I am a new nurse and I have a few lingering questions from my last shift.
Here is a little about my patient:
- end stage renal disease
- end stage liver disease
- non complaint with meds and dialysis
- found down with ammonia over 130. Ammonia levels below 90 for the past few days after dialysis.
After getting report from the night nurse here is what I found:
- ammonia over 190 in results from the am labs
- increasing confusion and lethargy
- itchy skin
My action:
- Notified provider about lab result and lethargy. He increased lactulose (45g QID).
- Continued monitoring
Throughout the 12 hour shift:
- Pt became increasingly lethargic.
- no pee or poop
My final action:
- Called the provider. Received order for fluid bolus and more lactulose (60g QID).
My question:
- I gave the fluid bolus, and went home. But now I am wondering if I should reminded the provider that this is a patient with end stage renal disease on dialysis.
What would you do? Could I have been a better advocate for this patient?
