pickles or boullion?

diabo, RN · Apr 7, 2007

lowering the dialysate temp by a degree can help support bp. Say 37 to 36. Our Dr. ordered 35.5 on one patient.

mo-mo · Apr 8, 2007

Seems to work sometimes, but I hate to do it b/c the salt makes pt thirsty, then they come back 5k heavy the next time, then you pull fluid, then they're hypotensive, then you give'em pickles, then pt is thirsty, then they come back 5k heavy...

diabo, RN · Apr 9, 2007

When I first read this, I thought it was a kind of joke. Does the doctor know of this practice? Uncontrolled salt intake can be very dangerous to dialysis patients. The majority of them already have weakened and enlarged hearts and are very prone to CHF. The sodium shouldn't be raised except by the doctors written OK anyways. It's considered medication. It's not all that uncommon that a patient would go home and have a heart attack after dialysis. Sometimes the nurse may forget to turn the sodium back down to 140 for the last hour. It can be a contributing factor. You are setting yourselves up for a big lawsuit and license loss. Always put these tricks back into the doctors lap. And not just a verbal either. He'll more than likely deny it in court, and the jury will be correct in nailing the one who actually did it.

kenzy · Apr 10, 2007

diabo, wow great point! In our unit we give saltine crackers, pickles, or apple juice. never really questioned it, due to the fact that they were doing this long before I started, but you bet I will now. Goes to prove the fact that everything done is not correct. "More Critical thinking and questioning needed on my part. Thanks!

mo-mo · Apr 10, 2007

If you give it, it should be in the medical director-approved policies! It's in the policies book where i did work, not where i currently work, so now i don't provide it!

Sometimes a little crushed ice or a few sips of water works. Also Na step programming or dropping dialysate temp have been mentioned (need Dr order or policies to back you up for this too!).

Typically you just gotta wait it out and figure out what went wrong so this doesn't happen next time! Prevention can be much easier, sometimes.

Usual suspects are: 1.EDW needs to be raised. 2. Pt takes antihypertensives before treatment. 3. Pt gained/ gains too much fluid for time allotment. 4. Pt has a medical condition like CHF, low protein, or severe diabetic neuropathy, and may need longer treatment time to pull fluid more gently. :twocents: