2 types of PD - ANS-Continuous ambulatory peritoneal dialysis (CAPD)
Automated peritoneal dialysis (APD)- uses cycled at night done 8-10 hours during sleep
During in center HD how much blood is outside of body at a time - ANS-1/2 cup
Short Daily Home Hemodialysis must be done - ANS-5-6days a week for the 2.5-4 hour
per tx
a bp cuff that is too small or to loose will cause a - ANS-Higher reading
Nocturnal home hemomust be done - ANS-At home 3-7 nights a week 8 hours per tx
A no cuff that is to big for a patients arm ... - ANS-Lower reading
Why would someone want to do more HD than standard? - ANS-Longer or more
frequent HD is gentle and cause fewer symptoms and may help Pt live longer, home
puts pt in charge
peritoneal dialysis - ANS-the lining of the peritoneal cavity acts as the filter to remove
waste from the blood through tiny blood vessels.
Placed in abdomen and sometimes chest wall
Dialysate sits in catheter for a few hours and excess water and waste flows from BV to
the dialysate. The dialysate is then drained and replaced. (Exchange)
Pt can use a cycle mahjne while they sleep
Can also be done by hand 4xa day and can be done anywhere.
In dialysis patients the reason BP drops during or close to the end of tx is because -
ANS-The total blood volume drops, from the water removal
, regular respiration rate - ANS-12-16 breaths per minute
In dialysis patients water may enter the lungs due to water weight gains this can cause -
ANS-Sob or trouble breathing
Payment for dialysis - ANS-Medicare pays for 80% of dialysis
Medicare makes rules a clinic must follow to provide coverage of tax.
Pt who don't have Medicare before CKD a pt must wait 3 months for it to cover in center
but it will cover home-hemo right away.
2011 change how they pay for dialysis and created a "bundle" (composite rate,
labs,drugs and home training)
Quality Incentive Program - ANS-Pay for performance, Cuts pay by 2% if measures
aren't met. (Kt/v and hemoglobin)
ESRD networks - ANS-Oversees quality of care, 18 mostly nonprofit organizations.
Renal physicians association(RPA) - ANS-1993 nephrologist made first clinical practice
guidelines, including minimum dose of HD , when to start and stop HD and care for
kidney disease for pt not on HD
National Kidney Foundation (NKF) - ANS-1995, experts set guidelines for anemia,
adequacy, and vascular access
KDOQI - ANS-Kidney Disease Outcomes Quality Initiative, improves care and
outcomes of all people with kidney disease
Dialysis Outcomes and Practice Pattern Study - DOPPS - ANS-Help pts love longer by
finding patterns incenter that can be changed to improve outcome
state survey - ANS-An inspection of the facility by state surveyors for compliance with
rules and regulations of Medicare. If clinics don't follow they must make a plan of
correction.
Continuous Quality Improvement (CQI) - ANS-Finding problems and fixing them. 4 step
process
4 steps of continuous quality improvement - ANS-1.identify the problem- collect data
and figure out how to fix
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