Question

1. James Bean, a patient 67 years of age, is 3 days postoperative after a coronary artery bypass graft operation. The patient has a history of hypertension, type 1 diabetes coronary artery disease, and end-stage renal disease, which is treated with hemodialysis three times per week. The patient has a left atriovenous (AV) shunt. The patient is taking the following medications: Sevelamer (Renagel): 2 capsules with each meal Vitamin D, Bi2, and iron supplements with meals . . . Calcium carbonate (OS-Cal): 3 tablets with each meal . Procrit (epoetin alfa): 100 U/kg/dose subcutaneously every Monday, Wednesday, and Friday (dialysis days) 70/30 NPH and regular insulin 30 U twice daily. Fingerstick blood sugars taken before meals and at bedtime and regular insulin given per sliding scale.) Coreg (carvedilol): 12.5 mg twice daily Lanoxin: 0.125 mg (every other day, on even days) Acetaminophen with Codeine No. 3: 1 to 2 tablets every 6 hours Diphenhydramine hydrochloride (Benadryl): 25 mg every 8 hours PRN for itching Docusate sodium (Colace): 100 mg b.id e . . . (Learning Objective 6) a. The patient is ordered to have daily dialysis. What is the rationale for this order? b. The patient is going to hemodialysis at 9 Ast on an odd day. Which medication or medications should the nurse hold before sending the patient? What nursing management considerations should be made for this patient? c.

Answer 1

ANSWERS :

a. The rationale for daily dialysis is removing of waste products from the body and to maintain body's homeostasis. The dialysis treatment monitors the functions of kidneys, it is most frequent when compared to other forms of kidney replacement therapies.

b. The nurse has to hold Procrit medication on the day of dialysis

c. The nursing considerations for the patient who is undergoing dialysis is as follows :

* Monitor for continuous blood pressure

* Assess for the dialysis injection site, and thrill

* Monitor for respiratory complications, fluid overload, etc

* Control of fluid and electrolyte imbalances