Hemodialysis hwk.

Daytonite, BSN, RN · Sep 26, 2008

You have the complications and some of the interventions for those complications, but none of those are nursing diagnoses. Nursing diagnoses are based upon the patient's symptoms.

Nurse AllBetta · Sep 27, 2008

You're right Day, in my post I just included the complications that we are to give interventions and outcomes for but I know I still need to add the RN Dx's.

What I mainly wanted to see was if I was on the right track AND to also see if there were any additional interventions I may have missed esp. with Trigemeny/Bigemeny PVC's.

Thxs.

Daytonite, BSN, RN · Sep 28, 2008

fainting (aka dfo) post-procedure: vitals, check for injuries and tend to them. why would a pt. faint? arrhythmias, blood loss, hypotension--anything preventing enough oxygenation of the brain cells

low blood pressure: trendelenburg position

cramps during procedure - electrolyte imbalances

ht (hyperthermia?, hypertension?) during procedure - offer pain relief as ordered. ???

n/v during/post procedure - offer dryfoods, emesis basin, antiemetics as ordered.

infection - wash hands, wear gloves and mask esp. when working with cath site, monitor labs:wbc, vitals esp. temp

trigeminy & bigminy pvcs --assess distal pulses for purfusion, assess heart sounds monitor vitals and tele call the md...?

and last but not least... fluid overload - assess i/o, heart sounds & lung sounds and edema in legs, monitor the weight (which they do anyway before and after.)

other complication of dialysis include:

other arrhythmias than pvcs
air embolism
thrombosis of the av fistula
dehydration

http://www.advancedrenaleducation.com/hemodialysis/intradialyticcomplications/tabid/464/default.aspx

Nurse AllBetta · Sep 28, 2008

Assesing the distal pulses! :banghead: I didn't think about that one. As for the 'HT' I'm sorry I used the wrong abbreviation *tired student brain fart* I meant to put HA for headache thus the intervention for pain relief but I am also thinking that they would have some Hypertension going on prior to dialysis thus causing a headache. Possibly..?

Thank you again for your help Day and especially for the helpful link.

Valerie Salva, BSN, RN · Dec 6, 2008

we were recently sent to our kd unit and were asked as a part of our homework to give the diagnosis and interventions for complications of hemodialysis. this is what i came up with but i wanted to know what i should add/take away and if i am on the right track. thanks for the help.
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fainting (aka dfo) post-procedure: vitals, check for injuries and tend to them.
why would a pt. faint?: orthostatic hypotension?, f&e shifting?
too much fluid pulled off during tx (hypovolemia)
low blood pressure: trandelenburg (sp?) position
again, too much fluid pulled off, or pulled off too rapidly, or delayed plasma refilling- check map trending to prevent.
cramps during procedure - dehydration and/or na loss - so hang a bag of ns
afterward as ordered of course.)
no, turn off ultrafiltration, lower tx goal- this is done before giving ns. ns is only given if turning uf off is not effective. ns can be given duriing tx, it is usually not given afterwards.
ht during procedure - offer pain relief as ordered.
ht? do you mean htn? this can be d/t renin response.
ha- often a sign of impending hypotension on dialysis. check map trending, vs, give small ns bolus (100-150cc) lower tx goal accordingly. this frequently resolves ha, and prevents complications.
n/v during/post procedure - offer dryfoods, emesis basin, antiemetics as ordered.
prophylaxis is best- n/v during/post hdtx is prevented by proper setting of tx goal. if pt nauseated while on tx, turn the pt on their side to prevent aspiration.
infection - wash hands, wear gloves and mask esp. when working with cath site, monitor labs:wbc, vitals esp. temp
adequate site prep of vascular access.
trigemeny & bigmeny pvcs -- monitor vitals and tele call the md...?
turn off uf, lower rate of blood pump.
and last but not least... fluid overload - assess i/o, heart sounds & lung sounds and edema in legs, monitor the weight (which they do anyway before and after.)

sometimes, due to poor cardiac function and/or low albumin, hd pts can have low bp, and still have edema. fluids become 3rd spaced and cannot be removed safely on hdtx. with these pts, client teaching to adhere to fluid restriction is especially important.