As the holidays approach, remember the dialysis patients!

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    Often over the holiday time dialysis patients are admitted to the hospital, this can be due to fluid overload or problems connected to over eating. In my experience healthcare staff see dialysis patients as difficult, so my article is a brief look at how things can be hard for these patients during times of celebrations.

    One of the benefits of working in Dialysis is that you get Thanksgiving, Christmas Day and New Years day off! Which is a wonderful thing for staff and patients alike. It means they can have normality for the holidays, spend it with their family, enjoy good food and relax.

    Even if staff work the day before, normally it is reduced hours and can be a lot of fun. Patients tend to be looking forward to the holidays and talk about what they are going to do, who they are going to see and what they are going to eat!

    Obviously this is a problem for patients on dialysis and they are inundated with information of what to eat and what they shouldn't eat over thanksgiving. How much to drink is a normal rule they have to follow, but as you can imagine people tend to get together and drinking is part of the ritual of holidays.

    Part of our culture is to offer people food and drink, the majority of us get pleasure from feeding people good food, we also enjoy offering a wide variety of drinks, we often suggest if a renal patients wants to consume alcohol then they should stick to shots which are lower fluid consumption compared to beer, larger and cocktails.

    The normal person does not always comprehend how much the renal patients diet is restricted, and even though they can let their hair down at Thanksgiving, they still need to observe their diet.

    In the dialysis unit, we know our patients and we know who will break the rules.

    Our patients are difficult because they have lost control of their life. They do not always comprehend that doing 12 hours a week of dialysis is keeping them alive. They do not comprehend that they need to follow a very strict diet. This is why when you advise some patients to use caution it is like a red rag to a bull!

    I know this does not apply to all patients 360 days a year, but there is something about Thanksgiving and Christmas that brings out the wants and desires for food in all our patients.

    Majority of patients will break the rules a little during the holiday, there are always the problem patients who have no STOP button so will take it to the excess. These are the patients you will often see in on your floor in the hospital

    These patients will have probably missed dialysis because they are starting their holiday earlier or attended treatment but cut it by 30 mins or more.

    I once knew a patient that went on vacation, didn't inform the dialysis staff and ended up in the ER because he thought he didn't have to do dialysis if he was at the beach!

    Over the holidays, renal patient visits to the emergency room increase by a substantial amount. The holidays include July 4th, Thanksgiving, Christmas and New year. In the dialysis units, we focus on education, how to prevent problems, decreasing the risk of complications from food which is not allowed, and how to manage fluid intake.

    It is hard for renal patients in their normal everyday life to resist foods and to not drink to excess, so you can only imagine how hard it is for them during any kind of national holiday.

    So when these patients are admitted to your floor, remember they are only human and they just wanted to enjoy themselves like everybody else.
    Have a little patience and send them back to us as soon as you can.

    Happy Thanksgiving everybody!
    Last edit by Joe V on Nov 27, '13
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  2. Visit  madwife2002 profile page

    About madwife2002 , BSN, RN

    madwife2002 has '24' year(s) of experience and specializes in 'RN, RM, BSN'. From 'Ohio'; Joined Jan '05; Posts: 9,762; Likes: 5,373.

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    13 Comments so far...

  3. Visit  traumaRUs profile page
    2
    Our call staff hate thanksgiving because it is sooo busy with admission...
    Guttercat and madwife2002 like this.
  4. Visit  westieluv profile page
    2
    Madwife2002, you must work in a chronic unit. I work in acute inpatient dialysis, and am absolutely THRILLED that this coming weekend is not my weekend to work and be on call! Unfortunately, those chronic patients who throw caution to the wind on Thursday often become inpatients by Saturday, and the acute dialysis nurses really have their hands full all weekend long.
    Guttercat and madwife2002 like this.
  5. Visit  prnqday profile page
    1
    Thank you for this article. I'll never forget the daily struggles our dialysis patients have to go through.
    madwife2002 likes this.
  6. Visit  not.done.yet profile page
    1
    Good reminder. I work a step down unit combined with the renal floor. I am working Saturday and will think of you as I take care of all my new admits!
    madwife2002 likes this.
  7. Visit  Liddle Noodnik profile page
    0
    Thank you! I would not have thought of it in that context!
  8. Visit  Guttercat profile page
    1
    Cherry picking season is kind of "holiday" around these parts. Everyone looks forward to the first day of harvest.

    I had a patient that couldn't (wouldn't) resist. He'd buy a bag of cherries, eat it, look at his watch and say, "Well, guess I'd better go to the ER now." I told him if he must, to please just eat the bag of cherries before his regularly scheduled treatment so we wouldn't get called out at 10 PM.

    But, he preferred going to the hospital. Comfy bed, a TV, a blanket and on-demand room service. I think it was like his annual vacation spot.
    OCNRN63 likes this.
  9. Visit  Guttercat profile page
    1
    Quote from westieluv
    Madwife2002, you must work in a chronic unit. I work in acute inpatient dialysis, and am absolutely THRILLED that this coming weekend is not my weekend to work and be on call! Unfortunately, those chronic patients who throw caution to the wind on Thursday often become inpatients by Saturday, and the acute dialysis nurses really have their hands full all weekend long.
    Uh huh. As an acute nurse it can make us a little cranky.
    madwife2002 likes this.
  10. Visit  Chisca profile page
    3
    Bill Peckham talks about this on his blog From the Sharp End of the Needle. 3 x a week dialysis is the bare minimum for life, it leaves you with a GFR of about 15. If 4 times a week became the norm that would allow the occasional skipping of treatments without harm. More design margin would cost more money but how much do all these "emergency" treatments cost? If we could stop being slaves to Kt/v as the measurement of dialysis adequacy and instead did what was best for patients perhaps we could change this dysfunctional system we have.
    Marisette, traumaRUs, and madwife2002 like this.
  11. Visit  ArtClassRN profile page
    0
    Quote from Chisca
    Bill Peckham talks about this on his blog From the Sharp End of the Needle. 3 x a week dialysis is the bare minimum for life, it leaves you with a GFR of about 15. If 4 times a week became the norm that would allow the occasional skipping of treatments without harm. More design margin would cost more money but how much do all these "emergency" treatments cost? If we could stop being slaves to Kt/v as the measurement of dialysis adequacy and instead did what was best for patients perhaps we could change this dysfunctional system we have.
    I work with many renal patients and I have never had any patient undergo "emergency" treatment who was compliant with his/her dialysis schedule and med regimen. Noncompliant ones? Yeah - all the time. I highly doubt increasing to 4x a week would increase quality of life or compliance or decrease emergent treatment.

    Given the disturbing amount of noncompliance with a 3x week regimen, can you imagine how bad it would be with 4x a week? Changing to enable "skipping" doesn't make any sense at all. Further, who wants to go to dialysis four times a week??

    I feel for dialysis patients, especially the ones tolerating it poorly. Unless I was on a reasonable track for a transplant, no way in heck I would do any type of dialysis. Turn out the lights, the party would be over.
    Last edit by ArtClassRN on Nov 30, '13
  12. Visit  i♥words profile page
    1
    Oh, this makes me think so much of a beloved family member who has been faithfully attending dialysis appointments three times a week for the past several months. I think he tries to forget his life depends on it, but I know it's never too far from his mind as he gets up before dawn to drive to the clinic. It really is a daily struggle for him, and if he even lets a little bit of hopelessness in he often talks about stopping treatment altogether. Thank you so much to the nurses who are there with him to give instruction and help, because I know you are giving hope as well.
    madwife2002 likes this.
  13. Visit  westieluv profile page
    3
    Quote from ArtClassRN
    I work with many renal patients and I have never had any patient undergo "emergency" treatment who was compliant with his/her dialysis schedule and med regimen. Noncompliant ones? Yeah - all the time. I highly doubt increasing to 4x a week would increase quality of life or compliance or decrease emergent treatment.

    Given the disturbing amount of noncompliance with a 3x week regimen, can you imagine how bad it would be with 4x a week? Changing to enable "skipping" doesn't make any sense at all. Further, who wants to go to dialysis four times a week??
    I have to agree with you on this. If someone can't be bothered to be at HD three times a week, what would make them be willing to show up four times a week?

    I agree that it would be a drag to have to be at dialysis at a set time, three times a week, every week, for the rest of my life. However, and this is what I tell noncompliant patients that I, as an acutes dialysis nurse, see far too frequently in the hospital...AGAIN, because they continue to skip their treatments. Since most of them are not employed in the traditional sense and are on disability (and I never say this in a condescending way or remotely imply that they should be working at a regular job), they must consider their dialysis treatments to be their "job" and take it just as seriously as if they were calling in sick to their employer every time they skip a treatment. Their reward, or "pay", is remaining as healthy as possible and getting to stay out of the hospital. Some of them groan and don't like this analogy, until I remind them that 3-4 hours, three times a week, really doesn't amount to all that much time out of their week, and the rest of the time is theirs to enjoy.

    Is this approach effective? Maybe, I'm not sure, but until I can come up with something better, that is what I tell them.
    ArtClassRN, i♥words, and madwife2002 like this.
  14. Visit  just keep swimming profile page
    1
    Thanks for the article Madwife. Good points....but I want to know what world you live in that gives staff holidays off? Lol, the only one we get is Christmas day and we have to open on Sunday to cover that. I have worked the last 6 Thanksgivings in a row!
    madwife2002 likes this.


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