New to Chronic HD

PLTSGT · Jul 11, 2006

I guess no one does assessments... : )

RemoteRN · Jul 11, 2006

I guess no one does assessments... : )

Are you still in orientation. You should be with an RN at some point and she should instruct you on assessments.

I listen to lungs, heart, and look at face for edema, and check ankles for edema.

Then I have my spiel

Have you had:

Chest pain, shortness of breathe, nausea, vomiting, diarrhea and or bleeding.

That helps to assess dry weight. I.E. No weight on but SOB and edema . But c/o of vomitting or diarrhea then their EDW needs to be lower. They have fluid on.

Good luck

It's a steep learning curve.

rn,lmt · Jul 11, 2006

Hi, It's been a little while since I was in chronic HD setting (I work in a hospital based dialysis clinic now), but regarding your question, when a patient arrives to the unit, it is really next to impossible to do an assessment prior to all your patients starting treatment. Often the assessment (listening to lungs, heart, checking for edema, questioning if patient has shortness of breath, chest pain, nausea, vomiting, or diarrhea, or any other problems) may be done within the first hour of treatment (it often depends on what your policy of your clinic says).

If within the first hour is not acceptable, if you as the nurse, stand at the scale and have each of the patients get a brief assessment as they are getting weighed, this could suffice until a more complete assessment is able to be done.

Hope this helps!

Farkinott, RN · Jul 12, 2006

We always do an oral and visual assessment of our chronic haemo patients. It doesn't take much to observe them walking into the unit. Are they short winded? Do they have obvious odeama? Many of my clients are Aboriginal or Torres Strait islander and they "hide" the excess fluid centrally or it shows up in the eye orbits, not in the ankles as with caucasians. Also looking at their weight and BP pst dialysis from the las few runs is vital. I never start dialysis unless I am sure my prescription is basically right.

PLTSGT · Jul 14, 2006

Yes, I also notice other nurses ask for nausea, vomiting and diarrhea. What's the significance?

Farkinott, RN · Jul 15, 2006

I just started working in a local outpatient hemodialysis center. I've been a nurse for over 10 years but (very) new to HD. My question is:
When the patient comes in, what is the basic assessment do I need to do or check; considering a ratio of 12:1?
Thanks in advance.

BP, obvious odema, what is the client;s ideal body weight? If they have vomiting and diarrhea play cautious and remove only the wash back. Get an expererienced colleague and talk about your assessment with them.

Marc

Trauma Columnist · Jul 15, 2006

Hi there...I'm a new chronic HD APN - yikes! I've been a nurse for 14 years, but only ER or ICU! I go to several facilities to do the medical management of the patient. First - the ratio at these facilities is 1 nurse to 4 patients which can go up to 6 pts if needed. However, I would question being responsible for 12 pts. Most dialysis changes seem to be handled by the RN working from established protocols and the dieticians - again working from protocols.

It is daunting to understand the pathophys behind all these changes. I'm starting my second full week.

PLTSGT · Jul 15, 2006

Hi there...I'm a new chronic HD APN - yikes! I've been a nurse for 14 years, but only ER or ICU! I go to several facilities to do the medical management of the patient. First - the ratio at these facilities is 1 nurse to 4 patients which can go up to 6 pts if needed. However, I would question being responsible for 12 pts. Most dialysis changes seem to be handled by the RN working from established protocols and the dieticians - again working from protocols.
It is daunting to understand the pathophys behind all these changes. I'm starting my second full week.

I believe it's 1:6 is the standard for hospital HD because the nurse would do what patient care techs do.

Trauma Columnist · Jul 15, 2006

I work in chronic outpatient HD and our ratio is no higher than 1:6 patients. The n/v/d, sob, cp question is to figure out if they are dialyzing adequately. You can also look at the URR and kt/V lab values but they just measure the current dialysis treatment, they aren't a trend. N/v, CP, SOB might be signs of fluid overload - maybe they need their dry weight adjusted.