SOB interventions on dialysis patients in ED

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Specializes in Emergency Nursing.

Dialysis patients who present with SOB who require urgent dialysis... what interventions can be done while the patients await dialysis.... recently had a patient who was tachypic. "Can't catch my breath."

I've run into this situation. Besides o2 and treating anxiety though therapeutic communication (telling patient to try to remain calm or administrating ordered anxiety meds, what are some other interventions? My lay patient was freaking out.... understandable when you feel like your suffocating. She was waiting for the dialysis nurse to come down and set her up. But I felt so bad.. her SOB was getting worse and worse. She was panicking and I kept telling my doc she was progressively getting more tachy and distressed. He just kept saying "she just needs her dialysis." Well obviously, but I felt helpless. So what else can I do or suggest to the MD as she waits? I felt like a horrible nurse. I charted that I kept notifying my doc as she got progressively worse. Should I have advocated for ativan? I had her on a non rebreather but she up on bipap and was on the road to intubation. Felt like the doc was ignoring my concerns.

Any suggestions?

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I'd have advocated for a little MS IV to decrease vascular resistance (afterload) and increase venous capacitance (preload) and decrease air hunger and buy her a little time before they start pulling some of her circulating volume out into the dialyzer. That would have been merciful for him to deign to prescribe. Otherwise, document, document, document, and go up the chain to get your patient the care she deserves.

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Specializes in Emergency Nursing.

Yup I stayed late to document the heck out of my chart. He prescribed a baby dose of MS, 2mg. Being a heavier lady and not super old it barely touched her. I just felt like crap not being able to put her at ease a little more. My md just didn't seem to care after he called the dialysis team.... it still takes a while for them to physically get there, Set up, and get her going.

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Well, when I said, "A little," it never occurred to me that he would order a measly 2mg and leave it at that. Did she not get any more, ever? I would be jumping up and down by then.

He'll get his reward in heaven. Or someplace. :devil:

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Specializes in Emergency Nursing.

Yep. He refused to Medicate her further. Felt awful for the poor woman. Once the doc he consulted was on board he pretty much blew her off. Hope I'm never put in this position again :(

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Have the dialysis order changed to stat! She could be waiting 4-10 hours if there are other patients ahead of her and dialysis isn't aware of the situation.

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Oooh, I just remembered-- rotating tourniquets. Old-fashioned, but it's what we used to do for CHF (which is what you're looking at here) before we had things like, oh, vasodilators and inotropes. Maybe he would remember them? Noninvasive, too. :eyeroll:

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Specializes in Critical Care.

This isn't unusual and basically you want to create a way to use the peripheral vasculature as temporary fluid storage which will help ease the burden on the lungs until dialysis can actually remove it. NTG, either SL or by drip is usually the first choice often along with morphine.

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Specializes in Emergency/Trauma/Critical Care Nursing.

If the patient is still able to make urine, what about some lasix? I agree with above posts about morphine and possibly bipap.

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Specializes in Med Surg.

Hate to say this out loud, but many caregivers feel a little SOB is what they get for skipping dialysis and/or not being compliant with their lifestyle and med regimens.

Not saying it's right but MS every 5 or 10 minutes until dialysis is rather unsustainable.

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Specializes in Emergency Nursing.

We did give nitro, and the baby dose of MS. Basically no relief. Thanks for the feed back, typically the interventions that have been mentioned are the ones I have seen. Definitely going to go up the chain of command next time.

And the dialysis order was stat when he FINALLY put it in.

I followed up on her. She ended up in the heart failure unit ugh...

And I know what you mean about compliance. But this lady is actually compliant.

Unlike the lady who skipped her dialysis to watch get grand son play baseball. She was suffering for days abd came in checking the drain for emergent dialysis. I told her I understand family is important, but you're grandson probably wants you around for a long , so take care of yourself!

Very frustrating population

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