Hemodialysis
A patient has a family wedding on dialysis day and asks to skip treatment. What should the nurse tell the patient?
Do not simply skip dialysis. Contact the dialysis team ahead of time to see whether treatment can be safely
A patient returns from dialysis dizzy and weak with a blood pressure of 82/48. What problem should the nurse suspect first?
Hypotension (low blood pressure).
A patient takes Velphoro but says, "I take it two hours after I eat." What needs correction?
Velphoro is a phosphate binder and should be taken with meals as prescribed.
A dialysis patient suddenly gains several pounds between treatments and develops shortness of breath. What complication should the nurse suspect?
Fluid overload.
A patient says, "My access looks red and feels warm, but I'll wait until my next dialysis appointment." What should the nurse teach?
Report it promptly because redness and warmth may indicate infection.
A patient missed dialysis and now has weakness and an abnormal heart rhythm. Which electrolyte problem is especially concerning?
Hyperkalemia (high potassium)
During dialysis, a patient becomes pale, nauseated, dizzy, and hypotensive. What is the priority?
Assess the patient immediately and address the hypotension according to dialysis protocol.
A patient taking tacrolimus and prednisone develops a fever. Why should this be reported promptly?
These medications suppress the immune system, increasing infection risk.
A patient's hemoglobin falls from 8.4 to 6.8 g/dL and the patient has black, tarry stools. What complication should be suspected?
Gastrointestinal bleeding causing worsening anemia.
A visually impaired patient says, "I can't read this discharge sheet." What is the best nursing response?
Provide accessible verbal teaching and use teach-back to confirm understanding.
A patient says, "I feel fine, so missing one dialysis treatment won't hurt me." What is the best response?
Missing treatment can allow dangerous fluid, potassium, and waste buildup even before symptoms appear.
The nurse prepares to take a blood pressure on an arm with a functioning dialysis access. What should the nurse do?
Use another appropriate site and protect the dialysis access arm.
A dialysis patient asks why they receive epoetin alfa-epbx (Retacrit) even though they are not actively bleeding. What is the best explanation?
Diseased kidneys make less erythropoietin, which contributes to anemia.
A dialysis patient's potassium is dangerously high. Why is this an emergency?
High potassium can cause life-threatening cardiac dysrhythmias (abnormal heart rhythms).
A patient says, "Since dialysis removes extra fluid, I can drink as much as I want between treatments."Correct or incorrect?
Incorrect. Fluid intake may still need to be limited according to the individualized treatment plan.
A patient has dialysis tomorrow but says, "I'll eat a huge salty meal tonight because dialysis will remove it anyway." What should the nurse explain?
Excess sodium can increase thirst and fluid retention, making fluid management and dialysis more difficult.
Your patient has ESRD, GI bleeding, hypotension, and heart disease. Why can't the nurse focus only on dialysis?
Multiple conditions affect circulation, oxygen delivery, fluid balance, and overall stability and must be assessed together.
A patient taking midodrine asks why it is prescribed. What is the best explanation?
Midodrine helps raise or support blood pressure in patients with symptomatic hypotension.
A patient with ESRD has low hemoglobin. Why should the nurse not automatically assume ESRD is the only cause?
Other causes, such as active gastrointestinal bleeding, may also be contributing.
A patient says, "I'll stop my transplant medications when I feel better." What is the priority teaching?
Do not stop immunosuppressive medications without instructions from the transplant or healthcare team because rejection can occur.
A patient arrives for dialysis with shortness of breath, swelling, significant weight gain, and very high blood pressure after missing treatment. What problem connects these findings?
Fluid overload from retained fluid between or after missed dialysis treatments.
A dialysis patient suddenly becomes confused and hypotensive during treatment. Should the nurse finish dialysis first or respond to the change in condition?
Respond to the acute change immediately. Patient stability takes priority.
A patient receives epoetin for ESRD anemia but continues having melena and falling hemoglobin. Why might epoetin alone not correct the anemia?
Ongoing blood loss must also be identified and treated.
Your patient's creatinine and BUN are elevated, but the hemoglobin also drops sharply with melena. Which finding points to an additional problem beyond kidney failure?
The falling hemoglobin with melena suggests active gastrointestinal blood loss.
A patient says, "I don't want my family involved in my care even though I need some help at home." What should the nurse do?
Respect the patient's preferences, assess needed support, and help arrange safe resources while promoting independence.