Urinary Disorders Q 48

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The hemodialysis client with a left-arm fistula is at risk for steal syndrome. The nurse assesses this client for which of the following clinical manifestations?

  

    A. Warmth, redness, and pain in the left hand.

    B. Pallor, diminished pulse, and pain in the left hand.

    C. Edema and reddish discoloration of the left arm.

    D. Aching pain, pallor, and edema in the left arm.

    

    

Correct Answer: B. Pallor, diminished pulse, and pain in the left hand.

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Steal syndrome results from vascular insufficiency after the creation of a fistula. The client exhibits pallor and a diminished pulse distal to the fistula. The client also complains of pain distal to the fistula, which is due to tissue ischemia. Ischemic steal syndrome (ISS) is a complication that can occur after the construction of a vascular access for hemodialysis. It is characterized by ischemia of the hand caused by marked reduction or reversal of flow through the arterial segment distal to the arteriovenous fistula (AVF).

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Option A: Warmth, redness, and pain more likely would characterize a problem with infection. The diagnosis of hand ischemia is based on physical examination, but imaging studies are very useful for detecting the true cause of ischemia and for selecting an appropriate therapeutic strategy. The distal ischemic steal syndrome (ISS) is a possible complication following the construction of an arteriovenous (AV) access for hemodialysis.

Option C: ISS is caused by a substantial decrease or even reversal of blood flow (“steal”) through the arterial segment distal to the vascular access. These changes are due to the presence of low resistance in the AV access or to hypoperfusion secondary to distal arteriopathy. Both of these factors frequently contribute to symptomatic ischemia.

Option D: It occurs in approximately 1–20 percent of patients with an upper extremity access, and its clinical manifestations can include various signs and symptoms, ranging from coolness, pallor, mild paresthesia, and pain during dialysis to severe symptoms, such as pain at rest, paralysis, ulceration, tissue necrosis, and loss of one or more fingers or the entire hand.

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