Pre/post treatment assessment in a chronic dialysis clinic advice/tips?

[ClumsyOne, ADN, BSN, RN]

How do you do pre/post treatment assessments in a fast paced chronic dialysis clinic? When I get to do a pre treatment assessment a patient's treatment is already running, some patients wear thick clothing and I cannot hear anything when auscultating, for instance. What should I pay special attention to when assessing the patient, how to do it effectively and in a less time, I guess?

[Twinmom06, ASN, APN]

Lung sounds and peripheral edema would be the two biggies. You may have to ask the patient to remove a layer to hear lung sounds (or invest in an amplified stethescope)

[thoughtful21, BSN, RN]

When I did a rotation in a dialysis clinic, the nurse was very good at doing a quick assessment. He was hard to keep up with! :) He checked vitals (especially BP), edema, lung and heart sounds, and the site of the fistula or central line. He asked the patient if there were any changes since last time he saw them, paying special attention to things like nausea, dizziness, or s/s of a potential infection. Through a quick conversation with the patient, he could tell their level of alertness. He got to know his patients very well, since he saw them so often, so he got very good at individualizing assessments, knowing each patient's norm, and recognizing changes. You'll be very good at it too in no time!

[rizahawkeye, BSN, RN]

I agree with the first two comments. Speed is something you learn later on. Being crucial in your assessments are very important. If they are wearing thick clothing, ask them nicely to remove it temporarily. Explain to your patients what you are doing (just a brief one and in layman's term). Be sure to take note of anything that is out of the normal and notify your doctor. Each time you encounter these patients, you will learn how to manage your time and be faster next time. Dialysis is a lot of multitask work, but doable.