Bonent Exam Questions with 100% Complete Solutions

In center hemo must be done - 3x a week for about 4 hours Cons of in center HD - Most limitation on Diet, fluid than other modalities Requires the most medication Most symptoms Patients who run 4 hour tx - 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 - 2 day no treatment weekend, the last 12 hours of the 2 days the risk of death triples diastolic blood pressure - When the heart is at rest. Benefits of nocturnal in center - 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 - Stethoscope and sphygmomanometer Nocturnal in center hemo must be done - 3x a weeks about 8 hours per tx If BP site is below the heart.... - The reading will be to high Benefits of nocturnal home hemo - 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.... - The reading will be to low Home hemo must be done - 3x a week 4-6 hours per tx Benefits of PD - 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 - 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 - 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 - 1/2 cup Short Daily Home Hemodialysis must be done - 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 - Higher reading Nocturnal home hemomust be done - At home 3-7 nights a week 8 hours per tx A no cuff that is to big for a patients arm ... - Lower reading Why would someone want to do more HD than standard? - Longer or more frequent HD is gentle and cause fewer symptoms and may help Pt live longer, home puts pt in charge peritoneal dialysis - 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 - The total blood volume drops, from the water removal regular respiration rate - 12-16 breaths per minute In dialysis patients water may enter the lungs due to water weight gains this can cause - Sob or trouble breathing Payment for dialysis - 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 - Pay for performance, Cuts pay by 2% if measures aren't met. (Kt/v and hemoglobin) ESRD networks - Oversees quality of care, 18 mostly nonprofit organizations. Renal physicians association(RPA) - 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) - 1995, experts set guidelines for anemia, adequacy, and vascular access KDOQI - Kidney Disease Outcomes Quality Initiative, improves care and outcomes of all people with kidney disease Dialysis Outcomes and Practice Pattern Study - DOPPS - Help pts love longer by finding patterns incenter that can be changed to improve outcome state survey - 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) - Finding problems and fixing them. 4 step process 4 steps of continuous quality improvement - ify the problem- collect data and figure out how to fix ze problem-see if there is a standard or guideline to fix it, look at patterns or trends of problem? 4.Plan,do,check,act- make a plan to fix, try plan, check results and make changes if needed Professionalism - The quality of performing at a high level and conducting oneself with purpose and pride Boundaries - 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? - size of fist, 5oz a piece What protect the kidneys - Pads of fat and the bones of the rib cage What makes up the outside of the kidney - Tough fibrous capsule, inside the capsule is the cortex which is made of layers of cells Medulla - Inner part of kidney which is made up of pie shaped wedges called pyramids In the medulla the points of the pyramid are called - Papillae calyx - Cup shaped opening at the end of the papillae, which sends drops of Urine to the renal pelvis. The renal pelvis links to ureters (tube to bladder) nephron - filtering unit of the kidney, In the renal cortex and ends into medulla, gets rid of excess water and waster keeps what the body needs. Made up of glomeruli and tubules glomeruli - Ball of capillaries in a sac called Bowman's capsule. Filtration system Capillary wall are semipermeable Blood enters the glomeruli through an afferent (towards organ) arteriole, with each heart beat blood pressure forces water out of blood through tiny slits and into Bowman's capsule. Small wast that passes through the pores is called glomerular filtrate Glomerular filtrate - Substances that filter out of the blood through the thin walls of the glomeruli, adults make 125ml each minute. And 180 liters a day. Nearly all filtrate is reabsorbed in the tubules Healthy glomeruli walls keep - Large cells like blood cells and protein If a nephron is damaged - Large cells can leak through the membrane like RBC and protein tubular system - proximal convoluted tubule, loop of henle, distal convoluted tubule, is shaped like an "s", receives filtrate from the glomeruli What happens in the tubules of the nephron - Chemicals and water that the body needs pad back into the blood. Waste and extra water empties into the calyces and become urine