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This Concept Map, created with IHMC CmapTools, has information related to: Renal1.2, interdialytic hypotension Assessments: early recognition of hypotensive symptoms during hemodialysis: feeling hot lightheadedness nausea muscle cramps, interdialytic wt. gain 3-4kg increased H2O intake "feels unwell" ???? Assessments: ******determine ideal body wt. by 1.BP (sitting, standing) 2.pulse 3.Respiration rate 4. wt. fluctuations of no more than 4% of dry wt. examine other S&S of fluid overload 1.periorbital sacral and peripheral edema 2.SOB in genral, at night and on exertion 3.hypertension 4.increased jugular venous pressure, bounding pulse 4. pericardial friction rub, interdialytic wt. gain 3-4kg increased H2O intake "feels unwell" linked to non-adherence, Mrs. T 68 yrs old Dx: CKD, stage 5, 2nd to nephrosclerosis PMHx: HTN, obesity, ex smoker retired nurse's aid X 3yrs married to Mr. T deceased accident X 7yrs, increase in BP during start of dialysis BP 188/99 HR 78 chest discomfort risk for CVD renal failure, Health Issues ???? interdialytic hypotension, Interventions: re-evaluate current anti-hypertensive drugs discuss informational needs re antihypertensive drugs administer antihypertensives prior to hemodialysis volume control establishing a correct target wt. ???? Outcomes: fluctuation of BP within normal range of pt's baseline ~BP /90, Assessments: early recognition of hypotensive symptoms during hemodialysis: feeling hot lightheadedness nausea muscle cramps ???? Interventions: 1.Examine the target weight critically and adjust it if necessary 2.Diet: limit the intake of fluid and salt 3.Limit the intake of food during the haemodialysis 4.Adjust the (cardiovascular) medication 5.Lower the dialysis fluit temperature 6.Bring a decreased calcium concentration in the dialysis fluid back up to a normal concentration 7.Use sodium-profiling and/or ultrafiltration-profiling 8.Dialyse more often and/or longer 10.Excercise during haemodialysis 11.Sympathicomimetic medication 12.Use biofeedback technology to control blood volume reduction during dialysis, Assessments: headache, dizziness, SOB, edema measure temp, O2 sat. + RR observe for orthostatic hypertension ???? Interventions: re-evaluate current anti-hypertensive drugs discuss informational needs re antihypertensive drugs administer antihypertensives prior to hemodialysis volume control establishing a correct target wt., interdialytic wt. gain 3-4kg increased H2O intake "feels unwell" risk for increase in BP during start of dialysis BP 188/99 HR 78 chest discomfort, Mrs. T 68 yrs old Dx: CKD, stage 5, 2nd to nephrosclerosis PMHx: HTN, obesity, ex smoker retired nurse's aid X 3yrs hemodialysis tx: 3x/week Health Issues, interdialytic wt. gain 3-4kg increased H2O intake "feels unwell" ???? Assessments: ******determine ideal body wt. by 1.BP (sitting, standing) 2.pulse 3.Respiration rate 4. wt. fluctuations of no more than 4% of dry wt. examine other S&S of fluid overload 1.periorbital sacral and peripheral edema 2.SOB in genral, at night and on exertion 3.hypertension 4.increased jugular venous pressure, bounding pulse 4. pericardial friction rub, Health Issues ???? interdialytic wt. gain 3-4kg increased H2O intake "feels unwell", Mrs. T 68 yrs old Dx: CKD, stage 5, 2nd to nephrosclerosis PMHx: HTN, obesity, ex smoker retired nurse's aid X 3yrs married to three children offer Mrs. T home care, Health Issues ???? increase in BP during start of dialysis BP 188/99 HR 78 chest discomfort, interdialytic wt. gain 3-4kg increased H2O intake "feels unwell" risk for interdialytic hypotension, Interventions: 1.Examine the target weight critically and adjust it if necessary 2.Diet: limit the intake of fluid and salt 3.Limit the intake of food during the haemodialysis 4.Adjust the (cardiovascular) medication 5.Lower the dialysis fluit temperature 6.Bring a decreased calcium concentration in the dialysis fluid back up to a normal concentration 7.Use sodium-profiling and/or ultrafiltration-profiling 8.Dialyse more often and/or longer 10.Excercise during haemodialysis 11.Sympathicomimetic medication 12.Use biofeedback technology to control blood volume reduction during dialysis ???? Outcomes: effective management of hypotension, Assessments: BUN prealbumin level freq and severity of nausea ???? Interventions: small, frequent meals administer gravol, Assessments: ******determine ideal body wt. by 1.BP (sitting, standing) 2.pulse 3.Respiration rate 4. wt. fluctuations of no more than 4% of dry wt. examine other S&S of fluid overload 1.periorbital sacral and peripheral edema 2.SOB in genral, at night and on exertion 3.hypertension 4.increased jugular venous pressure, bounding pulse 4. pericardial friction rub ???? Interventions: 1. teach pt. how to maintain a low sodium diet 2. fluid volume monitoring and control measures 3. daily weights 4. review alternative methods of reducing thirst: sucking on ice cubes, lemon or hard candies 5. encourage pt. to report wt. gainɰ% dry wt., Health Issues ???? nausea high serum creatinine 1270 mmol/L low albumin 32 g/L Hypothesis: poor nutritional status + ineffective dialysis