University of Nairobi Excessive Fluid Removal During the Dialysis Case Study
Question Description
A 47-year-old man is being sent back to the hospital unit after undergoing hemodialysis in the dialysis unit. The patient was initially admitted for pneumonia and has been receiving hemodialysis Mondays, Wednesdays, and Fridays for the past year for stage 5 chronic kidney disease. He has a functioning arteriovenous (AV) fistula of the left arm. On assessment, a positive thrill and bruit are confirmed. The nurse from the dialysis unit informs the unit nurse assigned to the patient that 1 liter of fluid was removed. She reports that, prior to dialysis, the patients weight was 80 kg, and after dialysis it is 79 kg. Vital signs prior to dialysis were: temperature, 98.0° F (36.7° C); heart rate, 90/min; respirations, 24 breaths/min; blood pressure, 102/70 mm Hg. At the end of the dialysis treatment, the patients vital signs were: temperature, 98.0° F (36.7° C); heart rate, 87 beats/min; respirations, 20 breaths/min; blood pressure, 90/61 mm Hg. A 2 × 2 gauze dressing covers the accessed site of the AV fistula and it is clean, dry, and intact. The patient is alert and oriented but reports feeling tired after the treatment.
1. Using the SBAR format, outline the conversation the nurse from the dialysis unit will have with the hospital unit nurse in the hand-off of this patient.
2. What side effects is the patient experiencing after removal of the 1 liter of fluid?
3. What is the reason for the patients low blood pressure?
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