FINAL EXAM

• Hypotonic sol
• sterilant in system
• transfusion reaction
• blood pump mal fx
• chloramines in h2o
• k,o in lines

Urea reduction Ratio-how well pt blood cleaned (>70%)

Hypotension

• Big meal during tx
• Htn meds b4 tx
• Too much fluid removed

Removing fluid under pressure

• To chk dialysate/blood comp
• Chk PHT/PIT
• Ensure pt safety

To ensure safe dialysate

• Htn
• SOB
• Edema
• MBS

• Ultrafiltration
• Diffusion
• Counter current flow

• Ro h20
• Elect: na+, ca++, k+, HCO3-, mg+, cl, dextros, acetate

• incr BFR
• incr tx time
• larger dialyzer
• incr dialysate flow rate
• counter current flow

mach response w/correct alarm

Decr

remove air fr lines & dialyzer, to coat fibers, & remove sterilant

drop in bp related to changes in positions

abnl breath sounds

heart rate <60

heart rate >100

top # of bp when heart pumps blood out

Bottom # of bp when heart relaxes and fills back up

fluid around the eyes

fluid accumulated that leave indintation when presses on

sound heard w/stetascope @ top of heart

incr in bp

feeling blood in access

sound of blood thru access

maintain acid base bal

assist with metabolism fx

not in dialysate-cellular & energy production

• bone/teeth development
• muscle contracting
• energy production
• cardiac fx
• blood clotting

maintains fluid bal

regulate muscle (heart)

Surgical connection between native artery and vein

access using synthetic material att 2 vein & artery

Savclavin & Jugular

1:1000 short acting blood thinner (IVP/IC)

1% anesthetic (ID)

Iron supplement 4 iron difficency (IVP)

for anemia stimulates bone marrow 2 produce RBC (IVP/SQ)

ca++ absorbtion, incr ca++ level (IVP)

antihestamine 4 all reaction/itching (IVP/PO)

prevents absorbtion of PO4- taken with meals (PO)

clotted v-drip cham, incr BFR, v-needle infiltrate, v-needle against wall, v-needle stenosis, low TMP, spasm @ v-needle, clotted v-needle, clotted v-line below v-drip cham, k/c/o on v-line below v-drip cham

a-needle infiltrate, clotted dialyzer, k/c on a-line, a-needle out of access, NSS administration, clotted a-needle, k blood pump segment, high TMP, decr BFR, NSS not clamped, v-needle out of access, a-needle against wall

bring the lower v-level closer to the LED so that it will alarm sooner & prevent blood loss

cross contamination & inaccurate a/v pressures

Step profile: moderate 2 large fluid gainers: return 2 na+ base 30min b4 tx ends

***Linear program: small 2 moderate fluid gainers: entire tx time: return 2 na+ base 5min b4 tx ends

150 (p)

152 (ami)

2000cc/hr

300cc/hr

13.5-14.5 (p)

13.5-14.3 (ami)

6.8-7.8 (p)

7.0 or 7.5 (ami)

dialysate bypassed dialyzer & goes dwn the drain

• Dizzy
• cramps
• n/v
• hypotensive

• SOB
• Htn
• Edema
• MBS

• N/v
• Dizzy
• Clammy
• Yawning
• Urg BM
• Pale
• blank stare

• T-burg position
• NSS 100-200cc
• UF off max 5min (p), 15min (ami) or decr UF min 300cc/hr
• bp q5min til pt stable

V-needle to top of v-drip cham

A-needle to v-needle

high/low a-pressure, high/low v-pressure, high/low TMP, air/foam in blood, blood in dialysate, no power

uf stops, blood pump stops, a/v alarms, rtd stops, v-line clamps, all fx cease, unmutable alarm

high/low temp, high/low conductivity, no h2o

a/v alarm, bypass, rtd stops

see att

see att

access visable, needles secure, trandsducers clean/intact, hemosafe on catheters, 160NVL/100 asymetrical

remove v-line from occlusion clamp; can crank max 15min

melons, bananas, salt subs, avocados

processed foods, beacon, pickles, lunch meats, chips

ice, soups, jellow, ice cream

diary products, nuts, peanut butter, beans

1 hr (p), 8hrs (ami)

pt name, rx name, rx route, rx dose, date/time, initials of who drew it

reddness, swelling, pn, tender 2 touch, warm

Exposure to PIM like dirty needle stick, blood splash

• fluid/elec bal done w/hemo
• waste/toxin removal done w/hemo
• Acid base bal done w/hemo
• Bp regulation done w/hemo
• RBC production not done w/hemo given EPO
• Vit d conversion not done w/hemo given synthetic form

emergency box, staff schd, and pt schd

Min q 30min

leakage of blood into sourrounding tissue

surgical connection of artery 2 vein on access

• transducers clean/intact; a-header up
• drip cham 85-95%; access visable
• pt alert; blood lines in guards
• tape intact/secure
• nss double clamped; counter current flow
• needles secure; min 300cc NSS

5min

pt (+) hep b

htn, anemia, poor apetitie

• SOB
• hypotension
• pale
• weakness

due to back filtration, dialysate in blood

See att

turn uf off, decr BFR 200cc/hr (p) or 150cc/hr (ami)

A-access prob

when rx'd BFR is reached

200cc/hr (ami)-100cc/hr (p)

lt side t-burg

to prevent absorbtion of PO4-

bp can drop (orthostatic bp)

left as is for TECH to chk

hemolysis, blood leaks, air embolism

press side of loop, side with strongest thrill is a-side

priming bucket disinfxn, blood spill, cannulation, initiation/termination, blood draw, bio haz, chk cond/ph

hemodialysis, Peritoneal dialysis, transplant, no tx

HIV, HEP B, HEP C

Trans membrane pressure: (+) pushing press of blood pump & (-) pulling press of dialysate comp

2 in apart; 2 prevent recirculation

• hypotension
• a-needle against wall
• infiltration of a-needle
• k/c/o bloodline between pt & a-monitor
• high BFR thru small needle
• high hbg/hct
• clotted fibers in dialyzer
• dialysate fiber screen dirty

• NSS administration
• wet transducers
• UF rate too low
• clampped monitoring line

- S/S: peppery taste, chpn, numb lips, burning @ needle site, sob, anx, hemolysis, hypotension

-causes: sterilants in system, improper priming, sterilant trapped, initiation not done after dump

- TX: clamp v-line asap, chk bp, no blood rtn,notify RN, code cart/o2, mach 4 tech's

- S/S: dizzy, HA, n/v, blank stare, sob, yawning, chg in level of consciousness

-causes: meds, eating during tx, cardia c/o, sepsis, excessive UFR, excessive blood loss

- TX: UFR off/down, t-berg, bp's, NSS 100-200, vs q5 min til stable, notify RN

- S/S: chpn, coughing, sob, air below air detector, noise in ears, sz's, cardiac

-causes: unarmed air detector, v-line not in clamp, empty meds/NSS bag, a- line disconnected, catheter disconnected from lines

- TX: clamp v-line asap,lt side t-burg, chk bp, no blood rtn, inform RN, code cart/o2, aspirate v-needle 2 remove air, mach 4 tech's, inform RN

- S/S: chpn, pn radiates arm/neck/jaw, bkpn, sob, heartburn, dizzy

-causes: excessive UFR, hypotension, anx, pericarditis, anemia, air embolism

- TX: UFR off, decr BFR 200, chk bp, no blood rtn, inform RN, code cart/o2, pn level/hx of chpn, inform RN

- S/S: tightness throat/chest, hives, itching, rash, flushed, swelling face/extremites, sob, bp's fluctuate

-causes: sensitivity to dialyzer/sterilant,gases, 1st use syndrom

- TX: clamp v-line asap, BFR off, chk bp, notify RN, code cart, o2, 911 prn, inform RN

- S/S: chills, fever, n/v, flu like symptoms, incr temp, bp chg

-causes: endotoxins, sterilant in dialyzer >30d, cannulated infected access, contaminated supplies, bicarb >24hrs, mach not disinfected

- TX: blood pump off, clamp v-line, chk vs, blood may b rtn if reaction not violent, meds tylenol/benadryl, blood cultures, mach 4 tech's, inform RN

- S/S: HA, edema, n/v, sz

-causes: fluid overload, bp meds removed during tx, incr na+ intake,

- TX: dialyze to remove fluid, meds, pt educ/diet/fluid intake, inform RN

- S/S: blank stare, convulsions of extremities, pt c/p floaties

-causes: extreme hypotension, cerebral hypoxia, electrolyte imbal, sz disorder, uremia, DES-dialysis disicolibrium syndrom, 1st tx syndrom

- TX: monitor bp, protect access, maintain airway, o2, cart, 911, inform RN

-s/s: pn/tightness in extremities, RLS, grabs leg, streching of legs

-Causes: fluid shifts, elec imbal, hypotension, pt below TW, poor circulation, Ph changes

-tx: NSS 100-200cc, hypertonic sol, na+ variation, streching/standing, DO NOT MASSAGE CRAMPS, vit E 400u 30min b4 tx, inform RN

-s/s: cranberry colored blood, burning @ v-site, abd/bck/chpn, feeling of warmth, hypotension, SOB, arrhythmias

-Causes: hypotonic sol, sterilant in system, k/o in lines, blood pump mal fx, chloramines in h2o, dialystate temp >41c, a-pressure >-250

-tx: clamp v-line ASAP, blood pump & UF off, vs, DNT RTN BLOOD, aspirate 10cc fr v-needle, o2, code cart, 911 prn, leave mach for tech, inform RN

-s/s: blood on floor, blood on pt, s/s hypotension, snoring, sz, cardiac arrest, low v-pressure,

-causes: disconnected needles/lines, access covered, wet transducer, clamped monitor line, hemosave not on

-tx: clamp lines ASAP, chk vs, t-berg if hypotension, o2, code cart, 911, inform RN

-s/s: chpn, fever, tachycardia, hypotension, heart sounds more distant

-causes: uremia, bacteria, TB, collagen disease, cancer, MI, trauma

-tx: notify RN, monitor vs, gentle dialy tx, decr or no heparin, 02, code cart, 911

-s/s: blood leak detector alarm, blood in a-dialysate hose, hypotension

-causes: defect of dialyzer, dropping dialyzer, too much (+ or -) pressure

-tx: chk a-dialysate hose w/hemastix, DNT RTN BLOOD, aspirate & flush needles, get new set up, tag dialyzer to tech

-s/s: unmutable alarm, all fx cease

-causes: power cord unplugged, circuit breaker mal fx, natural disaster

-tx: press power button on mach, remove v-line fr line clamp, open blood pump & extend handle, v-drip cham 85-95% full during craking, crank clockwise @ 6-10 rotation/min, cnt til power on or max 15min