The patient is in the critical care unit and will receive dialysis this morning. The nurse will: (Select all that apply.)

Question

a. evaluate morning laboratory results and report abnormal results.
b. administer the patient's antihypertensive medications.
c. assess the dialysis access site and report abnormalities.
d. weigh the patient to monitor fluid status.
e. give all medications except for antihypertensive medications.

Answer 1

A, C, D
The patient receiving hemodialysis requires specialized monitoring and interventions by the critical care nurse. Laboratory values are monitored and abnormal results reported to the nephrologist and dialysis staff. The patient is weighed daily to monitor fluid status. On the day of dialysis, dialyzable (water-soluble) medications are not given until after treatment. The dialysis nurse or pharmacist can be consulted to determine which medications to withhold or administer. Supplemental doses are administered as ordered after dialysis. Administration of antihypertensive agents is avoided for 4 to 6 hours before treatment, if possible. Doses of other medications that lower blood pressure (narcotics, sedatives) are reduced, if possible. The percutaneous catheter, fistula, or graft is assessed frequently; unusual findings such as loss of bruit, redness, or drainage at the site must be reported. After dialysis, the patient is assessed for signs of bleeding, hypovolemia, and dialysis disequilibrium syndrome.