Certified Nephrology Nurse Flashcards

Melissa Cheng, a 62-year-old woman receiving hemodialysis, complains of constant scratching. Question: If replacing Ms Walker's dialyzers and modifying her Kt/V do not relieve her itching, the most recommended step is:

Answer: Moisturizers/oil bath

Uremic pruritus, or itching, is a common and distressing symptom in hemodialysis patients. After optimizing dialysis adequacy (Kt/V) and ruling out other causes, the initial and most conservative approach to managing itching is often topical treatment. Moisturizers and oil baths help to hydrate the skin, reduce dryness, and alleviate irritation, which can significantly reduce the severity of pruritus.

Diana Walsh, a 62-year-old woman receiving hemodialysis, complains of constant scratching. Question: When the patient's Kt/V is 1.1, and Ms. Walker's itchiness doesn't go away, the first dialysis adjustment should be to

Answer: Increase Kt/V to >1.2

Kt/V is a crucial measure of dialysis adequacy, indicating the effectiveness of toxin removal. If a patient experiences persistent itching (uremic pruritus) with a Kt/V of 1.1, it suggests that the current dialysis dose might be insufficient to adequately clear uremic toxins. The recommended first adjustment is to increase the dialysis dose, aiming for a higher Kt/V, typically greater than 1.2, to improve solute clearance and potentially alleviate symptoms.

The use of an amino-based dialysate solution is primarily for

Answer: Nutritional supplementation

Amino acid-based dialysate solutions are primarily used in peritoneal dialysis for nutritional supplementation. Patients undergoing peritoneal dialysis can experience significant protein loss into the dialysate, leading to malnutrition. By including amino acids in the dialysate, these essential building blocks can be absorbed by the patient, helping to maintain or improve their nutritional status.

Dialysate glucose must be heat sterilized at a low pH to

Answer: Decrease generation of glucose degradation products

Dialysate glucose must be heat sterilized at a low pH to minimize the formation of glucose degradation products (GDPs). High temperatures combined with a neutral or alkaline pH during sterilization can cause glucose to break down into harmful GDPs. These GDPs are associated with inflammation and damage to the peritoneal membrane in peritoneal dialysis patients, so maintaining a low pH helps preserve the integrity of the dialysate.

What does the peritoneal equilibration test measure?

Answer: Calculate the volume of urea and creatinine filtered into the dialysate during a 4-hour dwell and the importance of glucose absorbed from the dialysate

The Peritoneal Equilibration Test (PET) is a diagnostic tool used in peritoneal dialysis to assess the transport characteristics of the patient's peritoneal membrane. It measures the rate at which solutes, such as urea and creatinine, move from the blood into the dialysate, and the rate at which glucose is absorbed from the dialysate into the blood, typically over a 4-hour dwell. This information helps tailor the optimal dialysis prescription for the patient.

Which of the following represents collegial communication when thinking about interdisciplinary communication?

Answer: The nurse reports on the patient’s condition in a team meeting

Collegial communication in an interdisciplinary healthcare setting involves professional, respectful, and collaborative information exchange among team members. A nurse reporting on a patient's condition in a team meeting is a prime example, as it facilitates shared understanding, coordinated care planning, and informed decision-making among various healthcare professionals to ensure comprehensive patient care.

The gradient of a substance's concentration, such as urea, during peritoneal dialysis

Answer: Decreases

During peritoneal dialysis, the dialysate solution is introduced into the peritoneal cavity, creating a concentration gradient for waste products like urea. Initially, urea concentration is high in the blood and low in the dialysate. As dialysis progresses, urea moves from the blood into the dialysate, causing its concentration in the blood to decrease and its concentration in the dialysate to increase, thus reducing the overall concentration gradient over time until equilibrium is approached.