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COURSE IN THE WARD

DATE

DOCTORS
ORDER

July 24,
2014
Time left:
1:00
BP:
190/100

July 27,
2014

NURSES NOTES
Hemodialysis
temporary
terminated.
Increase TMP
(304) due to
clotted dialyzer
and clotted
arterial and
venous chamber
Cramps /
UFR
=
FR

- Renogen 4,000
IU/ SC 2x/week

August 5,
2014
Time left:
0:30
BP: 140/80
September - Try to cannulate
19, 2014
AVF if possible

September - Problem fever


- Cannulate AVF,
23, 2014
if successful,
remove IJ
catheter
- Levefloxacin
(loxeva)
500mg/tab 1
tab OD x 7
days

INTERPRETATION
High TMP readings may indicate
that blood clotting is present in
the dialyzer. Flushing the
dialyzer with saline may reduce
the TMP to a normal range.

Renogen is a treatment of
anemia associated with chronic
renal failure. Reduction of
allogenic blood transfusion in
the surgery patient.
Hemodialysis
Clot at venous chamber cannot
temporary
be removed but can be
terminated due to
minimized by proper priming i.e.
clotted arterial and u have to check if the blood
venous chambers
level is too low that increase
blood contact surface with air.
Temporary
Chills during dialysis can be a
terminated due to
sign of infection, since the
severe chills
process of dialysis can activate
Act. UVF: 2. 4 L
dormant germs in your dialysis
Removing: 1:36
access and send them through
your blood stream, causing the
reaction of chills and shakes.
- The number one cause of fever
in renal dialysis patients is
infection. Dialysis patients
always have a poor immunity,
due to the great loss of protein
from urine and dialysis, as well
as strict diet control, which
makes them fail to get enough
nutrition for a strong immune

system.
October 17, - Transfuse 1
2014
unit PRBC

October 28, 2014


Time left:
2:00
BP: 160/80

November 25, 2014


BP: 130/70

November - May remove


28, 2014
suture of AVF

December - May remove IJ


2, 2014
catheter

December 8, 2014
Time left:
1:00
BP: 110/60

- A blood transfusion is a safe and


relatively simple medical
procedure that replaces blood
lost during surgery or because
of an injury or illness.
1:00pm
- In dialysis patient, blood
BT started PRBC
transfusion is required if the
B(+)
hemoglobin is low or if there is
a presence of bleeding. Since
2:45pm
in the patients case, there is
BT ended, no BT
no reaction noted which means
reaction noted
the blood transfusion is
successful.
Time left: 3:00
- The procedure was temporary
Temporary
terminated just because there
terminated due to
is insufficient or inadequate
insufficient supply
supply that must the patient
need to continue the
Time left: 2:30
procedure.
HD restarted
The suture may remove if the
physician foresee that there an
improvement of the laceration, it
may help for good healing of the
wound.
Internal jugular venous access is
the direct route from the right
internal jugular vein to the
superior vena cava facilitates
hemodialysis access and
pulmonary artery catheter
placement. Its removal is
defending on the physicians
order. It is remove if there is no
more need of the IJ catheter for
the patient who undergone
dialysis.
- FR=
UFR- In hemodialysis water is
110/60
removed by hydrostatic
- Placed in Tultrafiltration which is a
position
pressure phenomenon. The
- BP rechecked
pressure on the dialysate side

120/60
- (-) hoarseness of
voice
-

January 3, - Domperidone
2015
10mg 1tab 3x
a day
- Esomephrasole
40mg 1cap OD
before
bedtime
- Problem: with
dyspeptic like
symptoms

January 6,
2015
Time left:
0:30

January 13, 2015


Time left:
2:00

- Early termination, pain at arms

- (+) cramps
- UFR=
FR

is lowered and water moves


from a place of higher pressure
to one of lower pressure
T- position- the body is laid flat
on the back (supine position)
with the feet higher than the
head by 15-30 degrees. Use to
avoid hypotention.
Hoarseness, an abnormal
change in your voice, is a
common symptom often
experienced with a dry,
scratchy throat.
Domperidone is a medicine that
increases the movements or
contractions of the stomach
and bowel.
Esomeprazole is a proton pump
inhibitor which reduces
stomach acid secretion.
dyspeptic like symptoms is
characterized by the symptoms
like dyspepsia such as upper
abdominal pain, belching,
nausea, vomiting, abdominal
bloating, early satiety, and
abdominal distention
The fistula reduces the blood
supply, or rather makes the
flow over the fistula abnormal,
the reduction of blood supply is
known as Steal Syndrome and
may result from pain at arms
Ultrafiltration may also be
reduced due to very low
peritoneal solute transport
rates
Muscle cramping is common on
hemodialysis. The cause of
muscle cramping is unknown.
However, three conditions that
seem to increase cramping are:
1) hypotension; 2) the patient
being below dry weight; and 3)
use of low sodium dialysis

solution.
January 16, 2015
Time
left:0:30

- (+) leg cramps


- completed

January 27, - continue meds


2015
Time
left:1:30

- FR=
UFR
- (+) cramps

January 30, 2015


Time left:
0:20

- Early termination
as per patient
request due to
severe hand and
leg cramps

Muscle cramping is common on


hemodialysis. The cause of
muscle cramping is unknown.
However, three conditions that
seem to increase cramping are:
1) hypotension; 2) the patient
being below dry weight; and 3)
use of low sodium dialysis
solution.
Muscle cramping is common on
hemodialysis. The cause of
muscle cramping is unknown.
However, three conditions that
seem to increase cramping are:
1) hypotension; 2) the patient
being below dry weight; and 3)
use of low sodium dialysis
solution.
Muscle cramping is common on
hemodialysis. The cause of
muscle cramping is unknown.
However, three conditions that
seem to increase cramping are:
1) hypotension; 2) the patient
being below dry weight; and 3)
use of low sodium dialysis
solution.