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Discussion

dialysis question

Hi everyone. I was hoping some of you could give me some advice. I'm a new nurse. I worked 2 months at a LTC facility back in September to November, so that's the only bedside nursing experience I have. I started a new job a couple days ago in a LTC facility that does in house dialysis. I don't remember much of anything about dialysis from nursing school. Its been 2 years since I learned about it in school, so I'll be hitting the books again, studying up on it.

Does anyone have any advice on how to care for these residents? For example, I learned that if a resident is scheduled for dialysis at say 8am, make sure to call dietary to get them their breakfast early. I'm getting conflicting answers on if and when you should hold their BP meds before they go. One person said she holds it no matter the BP (unless its very high), another told me she only gives it if their BP is 140 or above. Are there other meds you would hold? I'll Google that too and look it up in my texts, but if you guys can think of any, I'd appreciate it.

Another thing, when they return from dialysis is there special care I need to give them? Are they weak? More at risk for falls? As you can tell, I know nothing of caring for the person on dialysis. Any advice is appreciated :)

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    Moving to Dialysis/Renal forum...

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    Call the dialysis staff & ask them, they'll check with the nephrologist if necessary & will appreciate that you are "thinking". Patients are different, but many of them should wait until after treatment. When they return you should be aware they have had fluid removed, sometimes large volumes 2-3 liters which can cause hypotension. If their BP gets too low they can clot their access in the arm (which you should listen to & or feel for the pulse every shift). Diabetics should have their blood sugar checked. Most will need their meal, any IV antibiotics should be given post dialysis (or sometimes given by the dialysis nurse) They usually will give any blood transfusions required to avoid rapid fluid overload & K+ loading. Those pills ordered with their meals , Calcium acetate, Tums, phoslo, renvela, etc. are phosphorous binders & only work when given immediately before eating; so if their scheduled at off times please leave them for the patient to dose at the appropriate time. High phosphorus levels in dialysis patients is one of their most challenging problems since phosphates are in so many foods, so please help them c this while they are there. Chronically high levels leads to bone disease & vascular calcification. I know this is a lot of advice. It takes time to learn about these things. If your pt is well enough, they can tell you about some of their issues. And last perhaps most importantly, most dialysis patients have a fluid restriction of 1 liter per day unless they still make urine. Please check your orders & post the notice so they don't get "pitchers of water". Thank you for asking! Good luck:)

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    Call the dialysis staff & ask them they'll check with the nephrologist if necessary & will appreciate that you are "thinking". Patients are different, but many of them should wait until after treatment. When they return you should be aware they have had fluid removed, sometimes large volumes 2-3 liters which can cause hypotension. If their BP gets too low they can clot their access in the arm (which you should listen to & or feel for the pulse every shift). Diabetics should have their blood sugar checked. Most will need their meal, any IV antibiotics should be given post dialysis (or sometimes given by the dialysis nurse) They usually will give any blood transfusions required to avoid rapid fluid overload & K+ loading. Those pills ordered with their meals , Calcium acetate, Tums, phoslo, renvela, etc. are phosphorous binders & only work when given immediately before eating; so if their scheduled at off times please leave them for the patient to dose at the appropriate time. High phosphorus levels in dialysis patients is one of their most challenging problems since phosphates are in so many foods, so please help them c this while they are there. Chronically high levels leads to bone disease & vascular calcification. I know this is a lot of advice. It takes time to learn about these things. If your pt is well enough, they can tell you about some of their issues. And last perhaps most importantly, most dialysis patients have a fluid restriction of 1 liter per day unless they still make urine. Please check your orders & post the notice so they don't get "pitchers of water". Thank you for asking! Good luck:)[/quote']

    Reading this after being on orientation for a week makes some things Ive seen a lot more sense now. Very informative. Thank you very much.

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    hi I worked in ltc and had dialysis patients--please make sure they take their phoslo's with meals...otherwise its useless...

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