What should EVERY nurse know about Dialysis - page 3

I am a dialysis nurse turned home care nurse...live in a rural area that recently has had a dialysis center open (I work there PRN). With this opening the local home care agency has seen an influx... Read More

  1. Visit  julzrncrn} profile page
    0
    Quote from sissib
    How important pt compliance is with diet, fluid restriction, and taking their meds as directed.
    - before advising the pt. to have eat all you can scenario maybe you should assess the pt. first if he can manage,because the pt. may experience hypotension while the Hd is ongoing.Maybe small frequent feeding may do to avoid that,..Fluid restriction is very impt., for ESRD pts. 500ml/day is advisable to prevent fluid excess.More than that may cause edema,ascitis,dyspnea, chest pain etc.
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  3. Visit  Tish88} profile page
    2
    Quote from julzrncrn
    - before advising the pt. to have eat all you can scenario maybe you should assess the pt. first if he can manage,because the pt. may experience hypotension while the Hd is ongoing.Maybe small frequent feeding may do to avoid that,..Fluid restriction is very impt., for ESRD pts. 500ml/day is advisable to prevent fluid excess.More than that may cause edema,ascitis,dyspnea, chest pain etc.
    Did you mean to write 500ml/day plus their volume output?
    I have been doing dialysis for over 20 years and never had a pt on a 500ml/day fluid restriction. They are generally on 1000 - 1500ml/per day.
    500ml of fluid is lost each day in their bodies through their lungs and skin alone

    The other thing to think about is infection control in a clinic is another reason for not eating....I do not allow any eating in the unit - I had to get my medical director to sign off on this policy and it was posted all over so the patients could see it
    dkadanny and tickledpink like this.
  4. Visit  Chisca} profile page
    3
    The most dangerous day for a dialysis patient is Mondays. More dialysis patients code on Monday than any other day of the week. 2 days is a long time to go without dialysis. The most dangerous time for a dialysis patient is the first two hours after a treatment, after they have returned to the floor or left the clinic. Large changes in electrolytes are occuring between the blood and tissue as these chemicals equilibrate after the dialysis treatment is completed.
    delphine22, thetalker, and hemanth like this.
  5. Visit  SuperStarRN} profile page
    1
    Pt.'s should also not eat on the machine for infection control issues. Blood+Food+Sharing food with neighbor=NASTY!
    traumaRUs likes this.
  6. Visit  just keep swimming} profile page
    1
    Quote from traumaRUs
    This is not sound medical practice. Pts should adhere to a low K+ diet because if there are unforeseen events and they miss dialysis, they can and do die of hyperkalemia.

    I know of no nephrologist or mid-level worth their salt who would advocate a 1k bath just because a pt wants to consume high-K+ food.

    You are just asking for a lawsuit.
    Yikes! What if they decided not to eat that extra bannana? Can anyone say code????
    dkadanny likes this.
  7. Visit  just keep swimming} profile page
    6
    1. Check that access every day! If it is clotted, the chances of saving the access are much better when caught early. They need to check for bruit and thrill each day
    2. Reinforce fluid and dietary restrictions. The more we tell them, the more hope there is of them understanding. Sometimes its better to hear it from someone other than the nagging dialysis nurse! lol
    3. Encourage them to come to all treatments. I can't tell you how many times a nurse has called from a nursing home or a HHN has called to tell me the patient just doesn't feel like coming. Yes it is their choice, but educate and encourage! It's not okay to skip because you don't feel well, you probably don't feel well because you need dialysis!
    4. Take medications as prescribed and at the time prescribed. Some medications need to be taken after HD so that they do not dialyze off. Some meds work better when taken at different times of the day, like sensipar.
    5. Incidence of stroke and heart attacks increase greatly in the hour or two post dialysis. Monitor patients closely.
    6. Education or reeducation on symptoms of different electrolyte imbalances
    7. If your patient is going to a dental appointment, they need abx before hand. If you don't have an order, call me and I will call it in for them.
    8. Do not get CVC's wet, and if you do, don't leave that wet dressing sitting on there. I know you aren't supposed to touch it, but really, where does bacteria thrive? Under a clean, dry dressing? I think not!
    9. Same goes for the dressings on AVF and AVG. If it's wet, take it off.
    10. Do not leave those dressings on until the next treatment, you are risking clotting off their lifeline!
    11. If an access starts bleeding, don't panic. Apply pressure and wait. If bleeding does not stop they may need a stitch
    12. NEVER be afraid to call the unit and ask about something! It makes our job easier if you call with questions instead of letting something go or doing what you would do for anyone else.
    Hope this helps!
    dkadanny, tickledpink, nurse671, and 3 others like this.
  8. Visit  RNtobeinSoCal} profile page
    0
    Many dialysis patients have psych/emotional issues. So you have a schizophrenic in a chair for 3-4 hours. Or someone who winds up crying towards the end of every treatment, three times a week. The nurse to patient ratio is 1:9, 1:10, or worse, depending on your state's laws. If you're used to an ER or LTC, this will be easy for you. If not, it is A LOT to handle at once.
  9. Visit  Vegan_RN} profile page
    5
    I would tell the would-be dialysis nurse that you have to have thick skin. Especially in a chronic unit, you'll feel like a hampster in a wheel....running as fast as you can, but never reallly getting anywhere. There will be days you will drive home sobbing from frustration with techs, patients, your administrator. There will also be days you know you've made a difference in someone's life, especially when they get transplanted and come back to thank you personally for everything you've ever done for them and that they'll never forget you.

    I'd also tell them it's the most rewarding job I've ever had, and I'll be in dialysis until I retire (though I may explore different modalities at some point).
    Anna S, RN, shamrick24, thetalker, and 2 others like this.
  10. Visit  alamia09} profile page
    0
    Quote from Vegan_RN
    I would tell the would-be dialysis nurse that you have to have thick skin. Especially in a chronic unit, you'll feel like a hampster in a wheel....running as fast as you can, but never reallly getting anywhere. There will be days you will drive home sobbing from frustration with techs, patients, your administrator. There will also be days you know you've made a difference in someone's life, especially when they get transplanted and come back to thank you personally for everything you've ever done for them and that they'll never forget you.

    I'd also tell them it's the most rewarding job I've ever had, and I'll be in dialysis until I retire (though I may explore different modalities at some point).
    Do u know where i can train to be a dialysis tech
  11. Visit  Vegan_RN} profile page
    0
    Quote from alamia09
    Do u know where i can train to be a dialysis tech
    Check your PM box
  12. Visit  Concrete Girl,RN} profile page
    1
    No!! It still needs monitoring, as well as fluid. Also pt's should only have light snacks during tx. Having a meal frequently causes bp issues, as well as other issues while being dialyzed.
    keepmovingrn likes this.
  13. Visit  katherine100} profile page
    0
    Patients eat all the time at my clinic. Who refuses to dialyze because they are eating? Patients do as they please.
  14. Visit  calliou} profile page
    0
    I just had a patient a couple of days ago that was doing fine during treatment... so I excused myself to go to the bathroom right after obtaining vitals. When I came out and back to the floor, another nurse had turned off the patients UF and given her a 300ml saline bolus because the patients BP dropped... yes, that fast!
    All because the patient was eating... you can never tell what is going to happen in a case like that, so it is preferred that they do not eat while on the machines... and since this is the first time happening to me, I must agree..... scared the bejebsus outta me!


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