Post Dialysis Nursing Care 1. Assess and document vital signs, weight, and vascular access site condition.

Rapid fluid and solute removal during dialysis may lead to orthostatic hypotension, cardiopulmonary changes, and weight loss. 2. onitor !"N, serum creatinine, serum electrolyte, and hematocrit levels #etween dialysis treatments. $hese values help determine the effectiveness of the treatment, the need for fluid and diet restrictions, and the timing of future dialysis sessions. $he anemia associated with renal failure does not improve with dialysis, and iron and folate supplements or periodic #lood transfusions may #e needed.

%. Assess for dialysis dise&uili#rium syndrome, with headache, nausea and vomiting, altered level of consciousness' and hypertension. Rapid changes in !"N, p(, and electrolyte levels during dialysis may lead to cere#ral edema and increased intracranial pressure. ). Assess for other adverse responses to dialysis, such as dehydration, nausea and vomiting, muscle cramps, or sei*ure activity.$reat as ordered. +,cess fluid removal and rapid changes in electrolyte #alance can cause fluid deficit, nausea, vomiting, and sei*ure activity. -. Assess for #leeding at the access site or elsewhere. "se standard precautions at all times. Renal failure and heparini*ation during dialysis increase the ris. for #leeding. /re&uent e,posure to #lood and #lood products increase the ris. for hepatitis ! or C or other #lood#orne diseases. 6. 0f a transfusion is given during dialysis, monitor for possi#le transfusion reaction 1e.g., chills and fever' dyspnea' chest, #ac., or arm pain' and urticaria or itching2. Clients in renal failure may receive multiple transfusions, increasing the ris. of transfusion reaction. Close monitoring during and after the transfusion is important to identify early signs of a reaction. 7. Provide psychologic support and listen actively. Address concerns and accept responses such as anger, depression, and noncompliance. Reinforce client and family strengths in coping with renal failure and hemodialysis. 3rieving is a normal response to loss of organ function. $he client may feel hopeless or helpless and resent dependence on a machine. $he nurse can help the client and family wor. through these responses and /ocus on positive aspects of living. 8. Refer to social services and counseling as indicated. Clients with renal failure may need additional support services to help them adapt to and live with their disease.

Post Dialysis 1. At the end of the prescri#ed time, the patient is disconnected from the plum#ing 4 #lood lines 1which is removed and discarded, e,cept perhaps for the filter, which may #e sterili*ed and reused for the same patient at a later date2. Needle wounds 1in case of fistula2 are #andaged with gau*e, held for 15 to 1- minutes with direct pressure to stop #leeding, and then taped in place. $he process is similar to getting #lood drawn, only it is lengthier, and more fluid or #lood is lost. 2. $emperature, standing and sitting #lood pressure, and weight are all measured again. $emperature changes may indicate infection. 6eighing is to confirm the removal of the desired amount of fluid. %. Care staff verifies that the patient is in condition suita#le for leaving. $he patient must #e a#le to stand 1if previously a#le2, maintain a reasona#le #lood pressure, and #e coherent 1if normally coherent2. Different rules apply for in4patient treatment.

Post Dialysis washout. /ollowing hemodialysis, patients may e,perience a syndrome called 7washout7. $he patient feels wea., tremulous, e,treme fatigue. Patients report they 7are too tired, too wea. to converse, hold a #oo. or even a newspaper.7 0t may also vary in intensity ranging from whole #ody aching, stiffness in 8oints and other flu4li.e symptoms including headaches, nausea and loss of appetite. $he syndrome may #egin toward the end of treatment or minutes following the treatment. 0t may last %5 minutes or 1241) hours in a dissipating form. Patients though e,hausted have difficulty falling asleep. +ating a light meal, rest and &uiet help the patient cope with washout until it has 9worn away.9

:u#mitted #y ; Noscal, +ugenio <r. !. !:N)4A, 3roup % :u#mited $o ; rs. Antonietta Rosemelinda C. +dra RN, Clinical 0nstructor. AN.

Resources ;
http://wps.prenhall.com/wps/media/objects/737/755395/hemodialysis.pdf Step-by-step_description_of_hemodialysis !ost-dialysis