Question

Patient Profile: C. S., a 60-year-old truck driver, has been diabetic and has required insulin therapy for the past 12 years. Diabetic neuropathy has led to several complications, including end-stage renal disease, which he developed two years ago. He now receives hemodialysis three times a week and has an AV fistula in his left forearm. Yesterday, C. S. presented in the ED with a respiratory infection and was hospitalized with pneumonia, hypertension, and fluid overload. He will receive dialysis while on your nursing unit.

Critical Thinking Questions: Answer each question completely and thoroughly.

1. Is it appropriate to administer an aminoglycoside antibiotic for his respiratory infection? Why or why not?

2. What changes would you expect to see in this patient’s blood glucose levels during and after hemodialysis? What nursing care would you provide during and after hemodialysis?

3. C. S. missed his dialysis treatment on the day of admission. How might this be evidenced in his respiratory status? What care would you expect to provide next and why?

4. His wife comments on the fruity odor of his breath. What complication would cause this sign? What should you do next and why?

5. C.S. complains of dry, itching skin. How would you explain this symptom to him? What nursing measures for skin care would you provide and why?

Answer 1

Aminoglycoside antibiotics are used for respiratory infectioninfections. It gives effective outcome for nephro patients. High dose antibiotics can't give for nephro patientpatients due to high creatinine value & low creatinine clearance.

During dialysis patient blood glucose level gone to hypoglycemia because blood purification & infiltration leads to low sugar level. That time they need iv dextrose administration to maintain blood glucose level. After dialysis sugar level comes to normal limits.

After dialysis nursing care

* Check BP & vital signs : during dialysis patient need minimum 120/80 BP. Otherwise patient gone to hypotension & need BP support.

* check blood sugar value to rectify hyperglycemia

* The fistula site must be give pressure which can be relieved after 4 hours ; prevent bleeding.

* check Thrill on fistula site; which will rectify fistula function properly.

* provides food.

* Spo2 must be check to identity any desaturation.

Missing dialysis :

Fluid over load can be cause breathing difficulty and lung infection. Regular followup & HD required. Next time fluid restrictions must be follow 600-800ml.

Fruity like smell on respiration means kussmaul respiration. It's sign for diabetic ketoacidosis. It's a complication of uncontrolled DM. Urine ketone & urine pH must be check for confirmation. Treated with iv fluids, insulin therapy, dialysis, inj. Sodium bicarbonate to clear the acidosis part.

Dry skin & itching is due to urimea. HD is a best treatment. Then for iteching skin care & body lotion is applied. Body care & bath given. Check renal function test.