Question

A 50 year old truck driver has been diabetic and has required insulin therapy for the past 20 years. Diabetic neuropathy has led to several complications, including end stage renal disease, which he developed two years ago. He now receives hemodialysis 3 times a week and has an AV fistula in his left forearm. Yesterday, C.S presented in the ER with respiratory infection and was hospitalized with pneumonia, hypertension, and fluid overload. He will receive dialysis while on your nursing unit.

1. What is hemodialysis and name 3 side effects and patient teaching in reference to hemodialysis?

2. What medication therapy is limited by kidneys inability to excrete?

3. What lab values would indicate the kidney is not functioning well?

4. What are the clinical manifestations of end stage renal dialysis (ESRD).  

Answer 1

1.

A procedure where dialysis machine and a special filter or a dialyzer are used to clean the blood is called Hemodialysis.

The 3 side effects of Hemodialysis are:

1. Low blood pressure.

2. Cramps in muscles.

3. Sleeping problems.

4. Anemia.

5. Diseases related to bones.

The patient should discuss the risks and benefits of the dialysis with the provider. The patient should discuss with the clinicians about the possibility of getting a kidney transplant. Further, the patient should have education on low sodium and potassium diet.

2.

The medication therapy which is limited by kidney ability to excrete includes methotrexate, lithium, enoxaparin and metformin.

3.

The lab values which indicates that is kidneys are not functioning properly is the Creatinine level, which is greater than 1.2 for women and for men greater than 1.4 are the early signs of the kidneys that are not working properly.

4.

Clinical manifestation of End-stage renal disease, is that the kidney does not work properly as they should actually work for the body. The kidney filter wastes and excess fluids from the blood, and then are excreted in the urine. For the end-stage renal disease, dialysis or a kidney transplant is required to stay alive.

At the final stage, the patient may have symptoms of fatigue, drowsiness, inability to pass urine or decreased urine, weight loss, nausea, pain in bones, nail and skin changes.