Dialysis case study
A 66-year-old black male was seen by his primary provider for complaints of fatigue, anorexia, swelling of hands, face, and ankles, muscles cramps, and increased difficulty breathing. He has a 3-year history of poorly controlled hypertension related to non-adherence to the medical regimen. His B/P routinely runs in the range 155-165/92-102. His B/P today was 170/105. The client does not like to take pills and feels that they are not necessary. He also has been reluctant to modify his diet and likes to eat fried foods. He does not think his eating habits are causing any problems. Because of these symptoms, the client was admitted to the hospital for treatment and ...view middle of the document...
List 2 advantages and 2 disadvantages of each of the sites.
Dual lumen catheter
1. Provides quicker access for dialysis doesn’t take as long as a fistula
2. Can still use arms to check blood pressure, draw blood, and administer IV
1. Unable to enjoy baths, swimming, or showers
2. Can get clogged or become infected
Internal Ateriovenous Fistula (AVF)
Advantage: 1. there is less chance for infection
2. Can be used long term
Disadvantages: 1. Need to be careful with that arm, (can’t sleep, put pressure, or carry anything heavy.
2. It can take up to four months for the fistula to develop
Advantage: 1. you can place it in three different arteries (radial, brachial, and femoral
2. No need to create a fistula, graft can come from human umbilical cord, saphenous vein, or bovine, (cows) carotid artery
Disadvantages: 1. it is not as strong as the fistula
2. Access site might need to be changed more often than fistula
During the hospitalization, he had a permanent hemodialysis catheter (perm- catheter: dual lumen catheter) inserted as an access site. He received dialysis three times each week and his condition improved. Because of the progress he made, he was sent home and was to continue his dialysis treatments as an outpatient.
What does the client need to be taught concerning the permacatheter?
Teach the patient how to care for the site such as keeping it cleans, not getting it wet.
Avoid removing the cap on the catheter, only the nurse should be doing this
Avoid swimming or taking baths or showers
Keep dressing dry at all times to reduce the risk of infection
Ensure that gloves and a mask are worn for your protection whenever the dressing is being changed
Report any signs of infection such as, drainage, bleeding, foul order, pain, swelling or redness
Keep all follow up treatment appointments
Call the doctor if he has any questions or concerns regarding the permanent catheter.
Educate patient to follow the treatment regimen such as following nutrition plan, taking medications, getting vital signs checked (Wt, BP, Pulse, RR, Temp) and ensuring he maintains his blood pressure under control based on his doctors recommendation.
Ensure that he keep the clamps tight and closed when not the ports are not being used
He was admitted to the hospital 4 weeks later for the creation of an arteriovenous (AV) fistula or graft. Outline the routine home care for these two access sites.
Routine home care for fistula or graft: this information pertains to the arm that has the fistula or graft for dialysis. Please follow guidelines below.
Use your arm for dialysis only.
Don’t allow anyone to check your blood pressure on this arm
Don’t sleep or put weight on your arm
Don’t lift or carry anything heavy and avoid putting pressure on your arm
Don’t allow anyone to take a blood sample...