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Cheat sheet

CDN Certified Dialysis Nurse Cheat Sheet

Practice QuestionsStudy Guide

Kidney Disease Concepts

27-29%of exam

CKD StagesElectrolytesAcid-BaseAnemiaBone Disease

Hemodialysis

51-53%of exam

HD PrinciplesVascular AccessHD ComplicationsWater TreatmentSymptom Picker

Peritoneal Dialysis

15-17%of exam

PD ModalitiesPD InfectionsCatheter CareCAPD vs APD

Transplant + Acute Therapies

4-5%of exam

ImmunosuppressantsRejectionCRRTTransplant Basics

Quick Facts

Exam
CDN
Credential
Dialysis Nurse
Items
150 MCQ
Time
3 hours
Pass
Score 95 (~70%)
Fee
$350 ($300 ANNA)
Valid
3 years
Body
NNCC via PSI

CKD GFR Stages

90 60 30 15 under 15

Stage 1: 90+Stage 2: 60-89Stage 3: 30-59Stage 4: 15-29Stage 5: under 15

CKD vs AKI

CKD

  • Months years
  • Irreversible loss
  • Staged GFR

AKI

  • Hours days
  • Often reversible
  • Rapid rise Cr

Chronic vs acute

CKD Stages

Stage 1
GFR 90+ damage
Stage 2
GFR 60-89 mild
Stage 3
GFR 30-59 moderate
Stage 4
GFR 15-29 severe
Stage 5
GFR under 15 ESRD
AKI
Sudden function loss
ESRD
Permanent kidney failure
Nephron
Functional kidney unit

CKD Electrolyte Triad

High K PO4 low Ca

K+: hyperkalemia riskPO4: binders neededCa: low with high PTH

Electrolytes

Hyperkalemia
High serum K+
Hypocalcemia
Low serum Ca++
Hyperphosphatemia
High serum PO4
Hyponatremia
Low serum Na+
Phosphate binder
Binds dietary PO4
Kayexalate
K+ exchange resin
Calcitriol
Active vitamin D
Fluid overload
Excess volume retention

Acid-Base

Met acidosis
Low HCO3 low pH
Resp alkalosis
Low CO2 high pH
Anion gap
Unmeasured anions
Bicarbonate
Primary buffer base
pH 7.35
Lower acidosis limit
pH 7.45
Upper alkalosis limit
Kussmaul
Deep rapid breathing
Uremic frost
Skin urea crystals

Anemia + Bone

EPO
Stimulates RBC production
ESA
Erythropoiesis-stimulating agent
Iron sucrose
IV iron replacement
Ferritin
Iron storage marker
Renal osteodystrophy
CKD bone disease
PTH
Parathyroid hormone
Cinacalcet
Lowers PTH Ca
Albumin
Nutrition marker

HD Hypotension

Fast UF dry weight vasodilate

Fast UF: volume shiftBelow dry weightVasodilator medsAutonomic neuropathy

AVF vs AVG

AVF

  • Native vein
  • Lower infection
  • Longer maturation

AVG

  • Synthetic tube
  • Faster use
  • Higher thrombosis

Native vs synthetic

Symptom Picker

  1. BP drop dizzy→Slow UF(Hypotension)
  2. Leg cramps→Saline bolus(Volume shift)
  3. Chest pain→Stop UF O2(Ischemia)
  4. Fever chills→Culture access(Infection)
  5. Headache nausea→Lower UF rate(Disequilibrium)
  6. Bleeding site→Reduce heparin(Anticoagulation)
  7. No thrill→Assess clot(Access failure)
  8. Air in line→Clamp clamp off(Embolism risk)

HD Principles

Diffusion
Solute gradient clearance
Ultrafiltration
Pressure water removal
Dialysate
Treatment bath fluid
Blood flow
300-500 mL/min
Dialysate flow
500-800 mL/min
Kt/V
Adequacy dose marker
URR
Urea reduction ratio
Recirculation
Blood short-circuit

HD vs PD

HD

  • In-center machine
  • Vascular access
  • Rapid UF

PD

  • Home peritoneum
  • Catheter access
  • Gentle daily

Machine vs peritoneum

Access Picker

  1. Long-term HD→AVF(Preferred)
  2. Veins poor→AVG(Synthetic)
  3. Urgent start→CVC(Temporary)
  4. Steal symptoms→Surgeon consult(Ischemia)
  5. New fistula→Wait maturation(6-8 weeks)
  6. Infection fever→Blood cultures(Bacteremia)
  7. High recirc→Reposition needles(Low clearance)
  8. Buttonhole site→Same track(Reduced pain)

Vascular Access

AVF
Gold standard access
AVG
Synthetic conduit access
CVC
Temporary central catheter
Steal syndrome
Distal ischemia
Maturation
Fistula vein enlargement
Thrill/bruit
Normal access sounds
Buttonhole
Constant-site cannulation
ROPE
Cannulation mapping

Diffusion vs UF

Diffusion

  • Solute clearance
  • Concentration gradient
  • Small molecules

UF

  • Water removal
  • Pressure gradient
  • Volume control

Solute vs water

HD Complications

Hypotension
Intradialytic BP drop
Muscle cramps
Fluid sodium issue
Air embolism
Venous air entry
Bleeding
Heparin anticoagulation risk
Chest pain
Ischemia or hypoxemia
Fever
Pyrogen or infection
Disequilibrium
Rapid solute shift
Clotting
Circuit access thrombosis

Water Treatment

RO
Reverse osmosis purification
Chloramine
Must be removed
Bacteria
Under 1 CFU/mL
Endotoxin
Under 0.25 EU/mL
Conductivity
Dialysate purity check
Hardness
Ca/Mg ion level
pH monitor
Dialysate acid-base
Loop system
Recirculating water design

Cloudy PD Effluent

Cloudy pain fever culture

Cloudy: peritonitis signPain: abdominalFever: systemicCulture: guide ABX

Peritonitis vs Exit-Site

Peritonitis

  • Cloudy effluent
  • Abdominal pain
  • Intraperitoneal

Exit-site

  • Local redness
  • Drainage only
  • Catheter surface

Inside vs outside

PD Modalities

CAPD
Manual bag exchanges
APD
Cycler overnight cycles
PD catheter
Tenckhoff peritoneal tube
Dwell time
Fluid in peritoneum
Exchange
Drain fill cycle
Icodextrin
Long-dwell osmotic agent
Ultrafiltration
PD fluid removal
Clearance
Creatinine urea removal

CAPD vs APD

CAPD

  • Manual exchanges
  • Daytime dwells
  • No machine

APD

  • Cycler machine
  • Night cycles
  • Dry day option

Manual vs cycler

PD Infections

Peritonitis
Cloudy dialysate pain
Exit-site
Redness drainage
Tunnel infection
Subcutaneous tract
Gram stain
Initial organism guide
Culture
Definitive antibiotic choice
Mupirocin
Exit-site prophylaxis
Aseptic technique
Hand mask drape
Catheter secure
Prevent trauma pull

Transplant + Acute

Tacrolimus
Calcineurin inhibitor
Mycophenolate
Antiproliferative agent
Prednisone
Corticosteroid suppressant
Rejection
Immune graft attack
CRRT
Slow continuous replacement
Hemofiltration
Convection clearance
Living donor
Preferred transplant source
Contraindications
Active infection cancer

Common Traps

AVF vs CVC

AVF long-term ≠ CVC temporary urgent

Diffusion vs UF

Diffusion clears solutes ≠ UF removes water

CKD vs AKI

CKD progressive ≠ AKI often reversible

Peritonitis vs exit

Peritonitis cloudy effluent ≠ Exit-site local only

Kt/V vs URR

Kt/V dose adequacy ≠ URR percent reduction

ESA vs iron

ESA stimulates RBCs ≠ Iron replaces stores

Last Minute

  1. 1.Weights: 28 / 52 / 16 / 4
  2. 2.HD = largest domain
  3. 3.AVF = preferred access
  4. 4.CVC = temporary only
  5. 5.HyperK = kayexalate insulin
  6. 6.Hypotension = slow UF saline
  7. 7.Cloudy PD = peritonitis culture
  8. 8.Kt/V = adequacy marker
  9. 9.RO water = chloramine out
  10. 10.Pass = score 95 (~70%)

CDN

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