Which answer would you have chosen?

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Hi everyone!

I had a test question yesterday that still has me stumped! What would you have chosen and why?

The hemodialysis nurse should keep which drug at the bedside?

A. Morphine

B. Digoxin

C. Can't remember

D. Diphenhydramine

I fought between Dig and Benadryl. I ended up chosing Dig. My rationale was hemodialysis pretty much assults the CV system. I'll find out which was the correct answer next week.

Thanks!

Dani

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Specializes in med/surg, telemetry, IV therapy, mgmt.

Well, I was thinking Digoxin too. Hypotension is a side effect of digoxin and I don't know if it's safe to give dig to a dialysis patient who might already be hypotensive. After dialysis most patients are a little hypotensive and all their electrolytes have returned to normal levels and are a little below normal. I've been around a lot of chronic renal patients who get dialysis and they are always chronically nauseated because of all the overages of electrolytes and waste products that build up in their systems. That makes me think that the Benadryl might be the right answer. My two books on dialysis list these as the complications of hemodialysis:

fever

  • dialysis disequilibrium syndrome
  • hypovolemia
  • hypotension
  • hyperglycemia
  • hypernatremia
  • hyperosmolarity
  • cardiac arrhythmias
  • angina
  • air embolism
  • hemolysis
  • hyperthermia
  • exsanguination
  • thrombosis of the AV fistula
  • Stenosis of the AV fistula
  • Nurse's 5-Minute Clinical Consult: Treatments, Nurse's 5-Minute Clinical Consult: Procedures

Sure would like to know what the fourth answer was.

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Specializes in Family Nurse Practitioner.

I think I would have picked Benedryl also because of the respiratory implications and urgency in the case of a reaction. Was this for NCLEX or a school exam? I'm interested to know what the correct answer was.

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Specializes in EMS, ER, GI, PCU/Telemetry.

i would have picked benadryl because incase of allergic rx, and also because pts on dialysis are usually itching and scratching from uremic pruritis, etc, and i think something in dialysate (sp) may exacerbate this. the others ones don't make sense on why you would keep at the bedside of a dialysis pt. let us know what the correct answer was. i am curious to know!

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I think it's c. None of the mentioned drugs are bedside-emergency stuff.

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I just remembered C. was protamine sulfate.

I threw that one off of the table because they really don't use heparin that often anymore.

I'll let you guys know once test review is over next week!

Dani

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Specializes in Cardiac.

They dwell the ports with Heparin (20,000 units!)

Interesting question. The only drugs I see our HD nurses having at the bedside is albumin, NS, and heparin.

So, I'll go with C as well due to the increased bleeding risk...in case those 20,000 units enter the bloodstream instead of being aspirated.

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Specializes in Ortho, Neuro, Detox, Tele.

I'd go with the protomine sulfate, due to increased bleeding possiblity if the tubes become detached from the fistula, if they start to clot off, etc....just my thought....

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Specializes in Maternal - Child Health.

My guess would be C as well.

You might want to check with traumaRus. She cares for dialysis patients on a regular basis.

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Specializes in Did the job hop, now in MS. Not Bad!!!!!.

I vote for Benadryl. You can automatically rule out Morphine as it is a strictly controlled opiate that would NEVER be kept at the bedside. And like Sue says, Dig isn't an emergency drug.

But Benadryl certainly can be considered safe enough to keep at the bedside and can also have therapeutic effect in case of an anaphylactic reaction. Or at the very least a reaction due to its antihistamine qualities.

Then again it could be a trick question because we are never allowed to keep any meds at the bedside!!

Oh, wait! Protamine sulfate? it's the antidote to heparin overdose and since many diasylates contain a hep additive, then that would make sense. There ya go! There's your answer. Benadryl really shouldn't be bedside, but if it was the only one of the first 3 possibilities, I'd have kept it in there. ;)

Can't wait to find out the answer!!!

Chloe

:nurse:

RN-BSN, BA

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Specializes in Dialysis.

well there ya go. protamine sulfate. we use heparin with practically every pt. as a bolus pre-tx and as a slow infusion during...

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Specializes in EMS, ER, GI, PCU/Telemetry.

oh now that you've posted the C answer choice i change my vote. protamine sulfate makes alot more sense!

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