Complications Of Hemodialysis

Question 1

Your patient is yawning, complaining that he/she is feeling dizzy and lightheaded. Eventually your patient begins to feel nausea and begins to vomit. In addition, he/she further tells you that his/her vision is blurred. What is you patient likely experiencing?

Answer 1

Hypotension

Question 2

What can happen to a patient experiencing hypotension without the the proper care given?

Answer 2

Patient can loss consciousness and go into cardiac arrest, even die.

Question 3

What are the interventions of hypotension?(4 steps)

Answer 3

Put patient is trendelenburg-feet elevated

Turn UF down or off

Notify RN

Give normal saline(NS)

Question 4

What are other causes, apart from hemodialysis treatment, can cause hypotension?

Answer 4

Patient is eating either immediately before or during dialysis treatment.

Patient took Blood pressure meds or narcotic pain meds prior to treatment.

Patient gained a lot of weight between treatments

UFR exceeds how fast their vascular system is refilling

Question 5

What is caused by the shifting of electrolytes, attempting to pull a large amount of fluid in a short period of time or going below a patients EDW.

Answer 5

Cramping

Question 6

What is cause by infection, contaminated dialyzer or lines, too cold dialysis; s/s shaking/shivering, high temperatures?

Answer 6

Fever/chills

Question 7

How do you prevent potential fever &/or chills?

Answer 7

Use infection control-hand washing.

Use aseptic technique in prepping and cannula toon of access, maintaining the sterility of the blood line by not allowing ends to touch anything (keep caps closed) infection can cause decrease in blood pressure.

Question 8

If the patient is experiencing chest pain, what can be occurring?

Answer 8

Angina( lack of oxygen to the heart muscle) can occur.

Question 9

What do you do if the patient is experiencing chest pains?

Answer 9

Notify the RN, turn the UF off.

Note: RN will administer O2(oxygen) and may administer nitroglycerin.

Question 10

If a patient is experiencing chest pain and goes into cardiac arrest, what should be done?

Answer 10

CPR

Machine needs to be pulled and biomed dept must preform functional test before using it on another patient

Question 11

If the patient is experiencing faintness, double vision, irritability, hunger, what is the complication?

Answer 11

Hypoglycemia

Question 12

Hypoglycemia complication occurs how?

Answer 12

Some glucose (Blood sugar) removed during treatment.

Question 13

What should be done when a patient is experiencing hypoglycemia?

Answer 13

Notify the RN.

Question 14

What could happen to a patient if they’re experiencing hypoglycemia?

Answer 14

Could lead to coma and death if not treated

Question 15

What is the complication of a patients BUN is exceptionally high such as with a brand new patient during his 1st treatment or a patient that has missed a number of his treatments.

Answer 15

Disequilibrium syndrome

Question 16

What are the S/S (signs/symptoms) of disequilibrium syndromes?

Answer 16

Nausea, vomiting, headache, HTN, confusion and restlessness.

Question 17

What should be done if a patient is experiencing disequilibrium syndrome?

Answer 17

Notify RN

Question 18

What is Hemolysis?

Answer 18

Red blood cells burst, releasing excess potassium (K+)

Question 19

what is the complication if the patient is having shortness of breath(SOB), chest pain, and/or bright red translucent blood in chamber?

Answer 19

Hemolysis

Question 20

What should be done should hemolysis occur?

Answer 20

Stop treatment, notify RN, DO NOT RETURN BLOOD(because hemolysis blood contains excess amount of K+, if returned the patient is likely to die)

Question 21

What are the causes of hemolysis?

Answer 21

Hypotonic dialysate, dialysate temperature > 40c(105F), kinks in the blood line. Arterial pressure greater than -250

Question 22

How do you prevent Hemolysis?

Answer 22

Test machines prior to each treatment, making sure they pass

Confirm conductivity and ph with independent meter

Place bloodlines in line guides

Do not run patient with a arterial pressure greater than -250

Reduce BFR if you have to in order to get AP

Question 23

How do you prevent air embolism?

Answer 23

Test machines prior to use, don’t use if it fails, make sure the air detector is armed throughout treatment, keep at least 300 cc in saline bag

Question 24

As fluid is pulled from the patient, the patients blood pressure usually drops. If it drops significantly, what can the patient experience?

Answer 24

Hypotension