A client receiving hemodialysis treatment arrives at the hospital with a blood pressure of 200/100, a heart rate of 110, and a respiratory rate of 36. Oxygen saturation in room air is 89%. He complains of shortness of breath, and +2 pedal edema is noted. His last hemodialysis treatment was yesterday. Which of the following interventions should be done first?
A. Administer oxygen.
B. Elevate the foot of the bed.
C. Restrict the client’s fluids.
D. Prepare the client for hemodialysis.
Correct Answer: A. Administer oxygen.
Airway and oxygenation are always the first priority. Because the client is complaining of shortness of breath and his oxygen saturation is only 89%, the nurse needs to try to increase his levels by administering oxygen. Evaluate development of tachypnea, dyspnea, increased respiratory effort. Drain dialysate, and notify the physician.
Option B: The foot of the bed may be elevated to reduce edema, but this isn’t the priority. Turn from side to side, elevate the head of the bed, apply gentle pressure to the abdomen. May enhance outflow of fluid when the catheter is malpositioned and obstructed by the omentum.
Option C: Maintain fluid restriction as indicated. Fluid restrictions may have to be continued to decrease fluid volume overload. Monitor BP and pulse, noting hypertension, bounding pulses, neck vein distension, peripheral edema; measure CVP if available.
Option D: The client is in pulmonary edema from fluid overload and will need to be dialyzed and have his fluids restricted, but the first interventions should be aimed at the immediate treatment of hypoxia. Alter dialysate regimen as indicated. Changes may be needed in the glucose or sodium concentration to facilitate efficient dialysis.
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