I just read where a patient, who does not have CHF, more than not, will develop CHF while on dialysis... Also,,, what would cause a low pulse 50s post dialysis of eight hours? Usually the pulse during dialysis is in the 80 to 100s.. then after the same.. although, once with last treatment, pulse rate went down to 59
thanks. no bp meds taken before dialysis..or after, only at night and that dose is very small of 12.5 lopressor.. bp runs in 90s.. i need some additional input to bring to unit monday, thanks lots.

If patient is taking no beta blockers, as you say, I would suspect first degree AV block - maybe the patient needs to be evaluated for a pacemaker. Read any previous EKG's, or have the patient get an EKG and be evaluated by a cardiologist. Dialysis patients have many comorbids-many problems are not dialysis related but occur due to their co-morbids. The dialysis process may exacerbate these conditions while the cardiovascular homeostasis is compromised during the treatment. Not on digoxin either? Any AV block may cause a patient to develop CHF. Hope this helps.

thanks... when we took the bp and p about half an hour later.. it was back to his normal 90/60 or thereabouts, and 97 pulse...i was concerned about giving him the loprssor.. that isthe only med he is on for heart.. and it is a low dose 12.5 .. considering the pulse was fluctuating so much..
i noticed yesterday the machine read high 50's once..that was the first time.... monday i willhave the dialysis unit doc speak with thecardiologist.. they, actually have had no communication.. the communication between docs leaves alot to be desired, bt we have good docs and i think good unit...

also, wondering about determining/calculating how much fluid is taken off... i read 3% of dry weight should be limit for gain and anything over thta is fluid weight..... however, the unit takes prior post dialysis dry weight and subtracts from new weight then adds .3 for rinseback,, ofcourse, they do take into account if there is any SOB lying down,,,edema, which there is NOT.....
thanks so much

It does take a while to determine dry weight in the beginning. Also, although don't quote me on this, it takes 2500 calories a day extra for a week to gain a pound a week...most patients starting dialysis don't have that kind of appetite. It sounds like the unit is calculating correctly for take off weight, and asking the correct questions during pre assessment. If your dad's appetite increases consistently, target weight will have to reevaluated. Good luck!

dialysis nurse.. yes, his appetite is increasing.. however,, the bp continues to be in the 80's syst.... and pulse is back to where it was............however, he is lightheaded when standing, so i gave him some canned chicken soup that had salt. that is what they said to do.....it seems like they dehydrated him.............this is tough... and, on him as well, more than I.
thanks, much appreciated.

Personally, I would never want salty chicken soup when dehydrated. Dehydration causes thirst. Any other suggestions?

tht is what the doc said to give, or bouillon ... to raise the BP.. but i see your point,,,

quote:

Originally posted by Lewis:
Personally, I would never want salty chicken soup when dehydrated. Dehydration causes thirst. Any other suggestions?

Does he still urinate? If so, let the staff know. They may be taking too much fluid off of him.

YES YES YES,,,, he does urinate.. we have told the staff.... tomorrow we will discuss the calculations of weight..... I think, maybe doing anything above 3% might be better,,,,,, that is, over 3% is fluid....
the staff are, more than, consiencious, i think we lucked out wtih a good facility, since all I have read about negative experiences... we are greatful,,altho, I am a perfectionist with health care, and not is not a reality. lol
thanks for help....

we did talk to doc about irreg HR and now we dont take Lopressor if bp is below 120... he said not to worry about irreg hr. however, i am going to have the kidney doc call the cardiologist tomorrow, along with my calling cardio doc....

quote:

Originally posted by Dialysis Nurse:
Does he still urinate? If so, let the staff know. They may be taking too much fluid off of him.

I have had four or more patients that have either high or low potassiums that have affected the heartrate. Many times the slow rate reflects PAC's, PVC's and blocks that resolve when potassium is corrected. I've had patients that are overloaded with very low blood pressures and when you pull off fluid both the heartrates and blood pressures pick up. I have had patients that are too dry and have low blood pressures. They can be tachy but I've seen bradycardia too. It's a matter of how much blood the heart is getting and what areas of the heart aren't getting much. Those damaged hearts (cardiac myopathy) may never regain the ability to eject blood with any pressure. And I believe it's 3600 calories stored not burned to gain a pound.