Admit I dread"generalized weekness a/o Dialysis pt, had dialysis today, Full code:"

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Specializes in Agency, ortho, tele, med surg, icu, er.

Ya you know it. Your day is doing ok, you have your patients settled, and everything is going great. Hell you might even say "its such a good night tonight" tempting the gods of nursing.

my god I spelt Weakness wrong typing to fast.

Then you get that admission call.

Mike you are up for admission... No big deal, my shift is going smooth.

Then you find out its an alert oriented dialysis patient who was dialized today.. patient felt week after dialysis and is now unable to ambulate, or they have a fever, or they suddenly had blood pressure drop... then the kicker... Full code.

Man these are the only patients that get me cringeing. You know there is a very good chance that the rest of your shift is about to suck.

Anyone else have a particular admit diagnosis that scares them?

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Specializes in CCU,ICU,ER retired.

Acute profuse rectal hemmorragh, or ruptured esphogeal varices The minute I hear that I know I doomed for the rest of the shift and probably well into the next shift

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Specializes in Agency, ortho, tele, med surg, icu, er.

Ha! you win didnt think of that. just had 4 of these patients in the past week. makes me wonder what is happening in that dialysis facility.

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"makes me wonder what is happening in that dialysis facility. "

I'll bite.

"patient felt week after dialysis and is now unable to ambulate, or they have a fever, or they suddenly had blood pressure drop... then the kicker... Full code."

1) Pt felt weak after dialysis. Pt came into dialysis with 3 kg of fluid on. Fluid was removed. Heart was unable to compensate for decrease in blood volume, fluid shifted slowly from interstitial and intracellular space to vascular system... you'd feel weak too. And pt's CO is probably 30%...

2) Fever. Pt was uremic prior to dialysis, maybe only slightly, which inhibited the inflammatory response of the immune system. Blood was cleaned, fever subsequently spiked. Sick renal pts often don't spike temps until after dialysis.

3) Blood pressure drop. Duh. See #1. Dialysis pts love to go hypotensive. You try pumping 5 extra kilos of fluid, then have it removed (out of necessity) and see how you do.

4) Full code. You mean that's their code status? Or the pt is arresting? Probably potassium here. You know kidneys excrete extra potassium and dialysis pt's kidneys aren't functioning... and surely you also know that what is even more important than the actual level of potassium is the speed in which the potassium level is altered. My pt comes in with a potassium of 7.5 and I put him on a K1 bath... well... it happens that some will arrest.

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etoh withdrawl last etoh ingestion 3days ago.

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Specializes in Agency, ortho, tele, med surg, icu, er.

"3) Blood pressure drop. Duh. See #1. Dialysis pts love to go hypotensive. You try pumping 5 extra kilos of fluid, then have it removed (out of necessity) and see how you do."

" You know kidneys excrete extra potassium and dialysis pt's kidneys aren't functioning... and surely you also know that what is even more important than the actual level of potassium "

I dont know if your being sarcastic or taking a rude tone with me. I was giving examples of a few of the dialysis patients IVe had the past week each being full code that has made my shift busy. And I know what happens in dialysis, I know the issues involved and the complications. Im not a retard.

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I don't think I was being sarcastic or rude.

You said your admits made you wonder what was happening at those dialysis facilities and I was trying to shed some light on it... My, "duh," comment was not necessarily directed at you it's just the most common complication of dialysis. I mean... really, EVERYONE goes hypotensive at one time or another.

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Specializes in Agency, ortho, tele, med surg, icu, er.

Ah ok gotcha, sorry for misinterpreting.

Cheers!

Mike

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Specializes in NICU.

Ha ha Mike I work on a renal floor so we get those admits all the time...

BUT what I hate worse it when my inpatient dialysis unit calls me report on the patient that is coming back from dialysis to say, Pt is having chills, no fever yet but I'd keep an eye on him if I was you because he doesn't look good.

By the time they get to the floor they have a temp of 101, then 20 min later there temp is 103, they are tachycardic and hypotensive! Always fun.

I'll tell you one thing. Renal patients can be some of the sickest patients in the hospital.

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etoh withdrawl last etoh ingestion 3days ago.

"...and he's coming up in four points!!"

Kill me. :banghead:

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Specializes in NICU.

And I hate patients coming up with suspected bowel obstruction. Vomiting out their nose practically... Oh and it just so happens the ER wasn't able to get the NG tube in... thanks I appreciate that

And I hate GI bleeds...

Pretty much anything GI.... woof

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"...and he's coming up in four points!!"

Kill me. :banghead:

And his wife doesnt know why all these MEAN nurses are doing this to him!

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