The client newly diagnosed with chronic renal failure recently has begun hemodialysis. Knowing that the client is at risk for disequilibrium syndrome, the nurse assesses the client during dialysis for:
A. Hypertension, tachycardia, and fever.
B. Hypotension, bradycardia, and hypothermia.
C. Restlessness, irritability, and generalized weakness.
D. Headache, deteriorating level of consciousness, and twitching.
Correct Answer: D. Headache, deteriorating level of consciousness, and twitching.
Disequilibrium syndrome is characterized by headache, mental confusion, decreasing level of consciousness, nausea, and vomiting, twitching, and possible seizure activity. Disequilibrium syndrome is caused by the rapid removal of solutes from the body during hemodialysis. At the same time, the blood-brain barrier interferes with the efficient removal of wastes from brain tissue. As a result, water goes into cerebral cells because of the osmotic gradient, causing brain swelling and the onset of symptoms. The syndrome most often occurs in clients who are new to dialysis and is prevented by dialyzing for shorter times or at reduced blood flow rates.
Option A: Symptoms are commonly seen in patients with high blood urea nitrogen levels, in patients with chronic kidney disease (CKD) versus acute kidney injury, and with aggressive urea removal after initial dialysis treatment. In severe cases, symptoms can progress to seizure, somnolence, stupor, or coma leading to mortality.
Option B: Some symptoms, such as dizziness and muscle cramps that occur towards the latter part of dialysis, are also considered to be part of DDS. Rarely, DDS can present as increased intraocular pressure. Dialysis disequilibrium syndrome is usually self-limited, with symptoms resolving in a short interval. The prognosis is generally favorable, and dialysis does not need to be stopped in the majority of cases.
Option C: Most cases of DDS can be mild and self-limited, with patients reporting headache, nausea, or blurred vision as well as other CNS symptoms such as restlessness and confusion. These symptoms usually begin soon after the initiation of dialysis and resolve within hours in most cases. The complications of dialysis disequilibrium syndrome include consequences from delay in recognition of the condition and delay in implementing prevention strategies.
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