Question

1. You are caring for a patient in end stage renal failure with an order for strict I+Os. The patient is receiving Replete via tube feeding in the J-tube at a rate of 45mL/hr with a 20mL flush. This is goal for the patient. The patient is also receiving NaCl at a rate of 60mL/hr. During your 12-hour shift, you administer multivitamin 2 times via the J-tube using a 30mL flush before and after medication administration. You crush the medication and mix it with 15mL of sterile water. Your patient also receives dialysis during your shift, where 1.4L of fluid are removed. Although the patient is receiving dialysis, they do still have some renal function, and has an indwelling catheter for urinary retention. At the end of the shift, you empty 350mL from the catheter.
   1. What is the amount of intake during your 12 hour shift (in mL):
   2. What is the amount of output during your 12 hour shift (in mL):
   3. Is the patient in fluid volume deficit, balance, or retention:
   4. Is the current plan of care (based on the information presented above) appropriate or would you recommend changes made to the treatment? If so, what would you recommend?
   5. You administered one of the doses of multivitamin 45 minutes before the patient was sent to dialysis. Is this appropriate? Why or why not?

Answer 1

a.

The patient is receiving Replete via tube feeding in the J-tube at a rate of 45mL/hr with a 20mL flush.

That means a total of 65 ml/hr

so, in 12 hours period patient receives a total of 780 ml

The patient is also receiving NaCl at a rate of 60mL/hr.

so, in 12 hours period patient receives a total of 720 ml

During medication administration, you administer it with 15 ml and flush with 30 ml 2 times in this shift

so, in 12 hours period patient receives a total of 90 ml

So, total intake in 12 hours period is 780 + 720 + 90 = 1590

Answer - 1590 ml

b.

1.4L of fluid is removed from the patient through dialysis.

you empty 350mL from the catheter.

So, total output in 12 hours period is 1400 + 350 = 1750ml

Answer - 1750 ml

c.

The total intake is 1590 ml and the total output is 1750 ml.

So, the patient is 160 ml fluid volume deficit.

d.

The intake should be increased up to 300 ml in a shift to maintain fluid balance. The patient should be kept on slightly positive balance because there are a lot more ways of fluid loss from body other than kidneys. If you keep the patient regularly on negative balance then the patient will go to dehydration state.

e.

No, it is not appropriate to take multivitamins 45 minutes before dialysis because during dialysis multivitamins can be removed from blood so, the body can not able to absorb it.

So, always give medications after the dialysis.