Sever hypertension during dialysis

[petiteRN88]

I just graduated in May 2010 and have been working in dialysis for 6 months. I have had so many dialysis patients come into treatment with BPs above 200. Once we start dialysis, the BP would drop. But there are some whose BP doesn't drop and we would give clonidine PO. Sometimes that doesn't help though. Is that seen frequently? How can I help these patients manage their HTN better?

[workingmomRN]

These patients with severe hypertension need to control their fluid gains, avoid high sodium foods, & take their bp meds as directed. If they are doing all these things & their bp continues to be high, then the MD needs to adjust their medication regimen. Normally, dialysis pts cannot take their bp meds prior to coming for treatment, but sometimes if their bp does not come down during tx, they may need to take their bp meds before dialysis. The MD would have to make that call, though.

[rain888]

which we should get more concern ? systolic or diastolic??? we have one patient came with bp 260/54mmhg ,then doctor instructed to start dialysis ,so get the point maybe only look at the diastolic ?

[Dialysis RN1]

In my opinion the Systolic is probably the most important as that is the pressure in the vasculature while your heart is contracting. the diastolic is when the heart is at rest (laymens terminology) If the Systolic is elevated the posibility for stroke exists and uncotroled reaks havoc on the kidneys. Of course the diastolic is very important as well but neither are indicators for the need to start dialysis. Other labs will indicate the need to start dialysis.

[traumaRUs, MSN, APRN]

I've got to point out too, you need to obtain an ACCURATE BP. A BP cuff placed on an ankle of a diabetic pt with neuropathy and PVD isn't going to be accurate.

Always, always take a manual BP if you doubt the veracity of a BP and frankly, I would doubt it with the 260/54.

[rain888]

Actually , this patient is neuropathy ,and we could not get the manual bp because the weaken sound .

[traumaRUs, MSN, APRN]

Then, if you can't hear it, what makes you think the machine is correct?

[pbilbrey]

I agree if you can not hear it then the automatic cuff will be incorrect.

The pt has to want to control their bP many do not. That is why most of them are in ESRD due to uncontrolled BP. You can give clonidine but can alway have rebound hypertension. Any SBP over 200 most places state need to call the MD before starting treatment it really depends on your medical director and your set policy and MD orders. They need better control over bp due to fluid gain or not taking meds or neededing different meds. Sometimes meds will just not work anymore due to many different reasons or not control as well as before