Preceptorship on renal floor

[wannabenursetx]

I'm a fourth-semester ADN student and will be starting my preceptorship (120 hours) in a couple of weeks. I've been assigned to the renal floor. Would love any advice or tips from renal nurses as to what I need to be prepared for that is specific to this floor. Also would like to hear some advice on working the night shift. I will be working weekends 7p-7a and have never worked at night in my life!

[november17, ASN, RN]

A lot of patients on renal floors tend to be very similar to any other med/surg patient. Many of them just happen to get lumped into renal because they need dialysis a few times a week.

[RNRutRO]

Renal patients are somewhat of a challenge since they don't break down meds like normal patients. Read up on when to hold cardiac meds the days of dialysis and from what I remember, their labs always needed to be done early so the dialysis nurse would have the results.

Not sure what your experience is with transplants, but if possible, encourage them to inform themselves about it. I can't tell you how many patients I have had in the past that the thought of having a kidney transplant NEVER occured to them. Some of it's cultural (I think). But having been on both ends of transplant--relative that had a kidney transplant, and mother whose organs were donated, I always try to educate my patients on it.

Good luck and keep us posted!

[Lacie, BSN, RN]

You may want to post this in the Dialysis/Renal Speciality forum and I'm sure you may get a lot more response. Renal patients are a whole different breed than any others I have worked with particularly those undergoing chronic dialysis even if in the acute setting. Meds are the big issue also and not necessarily just those dialyzed out but others they specifically need such as Epogen, Zemplar and Iron preps (Venofer/Ferrilecit), phosporus binders, etc. These are meds the patient cannot go without. I see many times when admitted to hospital they come back to us with bottomed out Hgb/hct or high PTH levels where they didnt recieve them in hospital. Same with phosporus binders for high phosphorus levels. Primarily want to be looking at the K, Ca, Phoshorus levels frequently. Ferritin levels also. Many will have permacaths, fistulas or grafts. Remembering these are thier lifelines and not to be used for anything else but dialysis. No b/p's in the arm, not using the cvc for iv solutions or blood draws, etc. Also they can be pretty angry patients (not all but most of them) so psych/social issues are a biggy! Theres so much more as it is a very specialized area. Good luck and dont feel bad if your not comfortable right away. It takes at least a good year to be comfortable with renal.