nursing assessment for dialysis patient

Direction of diffusion depends on concentration of solute in each solution. Use aseptic technique and masks when giving shunt care, applying or changing dressings, and when starting or completing dialysis process. Note reports of discomfort that is most pronounced near the end of inflow and instill no more than 2000 mL of solution at a single time. Rationale: Alleviates pain, promotes comfortable breathing, maximal cough effort. Learn how your comment data is processed. PRINCIPLES OF PERITONEAL DIALYSIS . Rationale: Occasionally used to alter pH if patient is not tolerating, Site near the bowel/bladder with potential for perforation during insertion or by manipulation of the catheter. Purpose is to create one blood vessel for withdrawing and returning blood. Fluid imbalance . The client is in pulmonary edema from fluid overload and will need to be dialyzed and have his fluids restricted, but the first interventions should be aimed at the immediate treatment of hypoxia. Allowing the passage of blood cells and protein molecules through it. Maintain proper electrolyte balance. Antihypertensives, sedatives and vasodilators are prevented in order to do away with hypotensive episode. These can be divided into acute or chronic indications. Check the results of the PT time as they are ordered. Rationale: Assists in identification of source of pain and appropriate interventions. A client receiving hemodialysis treatment arrives at the hospital with a blood pressure of 200/100, a heart rate of 110, and a respiratory rate of 36. What is the purpose of giving this drug to a client with chronic renal failure? There is no reason to contact the physician. Electrolyte abnormality, such as severe hyperkalemia, especially when combined with AKI. As renal failure progresses, bleeding tendencies increase. Typically, imbalances are dealt with via dialysis…you’re not going to replace K or Mag in a dialysis patient. The nephrologist will write orders for the patient’s dialysis while they are in the hospital. And, for instance, if potassium is elevated it’s not like they’re going to excrete it in the urine (so lasix is out UNLESS some kidney function remains). Note reports of dizziness, nausea, increasing thirst. These changes can cause cerebral edema that leads to increased intracranial pressure. Note character, color, odor, or drainage from around insertion site. The nurses responsibilities include: checking the patients' vital signs and talking with them to assess their condition teaching patients about their disease and its treatment and answering any questions overseeing the dialysis treatment from start to finish Some patients are so sick that require daily hemodialysis or, at least, daily evaluation for dialysis. Select actions that the nurse should take. Oliguria and anuria are not early signs, and polydipsia is unrelated to chronic renal failure. The client’s fluid status should be monitored carefully for imbalances on an ongoing basis. This would lead to ineffective control of the blood pressure. If you haven’t already noticed, your chronic renal failure patients take a lot of meds. Restrain hands if indicated. Purulent drainage at insertion site suggests presence of local infection. Some patients are so sick that require daily hemodialysis or, at least, daily evaluation for dialysis. Be alert for signs of infection (cloudy drainage, elevated temperature) and, rarely, bleeding. Allow an extra 500 ml of fluid intake to dilute the electrolyte concentration. In renal failure the patient’s capacity … Rationale: May be reduced because of anemia, hemodilution, or actual blood loss. Instruct patient not to sleep on side with shunt or carry packages, books, purse on affected extremity. Severe pain in the rectum or perinium can be the result of an improperly placed catheter. Patients undergoing hemodialysis can have a whole host of acute complications, including: Chronic complications include bone loss (due to altered calcium metabolism), cardiovascular disease, stroke and even gastric ulcers. Want to know what nursing school is like? Note color of blood and/or obvious separation of cells and serum. Case-based scenarios are used to discuss how to apply infection prevention and control guidance for nursing homes and other long-term care facilities preparing for and responding to COVID-19. Handle tubing gently, maintain cannula alignment. Absence of bruit on auscultation of the fistula. Note presence of fecal material in dialysate effluent or strong urge to defecate, accompanied by severe, watery diarrhea. Add sodium hydroxide to dialysate, if indicated. Pallor, diminished pulse, and pain in the left hand. This is important in view of under dialysis in patients of normal or near normal hematocrit and suggests the need for modification of dialysis prescription in such situations. Our nursing priorities are going to be fluid & electrolyte balance, elimination needs, and safety. Psychosocial Assessment of the Patient on Chronic Peritoneal Dialysis: An Overview Diane Wuerth, Susan H. Finkelstein, and Fredric O. Finkelstein The psychosocial assessment of the patient with end-stage renal disease is critically important because (1) there is growing evidence that the psychosocial status of the patient impacts medical outcomes and (2) the objective of … Rationale: To reduce pressure on the diaphragm and aid respiration. If loading fails, click here to try again. The vast majority of patients, however, dies in acute care facilities without accessing palliative care services. Ensure that small clamps are attached to the AV shunt dressing. Note presence of peripheral or sacral edema, respiratory rales, dyspnea, orthopnea, distended neck veins, ECG changes indicative of ventricular hypertrophy. Presence of a radial pulse in the left wrist. Assessment of the AV fistula for bruit and thrill is important because, if not present, it indicates a non-functioning fistula. Osmosis – movement of water through a semipermeable membrane from an area of lesser concentration of particles to one of greater concentration. Some blood thinners, for instance, have no antidote…you can either wait it out and replenish blood as you go, or dialyze it out. Get your patient on the monitor and keep an eye out for ectopy, dysrhythmias, bradycardia and tall T-waves. External shunts, which provide easy and painless access to bloodstream, are prone to infection and clotting and causes erosion of the skin a round the insertion area. Use of hypertonic dialysate with excessive removal of fluid from circulating volume. Peritoneal dialysis (PD) offers the opportunity of a better quality of life for patients as long as they are able to perform dialysis according to the set procedures. Maintain nutritional status. Patients who are fluid volume overloaded with renal disease are often VERY hypertensive. For example, if their electrolytes are fine but they are simply fluid overloaded, they’ll get one type of HD. Periodontal disease, premature tooth loss, and xerostomia are more common among dialysis patients and can lead to systemic inflammation … Airway and oxygenation are always the first priority. Rationale: Change of color from uniform medium red to dark purplish red suggests sluggish blood flow and/or early clotting. Aggressively restore fluid volume after major surgery or trauma. Contamination of the catheter during insertion, periodic changing of tubings/bags, Skin contaminants at catheter insertion site, Sterile peritonitis (response to the composition of dialysate). They shall independently perform critical tasks in assessing, initiating, monitoring and terminating treatment in an acute hospital setting. Presence of glucose-containing dialysate in the bladder will elevate glucose level of urine. Phosphate binding agents that contain aluminum include Alu-caps, Basaljel, and Amphojel. Inspect mucous membranes, evaluate skin turgor, peripheral pulses, capillary refill. Imbalanced Nutrition; Less than Body Requirements. Will achieve desired alteration in fluid volume and weight with BP and electrolyte levels within acceptable range. Monitor serum sodium levels. Rationale: Prolonged dwell times, especially when 4.5% glucose solution is used, may cause excessive fluid loss. Peritoneal dialysis is carried out at home by the patient. Advantage is greater activity range than AV shunt and no protective asepsis. Also, this page requires javascript. Passage of fluid toward a solution with a lower solute concentration. Add heparin to initial dialysis runs; assist with irrigation of catheter with heparinized saline. When the kidneys fail, magnesium can accumulate and cause severe neurologic problems. Using videotapes to reinforce the material as needed. Observe clotting time at 30 to 90 minutes while on dialysis (Normal value: 6 – 10 minutes). Maintain record of inflow and outflow volumes and individual and cumulative fluid balance. If your kidney failure patient becomes altered or has decreased LOC, you would be wise to get an ABG and check their pH. Note level of jugular pulsation, Rationale: Decreased BP, postural hypotension, and tachycardia are early signs of hypovolemia. The warmed solution does not force potassium into the cells or promote abdominal muscle relaxation. Which of the following clients is at greatest risk for developing acute renal failure? Rationale: Weight loss over precisely measured time is a measure of ultrafiltration and fluid removal. Rationale: Pain occurs at these times if acidic dialysate causes chemical irritation of peritoneal membrane. Prevent air from entering peritoneal cavity during infusion. As soon as you resume care of your patient postdialysis, you'll need to obtain a set of vital signs and a weight measurement and assess the access site. I remember one patient who would come in with a BP of 220-240…scary as heck! Elevate head of bed at intervals. Monitor for episodes of nausea and vomiting which may occur during the procedure. The nurse tells the client that it is important to maintain the dwell time for the dialysis at the prescribed time because of the risk of: An extended dwell time increases the risk of hyperglycemia in the client with diabetes mellitus as a result of absorption of glucose from the dialysate and electrolyte changes. Rationale: Treats infection, prevents sepsis, Insertion of catheter through abdominal wall/catheter irritation, improper catheter placement, Irritation/infection within the peritoneal cavity, Infusion of cold or acidic dialysate, abdominal distension, rapid infusion of dialysate, Guarding/distraction behaviors, restlessness. The nurse assesses this client for which of the following clinical manifestations? creatinine, urea, electrolytes, etc. Cloudy drainage indicates bacterial activity in the peritoneum. Administer protamine sulfate as appropriate. If unable to get more output despite checking for kinks and changing the client’s position, the nurse should then call the physician to determine the proper intervention. Hospital Discharge of the Dialysis Patient: assessment, barriers and a bit of everything in between Kristin Woody CM, MSN Supervisor Care Management Department Regions Hospital . Check the medications history of the patient before the procedure. peritonitis (this is a big concern, so keep the process sterile! The pores of a semipermeable membrane are small, thus preventing the flow of blood cells and protein molecules through it. The client is tachycardic, pale, and anxious. The client asks whether her diet would change on CAPD. There are two main types of dialysis: hemodialysis and peritoneal dialysis. Which of the following nursing diagnoses are most appropriate for this client? The electrolytes in the dialysate solution will be at a lower concentration than what you’ll find in the patient’s blood. The volume of dialysate removed and weight of the patient are normally monitored; if more than. Observe meticulous aseptic techniques and wear masks during catheter insertion, dressing changes, and whenever the system is opened. Rationale: High sodium levels are associated with fluid overload, edema, hypertension, and cardiac complications. When you think of dialysis, you probably think of patients who have chronic renal failure who go to the dialysis center three days a week, sit there for a few hours, then go home. Haemodialysis can either take place in hospital with full nursing supervision, in hospital at night, in a “Satellite Dialysis Unit” or at home.

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