The nurse is performing an assessment on a client who has returned from the dialysis unit following hemodialysis. The client is complaining of a headache and nausea and is extremely restless. Which of the following is the most appropriate nursing action?
A. Notify the physician.
B. Monitor the client.
C. Elevate the head of the bed.
D. Medicate the client for nausea.
Correct Answer: A. Notify the physician
Disequilibrium syndrome may be due to the rapid decrease in BUN levels during dialysis. These changes can cause cerebral edema that leads to increased intracranial pressure. The client is exhibiting early signs of disequilibrium syndrome and appropriate treatments with anticonvulsant medications and barbiturates may be necessary to prevent a life-threatening situation. The physician must be notified.
Option B: Regardless of severity, DDS is initially treated by modifying the dialysis prescription. This is done by changing the sodium dialysate bath or engaging the changed prescription on the dialysis machine. The symptoms should resolve as quickly as within 30 minutes. However, if symptoms do not resolve with treatment, it may be required to stop the dialysis occasionally to evaluate for other underlying causes of the symptoms.
Option C: Modalities to prevent the development of DDS include implementing a slow and gentle initial hemodialysis, limiting the clearance of urea to prevent the development of an osmotic gradient, increasing dialysate sodium level, and administration of osmotically active substances. Evidence-based guidelines are lacking, but most experts agree on the gradual clearance of urea.
Option D: In patients with severe symptoms of DDS despite sodium remodeling, a trial to decrease intracerebral pressure could be taken. Some experts suggest using 5 milliliters of 23% saline or 12.5 milligrams of intravenous mannitol to increase the plasma osmolarity and simultaneously decrease further osmotic shift, but these are based on anecdotal evidence and limited data.
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