Founding RN
Joined: 10 Jan 2003
Posts: 172
PostPosted: Thu Jul 31, 2003 8:00 am Post subject: Educational Questions, Part 47
To our Readers and Posters,<
>The best defense in any fight against a disease is education. <
>This column of questions and answers is an attempt in that direction. Anyone is welcome to ask questions. <
><
> What I want to reiterate again is that my answers to your questions DO NOT and SHOULD NEVER take the place of your Dr.'s advice. I am not a Dr. and my answers are based on my many years of experience in the dialysis field. What works for one patient may not work for another. EVERY Patient needs to schedule and attend regular visits with your Dr. in their office.<
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>This column is for dialysis and dialysis related questions. Please be aware that clinics and companies, machines, policies and procedures vary from place to place. <
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>I hope that we can help in furthering your dialysis education. If you wish to ask a question in private, I can be reached by E-mail at FRN2DE@yahoo.com.<
>Thank you!<
>Founding RN <
><
>P.S. I work full time so I may not be able to answer your questions right away. But I will get to them ASAP!<
>
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patientwife
Joined: 18 Jul 2003
Posts: 47
PostPosted: Thu Jul 31, 2003 1:23 pm Post subject: Treatment Plans
What are tx plans and what are their intended uses?<
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>Are tx plans mandatory? If so, who requires?<
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>Who is responsible for plan(s) development?<
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>Are patients involved in plan(s) development? If so, how and when?<
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>Is it customary that plans (with medical and/or other ab
eviations) are developed by physician/team members and merely given patients for signature and subsequent filing in medical records?<
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>
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Joel
Joined: 31 Jul 2003
Posts: 1
PostPosted: Thu Jul 31, 2003 6:40 pm Post subject: Machine prep
Please explain what steps the machine is put through inbetween patients. How long does each step take?<
><
>What does it mean to prime the dialyzer and lines? How is it done? Is this done before or after recirculation and hookup? Is priming the same thing as dumping saline from the lines to clear the lines and dialyzer of renalin, eto sterilant and mem
ane particles?
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high pulse
Joined: 01 Aug 2003
Posts: 6
PostPosted: Fri Aug 01, 2003 5:42 am Post subject: disequilibrium syndrome
I feel strained when my pulse goes up at the end of tx, but I do not get headaches. I feel unwell, like there is pressure on my whole body. It eazes up when the tx is over. But I feel wiped out after tx and all I can do is rest. Don't feel well enough to go anywhere, couldn't possibly work, don't regain strength until the next day. My appetite is up and down.
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Founding RN
Joined: 10 Jan 2003
Posts: 172
PostPosted: Fri Aug 01, 2003 12:44 pm Post subject: Patientwife
Treatment plans are the dialysis prescription, the size of dializer, K bath, hours of run, dry weight goal, etc. <
><
>I think what you are really asking about is the nursing care plans for each patient.<
><
>There are 3 kinds<
>Monthly care plan<
>6 month care plan<
>Annual care plan <
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>These are federally mandated and it is composed of several parts. Those who contribute to the total care plan are the following:<
><
>Nephrologist<
>RN<
>Dietician<
>Social worker<
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>Each of these people have a section to fill out on the care plans. My experience has been that these can and do vary widely from company to company and state to state. And it seems that as time goes by, more and more is required on these. <
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>Patients can and should contribute to their care plans, but reality is that the paperwork is filled out by the staff and then presented to the patient to review and sign. Most patients seem not to care at all and just sign. I personally would like to see more patients and their families involved in this process. I have seen a few care plans that have an area for patient comments, but they have been few and far between.<
><
>The care plans should not have medical ab
eviations on them and the patient has the right to ask that the ab
eviations be clarified in language they can understand.
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Founding RN
Joined: 10 Jan 2003
Posts: 172
PostPosted: Fri Aug 01, 2003 1:03 pm Post subject: Joel
Machine prep for another patient happens as fast as the person setting it up is. Here is what usually happens and this can very as there are different kinds of machines out there.<
><
>Strip the old lines off the machine.<
>Clean outside with a bleach solution or something comparable.<
>Put machine in test, this can take up to 5 min.<
>Restring with new tubing and the dializer.<
>Hook up saline line to saline and the blood tubing and prime the new lines with saline. This means that you are filling the lines with saline and pushing out( dumping) the air, mem
ane particles and Renalin if you are using a reused dializer. When the machine has completed the alarm test, then the hansons can be hooked up to the dializer.<
>1000 cc's of saline should be run through the whole dializer to rinse out any Renalin and to adequately prime the whole blood tubing system. The Renalin and saline are dumped into a bucket.<
>Recirculation takes place after the whole system has been rinsed/ primed with saline. <
>A second bag of saline is then used to recirculate for 10-15 min. <
>After the recirculation is done, then the system should be tested for any Renalin residual. If it passes, then the system is ready for the next patient.<
><
>This whole process can take 20-30 min depending on how fast the tech is and how fast the machine passes the tests. <
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>
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Founding RN
Joined: 10 Jan 2003
Posts: 172
PostPosted: Fri Aug 01, 2003 1:06 pm Post subject: High Pulse
It sounds like your dry weight is too low for you. Try for a dry weight that is 0.5 kilos above what it is now. I think you might feel a bit better. Also look at your fluid intake. Is it more than 4 kilos? If so, then you are adding extra stain to your body and this comtibutes to your feelings of being wiped out and not recovering very fast. Your body can take only so much before it says enough is enought.
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high pulse
Joined: 01 Aug 2003
Posts: 6
PostPosted: Sat Aug 02, 2003 6:29 pm Post subject: high pulse
I have tried upping my dw .5, my average gain is 2.4 - 3 and I have had my heart fully checked, but I still have a high pulse at the end of txs. My last sitting pulse will be about 100-110 and when I do the standing it jumps up to 120-140. I come in with a normal pulse and during tx my pulse is usually in the 80's-90's.
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Founding RN
Joined: 10 Jan 2003
Posts: 172
PostPosted: Sun Aug 03, 2003 4:47 am Post subject: High Pulse
Are you eating well at home? If so, then 0.5 may not be enough and you may need to add another 0.5 to your weight. Another thing you could try is drinking a cup of fluid at the beginning of the last hour of your run. It takes about 20 min for it to hit your blood stream and may help as it will give the machine something to pull from you without stressing your heart. <
><
>Also are you able to exercise any? Just walking for 20-30 min several times a week can help strengthen your heart and get your heart rate down a bit.
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high pulse
Joined: 01 Aug 2003
Posts: 6
PostPosted: Tue Aug 05, 2003 8:29 am Post subject: high pulse
No, I'm not gaining weight. That's an idea about drinking a cup of fluid the last hour. Should I add a .2 to my goal at the beginning of tx?
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Founding RN
Joined: 10 Jan 2003
Posts: 172
PostPosted: Tue Aug 05, 2003 10:23 am Post subject:
High Pulse
First try it without adding it to your goal and see what happens and how you feel. Then if it works, then try adding it to your goal. <
><
>If this doesn't work, then you may need to consult with your Dr. He / she has access to your records and may be able to figure it out. I can only advise with the info you have given me.
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Nancy
Joined: 04 Mar 2003
Posts: 3
PostPosted: Sat Aug 09, 2003 5:18 am Post subject: Hi K
I had a high K this month (6.5). I had eaten a moderate high K fruit right before the tx when the labs were taken as I wanted to see if the tx would remove K or not. Could that of affected my labs? I only ate 1 cup which should not of been terribley high K. <
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>My K is being retested so I'll know for sure what it is soon. But in the meantime I do not want to go on a 1 K as the last time I did it made me very sick and uncomfortable for my entire tx.(I run 2K) I've never taken Kayexelate, but think that might not be as bad an alternative. Also, If I am just very careful not to eat much K or all low K for a week, will it go down on its own?<
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>I feel fine. Would there be any symptoms (before fatal ones of course) if I was much too high on K?
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high pulse
Joined: 01 Aug 2003
Posts: 6
PostPosted: Sat Aug 09, 2003 5:30 am Post subject: high pulse
I tried drinking fluid the last hr. I decided to have the .2 added to my goal at put on. I didnt enjoy drinking the water my last hr as I wasn't in the mood for it then, but I drank it down. As it turned out, it didnt affect my pulse at all. It was still high.<
><
>I tried coming in with a lower fluid gain for the next tx to see if the amount of fluid I remove would make a difference. I came in with 1.8 and removed 2.5 with the rinseback and 2 drinks on tx. My ending pulse was still just as high. <
><
>I asked the tech if she let me know what other patients pulses run. Whereas mine runs in the 90s-100 during the tx, she said most patient run in the 80's. <
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>I have had both heart tests recently and everything checks out. I think I get enough exercise although I didn't this past winter.
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Founding RN
Joined: 10 Jan 2003
Posts: 172
PostPosted: Mon Aug 11, 2003 5:22 am Post subject: Nancy
Yes, eating a higher K+ fruit made the difference on your labs. Advise you not to do that before labs are drawn again! If you eat the fruit long enough before dialysis so that it has been digested, it will be removed. <
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>If you go right back to eating like before, watching your K+ intake, you should have no problem. Just be aware that if and when you eat higher K+ foods, that you do so in moderation. Planning ahead so that it is on a dialysis day is also wise.<
><
>Kayexelate removes K+ by giving you diarrhea. I would not advise it as an alternative. <
><
>The symptoms my patients have felt have been an irregular heart rate, feeling anxious, twitching, and just a generalized feeling of something not right. Many of these patients also had a lot of fluid that needed to be taken off and so they were short of
eath too.
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Founding RN
Joined: 10 Jan 2003
Posts: 172
PostPosted: Mon Aug 11, 2003 5:28 am Post subject: High Pulse
From the information you have given, it is telling me that your body is stressing. Don't decrease your fluid intake. If you don't have enough fluid for the machine to take off, you increase the stress your body is under. <
><
>How long are your runs? <
>Do you used sodium modeling?<
>Do you use fluid modeling? <
><
>If you are on the verge of dehydration when you go into dialize, then I would expect an increase in pulse and feeling crapy. Try not adding the .2 to your goal and try drinking the fluid earlier in your run. Do some experimenting and see if you can figure out something that may work for you.<
><
>It may be that the increase in pulse is going to be normal for you. But make sure that you have enough fluid on for the machine to work with.
