Question

c. Your patient with a right AV fistula is scheduled for hemodialysis this morning. • Explain what actions you will take to prepare the patient and which of these you can delegate to a PCA • Explain what actions you will take to after the patient returns to the unit.

Answer 1

Sol:

1. PREPARATION BEFORE HEMODIALYSIS:

Weight: Before your patient undergoes a hemodialysis treatment, you will need to obtain an accurate weight measurement. Document the weight obtained and be sure to share this with the hemodialysis nurse. The weight measurement will help determine the amount of fluid that will need to be removed during hemodialysis so that your patient can return to his dry weight.

Vital signs: obtain a complete set of vital signs and document your findings. Assess your patients BP indicates hyper of hypotension. Avoid monitoring BP in the arm with the AVF. Doing so can cause clotting and result in loss of access. Assess your patients temperature, respiration, heart rate be sure to also take note of the rhythm.

Access site: Before sending your patient for hemodialysis treatment, you will need to make sure that the access site is functioning properly, assess for bleeding at tha site, oozing or drainage, redness, warmth because these are key signs of infection and should be reported to health care provider.

Lab results: check the last ordered lab results; level of sodium, potassium, phosphorus, BUN and creatinine, CBC, RBC, HB, Hematocrit level. Make sure that labs never drawn from tha arm with the AVF.

Scheduled medications: patient, scheduled up to 4 hours before the treatment. Because your patient's BP will drop during treatment. Antiarrhythmic medications are given as scheduled due to tha high incidence of patients developing arrhythmia.

2. TAKE CARE AFTER HEMODIALYSIS:-

* As soon as you resume care of your patient post dialysis, you will need to obtain a set of vital signs and a weight measurement and assess the access site.

* Compare your findings baith pre-dialysis results and reports by the health care provider.

* Assessed by looking for elevation in temperature and WBC count.

* Assessing for warmth and redness at or around the access site.

* Monitor your patient closely for signs for confusion, decreased level of consciousness.