Question

A patient has end-stage kidney disease and is receiving hemodialysis. During dialysis the patient complains of nausea and a headache and appears confused. On examination, the nurse finds that the blood pressure is very low. What is the priority action by the nurse? Select all that apply.

A. Decrease the volume of fluids being removed.
B. Infuse 0.9% saline solution.
C. Infuse hypertonic glucose solution.
D. Avoid excess coagulation.
E. Transfuse blood, as ordered

Answer 1

In a patient on hemodialysis presenting with nausea, headache, confusion, and low blood pressure, the nurse should decrease the fluid removal and infuse 0.9% saline solution to help stabilize blood pressure and volume.

Step-by-step explanation:

When a patient with end-stage kidney disease on hemodialysis complains of nausea, headache, and appears confused, accompanied by very low blood pressure, the priority actions by the nurse include:

• A. Decrease the volume of fluids being removed. This adjustment might help manage the symptoms by preventing a rapid decrease in blood pressure.
• B. Infuse 0.9% saline solution to help increase blood volume, which may in turn stabilize blood pressure.

Option C is not prioritized as hypertonic glucose solution would not necessarily address the immediate blood pressure concern. Option D, avoiding excess coagulation, is always a priority in dialysis, but it does not directly address acute hypotension. Option E, transfusing blood, could be considered if the blood loss is identified as the cause of the hypotension and if ordered by the physician.

The symptoms suggest the patient may be experiencing a complication called dialysis disequilibrium syndrome (DDS), which can occur due to rapid changes in the composition and volume of the blood during hemodialysis. Decreasing the volume of fluids being removed and infusing saline could mitigate DDS by stabilizing the patient's volume status and blood pressure.