If dehydration is caused from vomiting and diarrhea, wot do?
- provide fluid
- send stool for C&S, c-diff
- obtain serum electrolytes
- increase blood return
- trendelenburg
- O2
Internal bleed (GI bleed, brain trauma, over anti-coagulated), wot do?
- if black shit; occult blood
- obtain CBC
- fluid resuscitation
- O2
- obtain INR, pTT
- possible blood transfusion
External Blood, wot do?
- apply compression
- fluid resuscitation
- p&p for exsanguination; give fluid, identidy source, vitals, O2, stop dialysis.
- check MAR for over anti-coagulation
- obtain CBC, INR, pTT
- possible blood transfusion
Crackles on auscaltation, pre-dialysis weight 90kg (DW: 85 kg), wot do?
-check O2 sat and admin O2
Blood pressure 80/40 (baseline 110/80), 35 C, 125, 24, pre-dialysis, wot do?
- get rest vitals again
- look at cause
- any other symptoms of hypovolemia?
- hydrate
Drop in URR, wot do?
- assessment; assess for swelling, pain or infection
- review blood work; look at potassium levels which can indicate recirculation
- review BP for the last 6 dialysis; low BP can increase arterial pressure
- assess for any difficulties with cannulations; infiltration?
- missed treatments? cut time?
- look at transonic trend for decreased flow
Feeling unwell or dizzy, wot do?
- WLM
- trendelenburg position; maintain cerebral blood flow
- check BP
- administer NS bolus; 200 cc clamp arterial pt line
- administer oxygen
What prompts kidney to produce more erythropoietin?
a. hypoxia
b. hypokalemia
c. hyperkalemia
d. hypercalcemia
a. hypoxia
Erythropoetin exerts its affects in the:
a. kidney
b. bone marrow
c. spleen
d. liver
b. bone marrow
Elevated systolic BP and enmia contribute to this cardiac abnormality.
LVH
Metastatic calcification and fibrous bone cysts often result from excess production of what hormone?
PTH
DW is defined by all, except:
a. weight with normal BP
b. no edema
c. no increase jugular venous pressure
d. exercise intolerance
e. SOB
f. weight at end of HD at which pt is normotensive until next HD
d. exercise intolerance
DW is clinically assess by all, except:
a. subject global assessment
b. plasma blood volume monitoring
c. BP
d. jugular venous pressure
e. edema
f. chest and heart auscultation
a. subject global assessment
Assessment of chest sounds/respiration/heart auscultation can be indicative of volume overload all, except:
a. quality of breath sounds
b. inability to lie flat in the bet without SOB
c. aspiration pneumonia
d. inability to walk usual distance without SOB
e. new edema
c. aspiration pneumonia
Over last 3 HD, pt left above his DW, wot do? select all apply
a. assess physical signs and symptoms of fluid overload
b. ask nephrologist to reassess dry weight
c. review hemoscan
d. ask nephrologist to order sodium ramping
a. assess physical signs and symptoms of fluid overload
b. ask nephrologist to reassess dry weight
c. review hemoscan
e. review the BP trends on previous treatment records
Pt refuses to be weight, wot do?
a. record run sheet of how much fluids the MD has ordered to be removed
b. tell pt he looks fluid heavy and should be weighed
c. record on dialysis treatment record his reason for not being weighed
d. explain rationale for being weighed and record the patients reason for not being weighed
e. document pt is not ambulatory and cannot be weighed
d. explain rationale for being weighed and record the patients reason for not being weighed
Hypotension is a result of intravascular volume depletion. it occurs when:
a. UFR is faster than plasma refilling rate
b. UFR is faster than fluid removal rate
c. UFR is slower than plasma refilling rate
d. UFR is slower than fluid removal rate
a. UFR is faster than plasma refilling rate
