UFR Goal questions

Specialties Urology

Published

I am having some frustrations at work. I have been in dialysis for 5 months/a nurse for 15 years. I am learning so much, which is why I changed specialties. I want to continue to learn and be challenged. I feel like my team questions everything I do as if I am new to nursing all together or I have no rationale for any decisions I make. The techs go behind me and ask other nurses about my decisions and the nurses change my interventions without speaking to me. I am a pretty thorough nurse but I find that more often than not the others cut corners and don't follow up on things I find important. They have indicated I need to let several things go. Two examples

1. Today a patient complained of pain at her fistula site. I looked at the site and it was extremely red and swollen. One nurse had told her just to put OTC ointment on it and another told her it was just from the topical numbing spray. I wanted to contact the physician but was dismissed quickly.

2. Here is the reason for the post. I have been learning about target weight, when to challenge patients, etc. My patient today has had increased weakness and pitting edema of +3. She has been educated on diet and home interventions. She has frequent gains of 5 kilos +. This week I got an order for an extra treatment. Today she came in after 2 days of consecutive treatment and was symptomatic. I got an order to challenge her by 2 kilos. My thinking/plan was to challenge her and if she could not tolerate it, reduce the goal. Another nurse went to my boss and changed my goal without speaking to me.

I felt like I had good rationale as this patient has been declining and been symptomatic of fluid overload.

Any advice or thoughts? When do you challenge patients?

Specializes in Dialysis.

1. Act as if every action you do will have to be explained before a jury.

2. UF removal rate no more than 10cc per KG per hour. Want more fluid removal? You need a longer treatment time.

Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

Often the rule above is the one to follow. Removing more and faster can cause "cardiac stunning" and kill your patient.

Longer and slower dialysis is best. But it's hard in units there are super busy and getting longer time slots is limited.

All we can do is encourage STRONGLY for our patient to limit fluid intake/IDWG and the multi-disciplinary team must be involved as often dietary info or social issues are needing to be addressed.

Extra tx are great (esp if you can SUF) for removing excess fluid, but unfortunately, I have found many patients come to rely on having a 4th tx every week----and do what they want anyway. That is a big challenge, esp if you having wait lists for chairs. Less and less often are we able to find them times for 4th tx.

Very challenging. Chart, chart chart!

Keep your ego in check. Then ask your boss and the experienced nephrology nurses what their assessment of these patients were. You need to know because you're new to dialysis and it will be a while until you have calibrated yourself to this environment.

With the second patient, the one who came in for an extra treatment, was the order for sequential ultrafiltration? That would make sense since that's what we usually do when we schedule extra treatments for fluid overload. But it could be that the patient told the other nurse that the she was cramping/dizzy/headaches and lowered her goal. Patients can take a while before they are comfortable with someone new, and maybe she talked to someone she was more familiar with.

Nurses in general have a problem with avoiding conflict and so they tend to appear passive aggressive. Just try to open dialogue with them, be humble and honest, and open to criticism. That's how you improve. But maybe the other nurse made a mistake, because the doctor's order was to challenge. You're not going to know without asking questions.

2. UF removal rate no more than 10cc per KG per hour. Want more fluid removal? You need a longer treatment time.

True. Our medical director will increase that to 13mL/kg/hour for some of our patients though if he feels that they can and need to tolerate more.

2. UF removal rate no more than 10cc per KG per hour. Want more fluid removal? You need a longer treatment time.

Interesting - most of our docs do 1 to 1.5 kg per hour max...

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