Bonent exam full solution pack 2023 with complete solution
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 tha...
Bonent exam full solution pack 2023 with complete
solution
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
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
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
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