The client being hemodialyzed suddenly becomes short of breath and complains of chest pain. The client is tachycardic, pale, and anxious. The nurse suspects air embolism. The nurse should:
A. Continue the dialysis at a slower rate after checking the lines for air.
B. Discontinue dialysis and notify the physician.
C. Monitor vital signs every 15 minutes for the next hour.
D. Bolus the client with 500 ml of normal saline to break up the air embolism.
Correct Answer: B. Discontinue dialysis and notify the physician
If the client experiences air embolism during hemodialysis, the nurse should terminate dialysis immediately, notify the physician, and administer oxygen as needed. This maximizes oxygen for vascular uptake, preventing or lessening hypoxia. Elevate the head of bed or have a patient sit up in a chair. Promote deep-breathing exercises and coughing.
Option A: Monitor respiratory rate and effort. Reduce infusion rate if dyspnea is present. Tachypnea, dyspnea, shortness of breath, and shallow breathing during dialysis suggest diaphragmatic pressure from a distended peritoneal cavity or may indicate developing complications.
Option C: Auscultate lungs, noting decreased, absent, or adventitious breath sounds: crackles, wheezes, rhonchi. Decreased areas of ventilation suggest the presence of atelectasis, whereas adventitious sounds may suggest fluid overload, retained secretions, or infection.
Option D: Note character, amount, and color of secretions. The patient is susceptible to pulmonary infections as a result of depressed cough reflex and respiratory effort, increased viscosity of secretions, as well as altered immune response, and chronic and debilitating disease.
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