Page 407 - Critical Care Nursing Demystified

392 CRITICAL CARE NURSING DeMYSTIFIED

Provide frequent oral hygiene to decrease oral dryness and improve appetite
and overall feeling of wellness.
Monitor for weight changes to determine if patient is adhering to dietary
restrictions.
Assess for symptoms that lead to decreased dietary intake to determine if other
interventions may help the patient, such as a dietary consult.
Promote a diet consisting of limited high-biologic protein, which includes eggs
and dairy products, to help maintain positive nitrogen balance, decrease nitrog-
enous waste production, and promote growth and healing.
Limit the amount of potassium and sodium in the diet and medications to
prevent hyperkalemia and fluid overload.
Administer phosphate-binding resins and calcium to keep the phosphate levels
low and prevent calcium from being absorbed from bones.
Monitor the patient for bleeding tendencies (Hct and Hgb; platelet count,
PT, PTT), which can be caused by platelet impairment.
Avoid administering aspirin or nonsteroidal anti-inflammatory drugs
(NSAIDs), which can further alter platelet function.

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are removed by the dialysis process.

Recounting a True Story

My husband worked with a gentleman who had CRF for many years. I knew his
wife as she was the head of the OR at a local hospital. I played golf with Pete
once and noticed how enlarged his AV graft arm was. He was still able to remain
physically active; however, he needed my assistance to look for his golf ball as
his vision was failing. He was particularly proud that he had maintained this
graft for many years without complications, but his other body systems were not
as fortunate.
He started requiring frequent blood transfusions as the Epogen he was taking
no longer maintained his oxygen levels, and he had had several bouts of infec-
tions that took their toll.
One day my husband came home and told me Pete and his wife decided he had
had “enough.” He refused any more dialysis treatments. It was very hard on his wife
and family, but with the support of physicians, family, counselors, and fellow
church members, Pete had a peaceful death with family and friends in attendance.
But it was the constant vigilance and support of the nursing staff that made the
most difference to Pete’s family.