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PCT Fresenius Exam | Correct
Answers | 2025 Version
What are the functions of a healthy kidney? - ✔✔REGULATE, SYNTHESIS, ENDOCRINE: Regulate fluid balance, blood volume, electrolytes, acid-base balance, synthesize calcitrol (active vitamin D), secrete erythropoietin and release renin what is the glomerular filtration rate in the five stages of kidney disease? - ✔✔flow rate of filtered fluid through the kidney stage 1 : 90 + stage 2 : 60 - 89 stage 3 : 30 - 59 stage 4 : 15 - 29 stage 5 : < 15 what are the types and stages of kidney failure? - ✔✔acute renal failure: sudden onset, severe, usually reversible. can be caused by drug toxicity, dehydration, or motor vehicle accident Chronic renal failure: slow onset, progressive, permanent. can be caused by diabetes, hypertension, or genetic disease such as glomerulonephritis or nephrosclerosis what are the signs and symptoms of renal failure or uremia? - ✔✔elevated serum levels of BUN/Creatinine, phosphorus, potassium. anemia, nerve damage, yellow-gray appearance of skin, fluid overload, dyspnea, edema, hypertension, proteinuria, uremia, lethargy, weakness, headache, itching, fatigue, nausea restlessness, mental change, loss of appetite. what is anemia and how is it treated? - ✔✔lack of RBC (decreased or lack of erythropoietin production). iron binds with hemoglobin in RBC and transports oxygen. it is treated using erythropoieting stimulating agents and usually administered IV.
which of the functions of healthy kidneys are replaced by dialysis? - ✔✔removal of waste products and regulation of fluid balance. dialysis does not regulate endocrine production list briefly and describe three modalities of treatment for end stage renal disease - ✔✔Hemodialysis: uses vascular access to draw blood from patient and send to dialyzer and into semipermeable membrane where diffusion removes waste products and ultrafiltration removes fluid. provides approximately 15 % of the normal function of the kidney. peritoneal dialysis: continuous cycling peritoneal dialysis and continuous ambulatory peritoneal dialysis. both types use permanent catheter in highly vascularized peritoneal cavity. dialysate is infused into peritoneal space and allowed to dwell and then drained. excess fluid and waste is removed through osmosis and diffusion what is the difference between hemodialysis and peritoneal dialyisis? - ✔✔Hemo: outpatient, dialyzer is used to remove waste from blood via diffusion and fluid is removed through ultra filtration. peritoneal: home setting, peritoneal membrane is the semipermeable membrane that filters waste and fluid removal occurs via osmotic pressure and concentration gradients caused by the dextrose solution and dwell times. when is it known that a patient has developed sensitivity to a dialyzer? - ✔✔seen within the first half hour of treatment. sneezing, itching, pain at access site, chest pain, rashing, hives, fever are symptoms. alarm conditions - ✔✔Blood: blood leak, air detector, venous/arterial pressure, TMP. stops the blood pump therefor blood is not cleaned and no ultrafiltration. potential for clotting due to stagnant blood Dialysate: conductivity high/low, temperature. dialysate goes into bypass so no cleaning of blood. uf continues. what are the body fluid compartments? - ✔✔ 50 - 70 % of body is water. intracellular, extracellular, intravascular, interstitial. what is diffusion - ✔✔movement of solutes across semipermeable membrane from high concentration to low concentration. solutes include urea, electrolytes, creatinine, drugs what is osmosis? - ✔✔movement of fluid from lower concentration of solutes to a higher concentration.
what is a semi-permeable membrane? - ✔✔A membrane made from protein, with small pores or holes. Only certain molecules can fit through RBC and proteins are too large to pass through the semi- permeable membrane pores. urea, sodium, potassium, and water can pass through. what is countercurrent flow? - ✔✔blood and dialysate flow in opposite directions. this allows for better clearance and diffusion what are three types of solutions? - ✔✔hypotonic=containing less particles isotonic=containing equal particles hypertonic=containing more particles what is ph? - ✔✔measure of hydrogen ion concentration. normal blood is 7. 35 - 7 .4 5. bicarbonate (HCO 3 ) is a buffer that helps maintain constant ph to solution even if acid or base is added. hco 3 production is decrasesed in people with renal failure, healthy kidneys maintain normal body ph by making and regulating hco3. what is conductivity - ✔✔ability of a solution to conduct electrical current.
- 5 = hypertonic dialysate and can cause crenation < 13. 5 = hypotonic dialysate and can cause hemolysis. what is dialysate? - ✔✔composed of purified water, acid solution, and bicarb solution (bicarb helps regulate metabolic acidosis). function is to remove waste products from blood and balance electrolytes what electrolytes are found in dialysate? - ✔✔Sodium (NA), potassium (K), calcium (Ca), magnesium (Mg), and chloride (Cl) 4 ways dialysate is checked to ensure safety - ✔✔ph, conductivity, machine temp, negative residual chlorine after machine disinfection and before first treatment after disinfection how is dialysis delivered? - ✔✔The Hemodialysis Machine. two sub sections: blood delivery system (circulates pt blood) and dialysate delivery system (mixes and circulates dialysate)
when are bloodlines replaced? - ✔✔when contaminated (dropped on floor or placed in prime bucket with open ends), clotted (line or drip chamber), or found defective what causes increased arterial and venous presssures? - ✔✔kinks, bfr exceeds vascular access flow, incorrect needle gauge size compared to bfr, needle placement, clotting stenosis, vasoconstriction of vasospasms, malposition of catheter tip, hypotension, poor cardiac output (increased blood viscosity due to high hgb or ultrafiltration) how do you test for a small blood leak? - ✔✔dipping test strip into dialysate obtained from outflow (arterial/red). test strip will change color if positive for blood. do not return blood if test is positive or if ther are visible signs of blood in dialysate. how is a large/major blood leak treated? - ✔✔dialysate will apear bloody or blood tinged. do not return blood. what are the two most commonly changed electrolytes in dialysate/ - ✔✔potassium and calcium- makes changes based on pt's current monthly lab results steps for treating an infiltrated access - ✔✔ 1. establish that infiltration has occurred
- sto pdialysis turn off blood pump, clamp bloodlines.
- notify rn
- disconnect bloodlines from fistula lines and recirculate blood. flush non-infiltrated needle with normal saline
- if infiltration occurred after heparin administration: cap end of needle and secure (to be removed at end of tx). apply ice
- if fistula is infiltrated, rest fistula for one treatment when ordered by nephrologist. next cannulation should be above infiltrate
- instruct pt to apply ice for 24 hours and watch for complications such as (pain, reoccurrance of bleeding, elevated temp, additional swelling, absence of a thrill)
when should conductivity and ph of dialysate be checked? - ✔✔prior to initiation of every tx, before hanson connectors are attached to dialyzer
disadvantage: high potential for air embolism, prone to infection and clotting, last option and sometimes only options for patients, lower bfr (increased tx time to improve adequacy), long term use can lead to major vessel stenosis, reversing lines will cause increased reciruclation and decreased adequacy 4 things to teach pt to prevent access from clotting - ✔✔ 1. avoid tight fitting clothing or jewelry on access arm
- avoid sleeping on access arm
- avoid lab draws or blood pressure checks in access arm
- avoid carrying heavy objects in access arm
- personal hygine and importance of keeping access clean to prevent infection what is emla cream - ✔✔Lidocaine 2 .5% and Prilocaine 2. 5 %. anesthetic cram used to numb area for cannulation. is applied at home at least an hour before tx Needle safety devices must: - ✔✔be engaged while removing needle from access what evaluation is performed on the vascular access pretreatment - ✔✔look- color, clean incisions, dry and intact, no sx of infection, prior cannulation sites healing listen= audible whoosh heard same throughout access. low pitched and louder on arterial side feel= feel for a thrill (vibration or buzz throughout length of access), pulse, and consistent temp when admitting anew pt what is performed before taking a blood pressure reading? - ✔✔both arms are xamined to evaluate for the prsence of a vascular access in what direction are fistula needles placed? - ✔✔venous always go with flow of blood, arterial can be in either direction what is needle flipping? - ✔✔prior to back eyes, needles were flipped to prevent needle from lodging against side of vessel. flipping has been found to damage intimal lining of vessel and is no longer recommended
from what compartment is fluid removed? - ✔✔fluid wastes and electrolytes are evenly distributed between intravascular, interstitial, and intercellular spaces. during dialysis, fluid is only removed from intravascular space. as wastes/electrolytes are pulled from intravascular space, these move from interstitial space into the intravascular space to promote homeostasis. if uf rate is higher than pt's ability to refill intravascular space, then pt becomes intravascularly dehydrated and will experience complications needle gauge size and corresponding bfr - ✔✔< 300 = 17 300 - 350 =1 6
350 - 450 = 15 450 = 14 access flow goals - ✔✔fistula: > 400 graft: > 600 what is adequacy of dialysis? - ✔✔Measurement of how well we are cleaning waste from the patients blood what can negatively impact adequacy? - ✔✔inadequate heparin, access recirculation, shortened tx time, air in dialyzer, improper priming, lower than ordered bfr, incorrect dialyzer size, lower than ordered dialysate flow rate how can we measure how well we clean our pt's blood - ✔✔blood urea nitrogen levels is measured to calculate the adequacy of a tx. by measuring the amount of wastes in the pt's blood before and after dialysis, the clearance can be calculated. what four items impact clearance (adequacy of tx) - ✔✔tx time, bfr, dfr, dialyzer size (surface area). dialyzer size has most impact on dialyzer clearance how is clearance best described? - ✔✔amount of urea cleared from blood in milliliters per minute. this is a measurement of dialyzer effectiveness
what is kecn and what range should it run - ✔✔clearance effective by conductivity of sodium. refers to clearance of sodium as measured by the conductivity changes during olc test. kecn should be less than bfr (impossible to remove wastes faster than the blood pump speed) and should be 200 - 300. what is the mean kecn - ✔✔average of all test performed during on line clearance and must be documented on the hemodialysis flow sheet and in computer system. how many kecn tests can be programmmed into olc? - ✔✔ 3 - 6 tests, if tx is 3 - 4 hours 6 tests should be programmed what does a steady decline in kecn test results signify? - ✔✔dialyzer clearance of waste from blood is decreasing, could be from inadequate heparinization, clotted dialyzer fibers. decrease in kecn can also be from obstructed arterial flow when is the machine temperature checked? - ✔✔when conductivity and temp are stable, document before tx is started what items are considered when administering medications to renal failure pts? - ✔✔kidneys are major route of excretion for drugs/ metabolites. caution must be used bc loss of renal function will decrease elimination of medications and could potentially cause toxicity, increased potency/duration of drug's effects, and increased frequency of side effects. can medications be pre-drawn? - ✔✔up to 4 hours prior to administration. must be labeled and kept under preparer's control or locked in designated medication storage area or refrigerated if necessary what if the patient doesn't come for treatment and the medications were pre drawn? - ✔✔could be relabeled and administered to another pt if it has not left the medication preparation area and the dose matches physician's order what lab is evaluated to determine adequacy of tx? - ✔✔blood urea nitrogen levels are evaluated to determine adequacy of tx
what is the procedure for drawing post tx lab work (post bun)? - ✔✔ 1. turn off UF (turn off dialysate flow and bfr is decreased to 100 for 15 seconds)
- stop blood pump
- clamp arterial and venous needle lines
- clean arterial port with alcohol wipe and collect sample
- invert sample 5 - 10 times
- turn dialysate flow on
- open clamps on needle lines
- return blood per termination procedure what complications require rn involvement and assessment? - ✔✔all findings outside normal and expected pt evaluation findings are reported to rn. rn is responsible for assessment, nursing intervention, and implementing emergency responses. what is bradycardia and whom is it reported? - ✔✔pulse less than 60 bpm. is concidered severe when 50 bpm or less. all episodes of bradycardia must be reported to rn why do some pts become hypoglycemic and what are the signs and symptoms? - ✔✔some glucose is removed during tx and pt may experience sx of hypoglycemia (faitness, double vision, irritability, hunger) what can lead to hemolysis? - ✔✔hypotonic solution, chlorine/chloramine breakthrough, high temp, kinks in bloodlines what steps are taken when hemolysis is suspected? - ✔✔ 1. notify rn, turn off blood pump and clam VENOUS line. do not return blood
- turn off ultrafiltration
- administer oxygen per physician orders
- recirculate pt blood, maintain sterility in event blood is not hemolyzed and can be returned to pt. flush needle lines or catheter lumens with 10 ml of saline. leave syringes in place and clamp needle lines/catheter lumens
- notify physician and provide vitals, sxs, time potential before hemolysis, estimated potential amount of hemolyzed blood, hbg/hct results. physician may order fluid replacement, transport to hospital
Parathyroid senses low bp (from no renin) so excretes PTH to signal calcium excretion from bone marrow what is estimated dry weight? - ✔✔weight of the pt if all excess fluid is removed and bp is normotensive. the leading cause of death in esrd pt is related to cardiac function and fluid. excess and removal plays a vital role in cardiac function what is the difference between available weight and target weight? - ✔✔aw is available fluid weight that needs to be removed from pt during today's tx. aw is calculated by substracting edw from pretreatment weight target weight is the weight loss plan including aw, priming/rinseback, and any fluid pt will receive during treatment to ensure pt safety and prevent hemolysis or crenation, the final dialysate is checked to verify that the dialysate is compatible with the human biochemistry. the following components are checked - ✔✔ph, conductivity, temp what are the details about checking ph and conductivity? - ✔✔when: prior to all tx initiated or anytime concentrates are changed. should be completed before the hanson connectors are attached to the dialyzer. why: to validate machine settings are correct expected result: ph range 6. 9 - 7 .6, conductivity range +- 0. what are the details about checking residual bleach post machine disinfection? - ✔✔when: prior to each shift of pt treatments why: to ensure no bleach remains in fluid pathway how: using residual test strips according to manufacturer's instructions for use what are the details about checking total chlorine routine testing? - ✔✔when: prior to each shift of pt treatments and not to exceed 4 hours where: post gac tank #
why: to ensure chlorine and chloramine levels are within aami standards how: sample collected after water system has run for 15 min. rpc test strip swished in sample for 60 seconds, strips conpared to color chart on container. results less than. 10 is safe for treatment, if higher, breakthrough testing initiated. what are the details about checking total chlorine breakthrough - ✔✔when: every 2 hours when total chlorine levels equal 0. 10 or higher post gac tank # 1 where: post gac # why: ensure total chlorine levels remain less than 0. 10 if result less than 0. 10 it is safe to continue, if 0. 10 or higher, immediately notify rn and sto treatments to avoid accidental pt exposure what are dialysis precautions? - ✔✔set of standard infection control practices that are used in all situations in the dialysis setting when caring for dialysis pts or performing related activities. dialysis precautions have been shown to reduce infectious disease transmission and are recommended by cdc when are dialysis precautions applicable? - ✔✔anytime there is the potential or actual exposure to blood, body fluids with visible blood, amniotic, cerebrospinal, pericardial, pleural, synovial, and peritoneal fluids, body tissues, feces, nasal secretions, sputum, sweat, tears, urine, vomit, vaginal secretion, semen. what approach is taken for dialysis precautions? - ✔✔assume all patients are infectious, and all blood, body fluids, tissues, needles, sharps, used dialyzers, supplies and equipment are contaminated. why dialysis precautions? - ✔✔dialysis patients are immunocompromised - > patients experiencing repeated invasive procedures - > dialysis is a high-risk area - > frequent exposure to blood or body fluids -
patients and staff in close proximity - > bleach solution strength 1 : 100 - ✔✔general disinfection when blood is not visible or blood spills less than 10 mls bleach solution strength 1 : 10 - ✔✔cleaning blood spills greater than 10 mls, then followed by cleaning with 1 : 00 solution
what blood test indicates infection with hep b? - ✔✔HbsAg test for Hep B antigen, indicates actual viral presence, infection with hep b, requires pt isolation and implementation of buffer zone what blood test indicates presence of immunit against hep b? - ✔✔anti-hbs and anti hbc required to reflect susceptibility/ immunity status. if greater than 10 mlU/mL, pt is immune. positive anti hbc coupled with anti hbs greater than or equal to 10 indicates person previously and hbv and immune system fought against virus and person is no longer infections (lifelong immunity). negative hbc with hbs 10 or hgiher reflect immunity gained through vaccination. these individuals must have titers checked annually to ensure levels remain immune. which vaccine provides long-term immunity to hep b? - ✔✔series of multiple injects from recombivax or engerix b. these vaccines stimulate immune system to produce hep b antibodies, helping to protect against getting hep b virus. what actions are necessary when a patient is suspected of having active tb? - ✔✔have patient don mask and call physician how is tb prevented in dialysis clinic? - ✔✔pt who have active pulmonary or laryngeal tb cannot dialyze in the clinic. pt must have 3 consecutive negative sputum cultures before returning to clinic for dialysis. ppd testing and chest x ray performed. active tb is airborne is considered contagious. tb that is contained does not have to be treated as active (tb of bone or organ) how is tuberculosis spread? - ✔✔tb is caused from tuberculosis bacteria, which is spread by droplet nuclei produced from infected individuals when they cough, sneeze, sing, or speak. positive tuberculin skin test or exposure to tuberculosis - ✔✔patients with active tb are contagious. latent tuberculosis is not contagious but can become active without tx tuberculosis signs and symptoms - ✔✔night sweats, productive persistent cough, unexplained weight loss, chills, fever, blood tinged sputum. what is documented if the pt is stable and resting - ✔✔pt status, changes in vs, security of connections, and no unusual findings were observed
Why is QAI so important? - ✔✔Improve pt outcomes is required by Federal regulations. Identify problems, create plans to correct, improve care, and to review results of our efforts. assess success of facility processes in meeting clinical and operational goals and objectives by reviewing cqs measurement tool. qai and cqs process drives empowerment to achieve: quality outcomes, regulatory compliance, day to day operations when is cardiac arrest suspected with a patient experiencing chest pain? - ✔✔chest pain, unrelieved by oxygen indicates cardiac arrest list some incidents that would require an adverse event report? - ✔✔abusive/violent behavior, acute and severe psychotic event, air embolus, blood loss > 100 ml, cardiac arrest, congestive heart failure/symptomatic fluid overload, inability to cannulate, contaminated needle stick by pt only, fall resulting in inury, incorrect dialyzer or dialysate used resulting in pt injury, medication errors or omissions what is a near miss? - ✔✔a potential hazard or incident that did not result in patient harm yet had the possibility of doing so why is water treated? - ✔✔patients are exposed to large amounts of water during dialysis, therefor the water must be treated to ensure it is free from harmful contaminates. chlorine and chloramines are added to city water to reduce/eliminated bacteria AAMI - ✔✔Association for the Advancement of Medical Instrumentation. develops voluntary standards for various aspects of dialysis treatment, including maximum levels of water contaminates water contaminants - ✔✔aluminum, chloramine, copper, zinc bacteria and endotoxins - ✔✔bacteria can cause sepsis, bacteria and viruses can cross dialyzer membrane. endotoxin is released from the cell wall of dead bacteria. characteristics include rapid growth and production of endotoxins or biofilm
RO product water exits the RO and meets AAMI standards for water to be used for dialysis - ✔✔performance measured by % rejection, membranes must be replaced at 80 % rejection. membrane must be replaced bc ability to remove dissolved solids is too low. TDS (total disolved solids) is measured and documented daily. water exceeding he TDS alarm limit is diverted to the drain ultrafilters - ✔✔remove bacteria and endotoxin and are located after the RO machine "final step" UV Light - ✔✔form of invisible radiation, kills bacteria Product water divert valvue - ✔✔sends water to drain when it exceeds the tms alarm limit deionization tanks - ✔✔method of water treatment used during RO failure and are part of the "alternate water supply plan" total chlorine testing - ✔✔ 1. RO machine runs 15 minutes before performing any total chlorine testing
- must be performed and documented by 2 qualified staff members (one pct and one nurse)
- 100 ml is the correct amount of water to collect (must rinse sample container 3 times)
- RPC ultra low total chlorine test strips are immersed in sample for 60 seconds
- total chlorine tested prior to initiation of tx and at least every 4 hours
- rpc ultra low chlorine test strips are used to test for total chlorine in water after carbon tank and post ro
- safe range is 0. 00 - 0. 09 ppm
- documentation in tms
- first total chlorine sample should be taken from post carbon tank (worker), second sample taken post RO total chlorine breakthrough procedure - ✔✔ 1. if occurs post carbon tank 1 , put machines in bypass and implement breakthrough action plan. test after carbon 2 (polisher)
- if total chlorine testing after polisher tank shows results above. 010 , immediately stop tx
- if total chlorine testing after polisher shows below action level, tx may be resumed with md approval and test every 2 hours.
- chlorine breakthrough requires notification of md, cm, director of operations, regional technical operations manager water hardness - ✔✔ 1. tested post water softner
- measured in parts per million (PPm)
- FKC acceptable limit is 20 ppm
- 2 tests done daily
- hardness strips test for presence of calcium and magnesium ph and conductivity - ✔✔ 1. meters must be verified and calibrated prior to use residual bleach - ✔✔test for residual bleach after disinfection procedures have been completed and before first tx after disinfection bacteria and endotoxin testing parameters - ✔✔ 1. routine testing monthly
- CFU (colony forming unit)
- FKC action level for bacteria i nproduct water exiting RO is 20 cfu/jl
- FKC action level for bacteria for water in tank, piping, and distribution loop is 20 cfu/ml
- fkc action level for endotoxin in product water exiting ro is 0. 125 EU/ml
- FKC action level for endotoxin for water in tank, piping, and distribution loop is .25 EU water room requirements - ✔✔ 1. water pathway begins where city water enters facility
- Ro holding tank low alarm level must be on at all tims
- 77 degrees F is recommended water temp for idea RO operation (warmer water may damage RO membrane)
- piping witin water treatment distribuionloop can be made of PVC, stainless steel, PEX, teflon
