People suffering from end stage renal disease (ESRD) and under hemodialysis may already have a different outlook in life. It may be that they already lost hope for a life they once had. However, anyone can help these individuals live happily everyday. Taking care of hemodialysis patients can be very difficult, you will face many hindrances from them. Some will say that what you will do is nothing important as they are nearing the end of their lives. But, you must know that these persons must be reminded that they can still enjoy their lives while on dialysis. In addition to the basic needs, dialysis can become a part of one's daily or weekly regimen. Pre-dialysis Regimen Knowing the schedule of the patient's therapy is very important. If he is for the morning schedule, arrange an early morning breakfast. Most centers do not allow patients to eat during treatment. If the patient is diabetic, make sure that he receives his insulin shot and breakfast before treatment. Another important note to consider when taking care of a hemodialysis patient is to give his medications only after hemodialysis. Most of these drugs are water-soluble and can be washed out of the system. Ask a physician about specific medications that can be taken during dialysis. Moreover, patients are at risk for compounding hypotension during hemodialysis. The doctor must be consulted for any anti-hypertensive drugs that must be withheld or postponed after treatment. Blood Works and IV Medications If there is an order of a blood work, coordinate with the nurse in the unit on who will extract the blood. This will avoid too many blood loss and needle sticks on your patient. Send I.V. medications, such as antibiotics and iron supplements, with the patient. The nurse in the unit will administer them, and this will avoid further needle sticks to the patient. Monitoring The Access Site Regularly assess the access of the patient by palpating the AV (arteriovenous) fistula, observing for a thrill or a vibrating sensation. If it is absent, notify the physician and the nurse immediately. Remind all staff to avoid using the arm where the dialysis access is for administering IV medications, taking the BP, or drawing blood. Avoid constrictive jewelries or tight clothing on the arm. After the dialysis session, check the access site for any signs of bleeding, redness, warmth, discharge, or aneurysm. Monitor the patient's vital signs before allowing him to resume any activity. If bleeding occurs, apply direct pressure for 15 minutes. If bleeding does not stop, notify the physician and note the observation on your daily log. Make sure to remove the dressing after 24 hours. Diet Changes and Water Restriction Taking care of a hemodialysis patient also includes monitoring the food he ingests. Hyperkalemia is very common in hemodialysis patients, monitor serum potassium regularly. Teach the patient to avoid foods rich in potassium and sodium. Exchange orange juice with an apple juice since citrus foods and juices are high in potassium. Each patient has limited water intake, depending on the doctor's assessment. Teach him how to control his urges and note his water intake. Provide frequent oral care to prevent drying on the oral mucosa. Monitor for Bleeding Blood-thinning agents are prescribed to most patients and used during dialysis, putting the patient at risk for internal bleeding. Monitor for black, tarry stools, bruising anywhere in the body, eye hemorrhages, and signs of severe anemia. Monitor his hematocrit and hemoglobin level for sudden changes and notify the physician when any of these symptoms occur. Psychological Well-Being The emotional well-being is very important in taking care of a hemodialysis patient. At most times, allow the patient to take control of his care to promote independence. More importantly, address the psychological aspect of ESRD patients since it causes many issues about employment, health, finances, and sexual functioning, leading to anger or depression. It is very important that patients know that they are not alone in their times of crisis. Taking care of a hemodialysis patient gives you self-satisfaction and hope for those individuals who are sick.
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