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

Answer:

1). Aminoglycosides are used to treat gram negative infections and eliminated through the kidney which is not metabolized. The half life of drug is 2- 3 hour in a normal adult. But half life is dramatically increased in renal patients as it excreted through kidney. To reduce further complications, the dosage should be reduced or increase the dose interval in patients with renal failure.

2). During and after the hemodialysis, the patient may develop hypoglycemia.

Nursing care during hemodialysis

*Monitor the vital signs

*Maintain aseptic technique during the procedure

*Monitor the weight

*Assessment of fistula site

*Management of bleeding

Nursing care after hemodialysis

*Screening of blood sugar levels

*Weight monitoring

*Vital signs assessment

*Fluid intake restrictions

*Assess the fistula site

*Documentation of the procedure

3). Patient is suffering from pneumonia. Missing his dialysis may lead to fluid overload, which resulted in CHF and pulmonary edema.

Diuretics should be administered to prevent fluid overload. Arrange hemodialysis for the patient as per physician's order.

4). Fruity breath is due to metabolic acidosis. Patient also experience with malaise, headache and abdominal pain .

To prevent further complications of metabolic acidosis, monitor the serum bicarbonate levels of the patient. Metabolic acidosis in patients with renal failure treated with sodium bicarbonate is safe and well tolerated.

5). In renal failure, the kidney is unable to excrete waste material from the body and it leads to dry skin and itching of skin. It common in patients with kidney disease. To prevent itching skin, use high fat soap and lotion, control phosphorus intake, and benadryl.