Question

. 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, B12, 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.i.d. (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 AM on an odd day. Which medication or medications should the nurse hold before sending the patient? c. What nursing management considerations should be made for this patient?

Answer 1

1. Rational for this order:

Here patient is having and stage rental failure, in this stage patient kidney unable to filter the urine, so need dialysis.

2. Medication hold:

Anti hypertensive drugs has to be with hold before dialysis, so tablet. Carvedilol has to be withhold before dialysis.

3. Nursing management:

1. Maintain strict intake and output chart.

2. Monitor vitamins signs closely.

3. Explain the procedure to the patient.

4. With hold anti hypertensive drugs.

5. Monitor weight closely.

6. Follow aseptic techniques.

7. Keep dialysis port close tightly.