Chronic Hemodialysis Nursing Interventions by MConcepcion

INTERVENTIONS

PRE-DIALYSIS

AVF/AVG (MALE)
Pleasant male; no complaints noted; denies any discomfort; access washed with soap and water; access site is clean & dry, positive bruit & thrill; no s/s of infection on access site noted. UF goal set to __kg.

AVF/AVG (FEMALE)
Pleasant female; no complaints noted; denies any discomfort; access washed with soap and water; access site is clean & dry, positive bruit & thrill; no s/s of infection on access site noted. UF goal set to __kg

CATHETER (MALE) 
Pleasant male; denies any discomfort; no complaints noted; cath access site is clean and dry; cath is patent; no s/s of infection on catheter site noted. UF goal set to __kg 

CATHETER (FEMALE) 
Pleasant female; denies any discomfort; no complaints noted; cath access site is clean and dry; cath is patent; no s/s of infection on catheter site noted. UF goal set to __kg

INTRA-DIALYSIS

BP Drop
significant BP drop; asymptomatic; no complaints noted; feet elevated; no saline bolus given; UF still on; will continue to monitor patient

Low BP/ Low Systolic BP (Asymptomatic)
low BP noted; asymptomatic; no complaints noted; feet elevated; UF off; no saline bolus given; will continue to monitor patient 

Low BP (Symptomatic)/ 80s systolic
low BP noted; feet elevated; UF off; 100mL NS bolus given; will continue to monitor patient

BP Improving with UF OFF
blood pressure improving; patient is still asymptomatic; UF off; will continue to monitor patient

BP Improving with UF ON
blood pressure improving; patient is still asymptomatic; UF on; will continue to monitor patient

Elevated BP
elevated BP noted; patient is asymptomatic; placed patient in upright position with feet down; UF still on; will continue to monitor patient

 still with elevated bp; asymptomatic; uf on; will continue to monitor pt

bp trending down but still elevated; asymptomatic; will continue to monitor pt


Dizziness with NS Bolus
patient complained of dizziness; UF off; 100ml NS bolus given; will continue to monitor patient 


Dizziness without NS Bolus
patient complained of dizziness; UF off; patient refused NS bolus given; will continue to monitor patient

Novasource
Novasource 8oz given PO 

Sensipar
Sensipar 30mg given PO with snack

Low Diastolic BP (Asymptomatic WITH ORDERS)
low diastolic blood pressure noted; patient is asymptomatic; patient has orders to call MD for DBP <50 and is symptomatic;  will continue to monitor patient

Low Diastolic BP (Asymptomatic WITHOUT ORDERS)
low diastolic blood pressure noted; patient is asymptomatic; will continue to observe and monitor patient for now

Combination Orders (low pulse and low diastolic)
asymptomatic; pt has MD orders for pulse <50 and diastolic BP <40; will continue to monitor pt

Low Pulse (Asymptomatic WITH ORDERS)
low pulse noted; patient is asymptomatic; patient has orders to call MD for PR <50 and is symptomatic;  will continue to monitor patient

Low Pulse (Asymptomatic WITHOUT ORDERS)
low pulse noted; patient is asymptomatic; will continue to monitor and observe patient for now

Elevated Pulse (Asymptomatic WITHOUT ORDERS)
low pulse noted; patient is asymptomatic; will continue to monitor and observe patient for now

Cramping
cramping noted; UF off; 100mL saline bolus given; applied opposing pressure to cramping lower extremity; will continue to monitor patient

Cramping Resolved
cramps relieved; comfortable; will continue to monitor pt.


Low KECN
low KECN noted; patient is asymptomatic; verified hemodialysis settings and orders are correctly set on the machine; bloodlines checked for clots and kinks; ensured that heparin (if ordered) is administered in a timely manner; will continue to monitor patient

Yellow Light
yellow light noted; patient is asymptomatic; verified hemodialysis settings and orders are correctly set on the machine; bloodlines checked for clots and kinks; will continue to monitor patient


POST DIALYSIS

DISCHARGE (UNCOMPLICATED)
Tx well tolerated; denies chest pain, headache, dizziness, cramping or SOB; patient went home ambulatory with stable blood pressure and pulse after rinse back; no complaints noted

DISCHARGE ABOVE EDW
patient left with __ kg above EDW; advised to limit oral fluid intake in between treatment days; denies chest pain, headache or SOB; patient went home ambulatory with stable BP and pulse after rinse back; no complaints noted

DISCHARGE with 2kg ABOVE EDW
pt left with __ kg above EDW; advised to limit oral fluid intake in between tx days; extra tx offered; CN aware; MD notified; pt went home ambulatory with stable BP and pulse after rinse back; denies chest pain, headache or SOB; no complaints noted

DISCHARGE BELOW EDW
patient left with __ kg below EDW; denies chest pain, headache, dizziness, cramping or SOB; patient went home ambulatory with stable BP and pulse after rinse back; no complaints noted

DISCHARGE WITH CHRONIC EDEMA
chronic edema unresolved after treatment; advised to limit oral fluid intake in between treatment days

DISCHARGE WITHOUT EDEMA
edema improved post tx; hands sanitized; assisted to scale

Access washed with soap and water, no s/s of infection, positive bruit/thrill, no edema to BLE, no voiced complaints at this time, will monitor throughout tx for changes.

Access with no s/s of infection, positive bruit/thrill, no edema to BLE, no voiced complaints at this time, will monitor throughout tx for changes.

Catheter site with no s/s of infection, no edema to BLE, no voiced complaints at this time, will monitor throughout tx for changes.

Patient with MD order for pulse <50, and diastolic bp <40, asymptomatic, uf remains on, will continue to monitor for further changes.

Patient with MD order for pulse <50, uf remains on, will continue to monitor for further changes.

Significant decrease in bp, pt asymptomatic, uf remains on, feet are elevated, will monitor for further changes in bp.

Tolerated tx well, denies s/s of sob, chest pain, headache, hypotension, or cardiac distress.

Patient refused protein, educated on the importance of medication, verbalized understanding and refused once again.

Educated to monitor blood pressure at home and take blood pressure medication if elevated above 140s/90s, if feels sick, headaches, change in vision, chest pain, go to ER, pt verbalized understanding.