Mixed Deck — All CCHT Topics Flashcards

Which assessment finding during dialysis should prompt the technician to notify the nurse immediately?

Answer: Patient reports chest pain and shortness of breath

Chest pain and shortness of breath during dialysis may indicate air embolism, cardiac event, hemolysis, or pulmonary edema, all emergencies requiring immediate nursing assessment.

What assessment finding during hemodialysis most strongly suggests that a patient's AVG has developed significant stenosis at the venous anastomosis?

Answer: Progressively increasing venous pressures over multiple treatments with reduced blood flow rates

Rising venous pressures over time indicate increasing outflow resistance, most commonly from stenosis at or near the venous anastomosis of an AVG.

Three hours into a hemodialysis session, a patient develops painful bilateral leg cramps. Their blood pressure has decreased from 138/82 mmHg at treatment start to 108/66 mmHg. What should the technician do first?

Answer: Decrease the ultrafiltration rate and notify the nurse

Muscle cramps accompanied by a significant blood pressure drop indicate the ultrafiltration rate is exceeding the patient's plasma refill capacity. Reducing the UF rate is the immediate first response, followed by notifying the nurse, who may also order a saline bolus.

The most common treatment for patients with end-stage kidney disease in the United States is _____________.

Answer: daytime in-center hemodialysis

Despite the availability of various modalities, daytime in-center hemodialysis remains the most prevalent treatment option for patients with end-stage kidney disease in the United States. This is often due to factors like patient preference, medical suitability, social support, and insurance coverage. It provides structured care in a supervised clinical environment.

In chronic kidney disease, what is the typical relationship between serum calcium and serum phosphorus levels before treatment?

Answer: Calcium is low, and phosphorus is high.

Failing kidneys are unable to excrete phosphorus effectively, leading to high serum phosphorus (hyperphosphatemia). The high phosphorus levels and lack of activated Vitamin D lead to low serum calcium (hypocalcemia).

During hemodialysis, a patient develops sudden severe chest pain, dyspnea, and becomes cyanotic. The blood in the venous line appears pink/clear instead of dark red. What emergency is occurring?

Answer: Hemolysis (red cell destruction from mechanical or chemical causes)

Pink/clear blood (hemolyzed blood) indicates massive hemolysis, a life-threatening dialysis emergency where red blood cells are being destroyed.

What is the appropriate intervention if a patient reports severe back and chest pain coinciding with a pink-tinged dialysate in the waste line?

Answer: Stop treatment immediately, do not return blood, clamp all lines, and call for emergency assistance

Pink dialysate with pain indicates membrane rupture with potential blood leakage into dialysate or severe hemolysis, an emergency requiring immediate treatment termination.

During assessment, a patient's blood pressure is 185/110 mmHg pre-dialysis. What information is most important to collect before proceeding?

Answer: Current medications taken that day, compliance with antihypertensives, and comparison to baseline BP

Determining medication compliance and baseline BP patterns helps identify whether this represents a hypertensive emergency, volume-related hypertension, or medication non-compliance requiring specific intervention.

During routine water testing, the technician notes that the chloramine level after the first carbon tank is 0.2mg/L. Which of these actions should the technician take next?

Answer: Obtain a sample after the second

Carbon tanks are used in series to remove chlorine and chloramine from the water. If the chloramine level is detected after the first carbon tank, it indicates that the first tank is becoming saturated or is not fully effective. The next step is to check the water after the second carbon tank to ensure that the chloramines are completely removed before the water reaches the patient, as the second tank acts as a safeguard.

What does access recirculation mean in the context of patient assessment, and how does it affect treatment quality?

Answer: Dialyzed blood from the venous needle being immediately re-drawn through the arterial needle, reducing efficiency

Access recirculation occurs when cleaned blood from the venous needle re-enters the arterial needle, diluting uremic blood and reducing dialysis efficiency.

A patient on hemodialysis is prescribed a phosphate binder. When is the most effective time for the patient to take this medication?

Answer: With meals

Phosphate binders work by binding to phosphorus in food while it is in the gastrointestinal tract, preventing its absorption into the bloodstream. Taking them with meals ensures they are present when the dietary phosphorus is ingested, maximizing their effectiveness.

How should a CCHT respond to a patient who repeatedly refuses to follow their prescribed dietary restrictions and is consistently arriving with high fluid gains?

Answer: Provide supportive education, involve a social worker and dietitian, and document all interventions without threatening the patient

Non-compliance requires a compassionate, multidisciplinary approach addressing barriers to adherence rather than punitive measures, while documenting all interventions.

What does the albumin level in a dialysis patient primarily reflect?

Answer: Nutritional status and inflammation

Serum albumin primarily reflects nutritional status and the presence of inflammation (acute phase response). In dialysis patients, low albumin (<3.5 g/dL) is strongly associated with increased mortality and reflects either protein-calorie malnutrition, systemic inflammation, or both.

During hemodialysis, the blood pump suddenly stops and the venous pressure alarm activates. What is the most likely cause?

Answer: Clotting in the venous needle or access

A sudden increase in venous pressure with blood pump stoppage typically indicates a clot or obstruction in the venous return pathway.

A hemodialysis patient reports eating the following foods since their last treatment: a banana, tomato soup, a glass of orange juice, and potato chips. Which electrolyte imbalance is most concerning?

Answer: Hyperkalemia from multiple high-potassium foods consumed simultaneously

Bananas, tomatoes, orange juice, and potatoes (in potato chips) are all high-potassium foods. Consuming multiple high-potassium items between treatments significantly increases the risk of dangerous hyperkalemia in an anuric dialysis patient.

Which iron preparation is commonly administered intravenously during hemodialysis sessions to treat iron deficiency anemia?

Answer: Iron sucrose

Iron sucrose is a commonly used IV iron formulation that can be administered during hemodialysis to replenish iron stores.

How many consecutive cannulations are typically necessary to form a buttonhole tract before it is sufficiently formed?

Answer: 8 to 10.

Usually 8 to 10 consecutive cannulations are needed to establish a buttonhole tract before it is complete. It is crucial that the same individual do the cannulations throughout this development phase because doing so increases the likelihood that the same angle will be applied each time. Grafts cannot be operated on using the buttonhole technique because they lack the muscle fibers that constrict around the tract once the needle is removed.

If a patient comes for hemodialysis treatment but weighs less than the target dry weight before treatment, the technician should ______________.

Answer: notify the nurse and dietician

If a patient weighs less than their target dry weight before treatment, it indicates potential dehydration or significant fluid loss, which could lead to complications like hypotension during dialysis. The technician must notify the nurse, who can assess the patient's clinical status and determine if adjustments to the treatment plan are needed. The dietician may also be involved to assess nutritional intake and fluid management, ensuring patient safety and appropriate care.

What is the purpose of administering normal saline (0.9% NaCl) boluses during a hemodialysis session?

Answer: Treat intradialytic hypotension

Normal saline boluses are given during dialysis to treat intradialytic hypotension by rapidly expanding intravascular volume.

A patient who has an AV graft for vascular access arrives for dialysis and the graft feels very firm, rope-like, and pulsatile throughout with no audible bruit. What does this finding suggest?

Answer: The graft is likely thrombosed (clotted), and treatment should be delayed while the access is evaluated

A thrombosed AV graft typically feels firm and pulsatile (transmitted cardiac pulsation without actual flow) without the continuous thrill or bruit of a patent graft. Absence of bruit and thrill strongly suggests thrombosis. The technician should not cannulate the graft and must notify the nurse immediately.