Patient on Hemodialysis

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Case Study #1: Patient on Hemodialysis A 47 year-old man is being sent back to the hospital unit after undergoing hemodialysis in the dialysis unit. The patient was initially admitted for pneumonia but has been receiving hemodialysis Mondays, Wednesdays, and Fridays for the past year for kidney failure. He has a functioning arteriovenous fistula on the left arm. On assessment a positive thrill and bruit are confirmed. The nurse from the dialysis unit informs the unit nurse assigned to the patient that 1 L of fluid was removed. She reports that prior to dialysis the patient’s weight was 80kg, and after dialysis it is 79 kg. At the end of the dialysis treatment the patient’s vital signs are: temp 36.7 (98.0) degrees; heart rate 87 bpm; respirations 20/min.; blood pressure 90/61 mmHg. A 2x2 gauze dressing covers the accessed site of the AV fistula and it is clean, dry, and intact. The patient is alert and oriented but reports feeling tired, complains of being dizzy after the treatment. 1. What side-effects is the patient experiencing in the post-dialysis stage? Describe the appropriate nursing actions that need to be taken. Common problems of post dialysis include hypotension, headache, nausea, malaise, vomiting, dizziness and muscle cramps. Also, many fluid-related and infectious complications can occur from hemodialysis (HD). The most common complications include disequilibrium syndrome and viral infections. The cause appears to be the rapid decrease in fluid volume and BUN levels during HD. Post dialysis care includes close monitoring of the patient immediately after and for several hours after the treatment. Close monitoring of the patient is vital to assess and watch for any side effects from the treatment. Vital signs must be obtained and weight is necessary to compare pre to post dialysis. Both are expected to be reduced

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