Ideas to help my pt

nursingisok · Oct 26, 2012

Dry weight probably needs increasing.discuss with Dr. Patients never like to accept the fact thier weight needs increasing.

nlhrn2 · Oct 26, 2012

1st I would set the machine temp to 35.5 or even 35,,is there na modeling set? A UF profile? Those things along with increasing the EDW should help BP drop,,,now for the URR what size dialyzer? Sounds like the dialyzer needs to be 180 or 200 or pt needs 4:15hr tx? Good Luck!!

dmapp63, MSN, RN · Oct 30, 2012

What is your total UF goal? How old is the patient? Is this pt a gainer? Symptoms are either volume or dry weight related IMHO. If volume, pt needs to be more compliant with restrictions. If not volume, EDW needs increasing.

Guttercat, ASN, RN · Nov 1, 2012

So much more info needed in the clinical picture here, that it's impossible to give definitive explanations.

I'll suggest the following: start by looking at the patient's cardio history (cardiomyopathy? decreased cardiac output? left or right sided heart failure?); dialyzer size...can the patient tolerate large volumes of extracorporeal blood? BP medications and when he or she takes them; overall body mass/blood volume; average IDWG's; and any history of diabetes that could indicate diabetic vasculopathy (which leads to decreased ability of the vasculature to compensate for volume loss... hint...often these patients will present with hallmark post-tx orthostatic hypotension).

Think "big picture", and devise a treatment plan from there.

Good luck.

Joni's Mom · Nov 1, 2012

Thanks for all the comments,

Not sure what you mean about devise a treatment plan from there??? Yes he does have a cardio history, dialyzer size Revaclear MAX he doesn't gain a tremendous amout, but about 3-4kg, which should be easy to remove in the 4 hour treatment.

It does seem to help with the BFR turned down, but again if the BFR is down then the URR will decrease and not be WNL of 65 or above. I also have a tech that gets orders from the MD to increase the machines BFR to the max of 500, and argues when I turn the rate down d/t excessive sweating.

Brookeylea · Nov 1, 2012

If your continuously turning the BFR down to 450 then the MD orders will need to be changed. What's the point of using 14g needles if the BFR is continuously being turned down. Possibly NA profiling or adjusting temp to 36 with MD orders obviously. Are they diabetic and their sugars are low which is causing them to keep getting hot?

Joni's Mom · Nov 3, 2012

No need to be angry. Just trying to gain insite from other nurses that could possibly have this same issue. Read above post and note that the pt is on UF profiling, and with cardiac issues you do not want the pt to be on a sodium profile. Temp is always 36 degrees.

Good advise on checking blood sugar, I will do that.

land27 · Nov 4, 2012

Do you have access to a Critline. I think it would be helpful to actually see if the patient is shifting fluids or not. Additionally, put the patient on some oxygen. Just 2 liters can make a big difference. I agree with another post to evaluate blood sugar. If the patient has a cardiac history such as CHF or Cardiomyopathy, how much and how fast you can remove fluid must be different. Body mass changes are important to look at as well. Get the whole picture.

Joni's Mom · Nov 4, 2012

Critlines are great, but they are not available at our facility. I'll ask the patient if he would be game for the use of O2 just during treatment, but he doesn't like the nasal cannula in his nose, if it works I'll be sure to get a MD order. Again I'll check his blood sugar this Monday, as I haven't had contact with my AM pt for over a week, I worked the late shift.

Thanks for all the advice

Tish88 · Nov 18, 2012

What is his starting BP?

To me, it sounds like his dry weight needs to be adjusted. When was the last time it was adjusted. If he does have a cardiac history, 4kg sounds like a lot for him.

There are so many variables it could be and is hard to tell without a full history of the patient and about his treatments.