In center hemo must be done - Answer- 3x a week for about 4 hours
Cons of in center HD - Answer- Most limitation on Diet, fluid than other modalities
Requires the most medication
Most symptoms
Patients who run 4 hour tx - Answer- Are 30% less likely to die than pts who run shorter times
...
Bonent exam Questions And Answers
In center hemo must be done - Answer- 3x a week for about 4 hours
Cons of in center HD - Answer- Most limitation on Diet, fluid than other modalities Requires the most medication Most symptoms
Patients who run 4 hour tx - Answer- 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 - Answer- 2 day no treatment weekend, the last
12 hours of the 2 days the risk of death triples
diastolic blood pressure - Answer- When the heart is at rest.
Benefits of nocturnal in center - Answer- 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 - Answer- Stethoscope and sphygmomanometer
Nocturnal in center hemo must be done - Answer- 3x a weeks about 8 hours per tx
If BP site is below the heart.... - Answer- The reading will be to high
Benefits of nocturnal home hemo - Answer- 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.... - Answer- The reading will be to low
Home hemo must be done - Answer- 3x a week 4-6 hours per tx
Benefits of PD - Answer- 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 - Answer- 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 - Answer- 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 - Answer- 1/2 cup
Short Daily Home Hemodialysis must be done - Answer- 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 - Answer- Higher reading
Nocturnal home hemomust be done - Answer- At home 3-7 nights a week 8 hours per tx
A no cuff that is to big for a patients arm ... - Answer- Lower reading
Why would someone want to do more HD than standard? - Answer- Longer or more frequent HD is gentle and cause fewer symptoms and may help Pt live longer, home puts pt in charge
peritoneal dialysis - Answer- 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 - Answer- The total blood volume drops, from the water removal
regular respiration rate - Answer- 12-16 breaths per minute
In dialysis patients water may enter the lungs due to water weight gains this can cause -
Answer- Sob or trouble breathing
Payment for dialysis - Answer- 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 - Answer- Pay for performance, Cuts pay by 2% if measures aren't met. (Kt/v and hemoglobin)
ESRD networks - Answer- Oversees quality of care, 18 mostly nonprofit organizations.
Renal physicians association(RPA) - Answer- 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) - Answer- 1995, experts set guidelines for anemia, adequacy, and vascular access
KDOQI - Answer- Kidney Disease Outcomes Quality Initiative, improves care and outcomes of all people with kidney disease
Dialysis Outcomes and Practice Pattern Study - DOPPS - Answer- Help pts love longer by finding patterns incenter that can be changed to improve outcome
state survey - Answer- 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) - Answer- Finding problems and fixing them. 4 step process
4 steps of continuous quality improvement - Answer- 1.identify the problem- collect data
and figure out how to fix
2.analyze problem-see if there is a standard or guideline to fix it, look at patterns or trends
3.cause of problem?
4.Plan,do,check,act- make a plan to fix, try plan, check results and make changes if needed
Professionalism - Answer- The quality of performing at a high level and conducting oneself with purpose and pride
Boundaries - Answer- Never share personal life or concerns with patients, never date pts, never borrow money, never invite to home or events, never except tips or money, do not sexually harass
How big are the kidneys? - Answer- size of fist, 5oz a piece
What protect the kidneys - Answer- Pads of fat and the bones of the rib cage
What makes up the outside of the kidney - Answer- Tough fibrous capsule, inside the capsule is the cortex which is made of layers of cells
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