Nursing Management of Hemodialysis Clients

Question: Who usually gets hemodialysis?

Answer: Chronic renal failure clients who have reached the end stage or stage four. This last stage of renal failure is where only 15% of the kidneys are functioning. This means that majority of the kidneys are “killed off” because of the following reasons:

• Increased pressure
• Increased blood sugar
• Decreased oxygenation

If these factors occur continuously for an extended period, the kidneys will malfunction.

What is Hemodialysis?

The “hemo” in hemodialysis means blood. In this procedure, there is a fat shunt inserted in the arm which is called an AV fistula. A Quinton catheter is also used, being inserted in the neck. Only hemodialysis nurses are allowed to flush or touch Quinton catheters.

Nursing Management

Here, we will elaborately specify what the nurse in charge should do when dealing with a client for hemodialysis.

1. Fluid restriction with constant input and output monitoring

Clients on hemodialysis have very little to no urinary output; therefore, they will be on fluid restriction, and anything that they are taking in has to be accounted for which is why input and output must be strictly monitored.

2. Administration of antihypertensive medications

Hypertensive drugs are given to hemodialysis clients due to the increased volume of the body that directly affects the heart – working harder, pushing more volume. Hypertension is a huge issue for hemodialysis client. Diuretics are given even if there is little to no urine output.

3. Food restrictions

Anything that goes inside a hemodialysis client’s mouth – blood pressure medications, foods high in sodium and potassium – is not going to be filtered out. Therefore, if the client ingests sodium or potassium-rich foods, sodium and potassium will be increased in between sessions, which is detrimental to the client’s condition. Teach your client not to take sodium and potassium, and even iron supplements. Be very careful with medications being administered.

4. Watch out for H&H

Aside from filtering, the kidneys also regulate certain hormones that stimulate blood cell production. Therefore, clients undergoing hemodialysis is chronically expected to have a decreased hemoglobin-hematocrit (H&H) level – a low red blood cell production. Normal H&H is around 12 to 15 g/dl. With hemodialysis clients, expect that H&H to hover around eight or nine; this means that your client is at a critical level. Thoroughly assess your client who has a trending hematocrit-hemoglobin level and give two units of blood during hemodialysis. Epogen is also given after the procedure.

5. Withholding medications

Clients who have chronic renal failure who are about to undergo hemodialysis are restricted from taking any drugs an hour before the procedure. This is because, once the client is hooked up to the hemodialysis machine, it will suck all the blood out of the client, filter it and push that blood back into the client all at the same time. Therefore, if you give the client blood pressure medications right before they go into hemodialysis or any medication for that matter, the medication will also be sucked out of the body and be filtered. The body will not absorb any of the medication’s effects because the hemodialysis machine cleansed it.

6. Monitor blood and electrolyte panels

Hemodialysis clients have unstable electrolyte levels – potassium, BUN, and creatinine are all increased. Creatinine will be around 8 when it’s normal should be around 1.2. Since H&H are chronically low, you are expected to do a blood transfusion, and Epogen is also provided.

On the next lecture, we will be discussing peritoneal dialysis and how it’s different with hemodialysis.

Until next time!