Page 391 - Critical Care Nursing Demystified

376 CRITICAL CARE NURSING DeMYSTIFIED

NURSING ALERT

A bruit should be auscultated and thrill felt over the AV fistula or graft. If this is not

observed, then the surgeon or nephrologists should be notified as soon as possible!

NURSING ALERT
A patient with an AV fistula or graft should have no BPs, venipunctures, or laboratory

work in the extremity of the internal access site. Trauma to the site from these procedures
has been known to clot the site.

Prior to starting HD, there are critical assessments that need to be completed
by the critical nurse. These assessments include:

History, including reasons for HD.
Taking VS and comparing them to baselines.
Reviewing current laboratory studies confirming the need for dialysis.
Predialysis weight, which is subtracted from the postdialysis weight to deter-
mine fluid removed.
Checking intake and output history confirming the need for dialysis. Downloaded by [ Faculty of Nursing, Chiangmai University 5.62.158.117] at [07/18/16]. Copyright © McGraw-Hill Global Education Holdings, LLC. Not to be redistributed or modified in any way without permission.
Evaluating the function of the access site.
Describing the outcomes of the HD—is the treatment for fluid removal,
electrolytes, or drugs?
Performing a neurological assessment to determine baseline.
Assessing the patient’s knowledge of the procedure.
Hold any medications that could cause hypotension like beta-blockers and
may be dialyzed out of the patient (see Table 8–5).

TABLE 8–5 Medications Frequently Held That Would Be Removed by HD
Acyclovir (Zovirax)
Ceftazidime (Fortaz)
Folic acid
Iron
Gentamycin (Garamycin)
Multiple vitamins (MVIs)
Salicylates
Tobramycin (Tobrex)
Vitamins B1, B6, B12, and C