Dialysis patient

[Cren]

I know it is common for dialysis patients to have HTN and diabetes. However I picked up a patient the other day who had a BP of 196/60. The nurse with the patient said her BP was ok because she has dialysis. I thought the systolic was high, any thoughts?

 

[Aprz]

Yeh, I think it's high, but dialysis patients have difficulty getting rid of fluids without dialysis because of end stage renal disease (ESRD).

 

[Cren]

Yeh, I think it's high, but dialysis patients have difficulty getting rid of fluids without dialysis because of end stage renal disease (ESRD).

I agree 100 percent. This patient however had her dialysis done the day before I picked her up so it is not like she went without it for a long period of time. With that said I guess everyone is different and maybe this patient in particular tends to hold fluids differently.

 

[Clipper1]

Duplicate

 

[Clipper1]

What type of renal insufficiency does she have? Meds? Is it time for her meds? How much did they pull off? Fluid is only one issue. Didshe get anything in addition? Dialysis patients are brittle but somehow tolerate lab imbalances and BP fluctuations. That is not to say they cannot have other issues which probably le ad to the dialysis.

 

[VFlutter]

Was it just before or after Dialysis?

 

[Cren]

The pt had dialysis the day before I picked her up. She had a Hx of psychosis, Esrd, HTN, and diabetes. Nurse said she was maxed out in labetalol.

 

[Handsome Robb]

ESRD + HTN would explain that BP. Clipper brought up some very good and important questions to ask as well.

 

[Cren]

Yes I agree Esrd and HTN explains the BP. I just thought the fact that this Pt is maxed out on labetalol and the BP is still in the 190s systolic that it is still high even for a dialysis Pt. basically the nurse was telling me not to worry about the BP because the Pt is a dialysis Pt.

 

[Clipper1]

Yeh, I think it's high, but dialysis patients have difficulty getting rid of fluids without dialysis because of end stage renal disease (ESRD).

Dialysis is also about getting rid of the toxins. Some patients still urinate (sometimes frequently especially at night) but their kidneys are no longer able to filter the toxins. If you listen to some of the dialysis patients on Monday following a weekend off dialysis you will find they are free of crackles and may have urinated regularly especially if they maintain a good diet. These are also rather difficult to assess since they will be symptomatic but from serious electrolyte imbalances and the symptoms might be difficult to assess. These are the ones who may get a quick 20 - 30 mg Albuterol neb by a BAN while dialysis is being set up.

Remember the kidneys influence blood pressure by causing the arteries and veins to constrict as well as increasing the circulating volume in the blood.

 

[mycrofft]

They may have meant that pt's usual BP is in that range.