New job in short term rehab/ALF with in-house dialysis

five10fevr, ASN, RN · Apr 30, 2013

Best of luck!!! Remember they have fluid and food restrictions. Most have 15+ medication at 9 am. They can be very unstable especially after during and after dialysis. A majority are admitted for fluid overload or hyperkalemia from miss treatments.

pinkiepieRN · Apr 30, 2013

Thank you. The DON did tell me that a majority of the patients are in for treatment non-compliance and have often bounced between the hospital and the facility. I'll definitely get more familiar with labs and the patho. :)

westieluv · Apr 30, 2013

Never take a blood pressure, lab draw, or finger stick on the arm with the AV fistula. If your facility doesn't already have a policy in effect where they place a sign over the patient's bed and/or give them a bracelet that clearly states "NO BP or lab draws in left (or right, depending on which side is affected) arm" then suggest it and try to get it implemented. Most facilities already have a policy like this. AV fistulas are fragile and require extra special care. Always check for a thrill and bruit every single shift as well. The sooner a problem is detected, the easier it will be to fix.

My experience as a bedside nurse of over twenty years is that renal patients often times require a little extra empathy and TLC. Being on dialysis is a tough life where you don't feel good a lot of the time, and it requires huge, unwanted, lifestyle changes. They often get discouraged, frustrated, and sometimes angry due to circumstances out of their control. This is one area where it is especially helpful if you can put yourselves in their shoes.

Good luck and congrats on your new job! :)