Author Topic: Questions Part 44 (part a)  (Read 1538 times)

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Questions Part 44 (part a)
« on: August 30, 2009, 10:12:41 AM »
Founding RN



Joined: 10 Jan 2003
Posts: 172

   
PostPosted: 05 Mar 2003 16:31    Post subject: Educational Questions, Part 44    

To our Readers and Posters,<
>The best defense in any fight against a disease is education. <
>This column of questions and answers is an attempt in that direction. Anyone is welcome to ask questions. <
><
> What I want to reiterate again is that my answers to your questions DO NOT and SHOULD NEVER take the place of your Dr.'s advice. I am not a Dr. and my answers are based on my many years of experience in the dialysis field. What works for one patient may not work for another. EVERY Patient needs to schedule and attend regular visits with your Dr. in their office.<
><
>This column is for dialysis and dialysis related questions. Please be aware that clinics and companies, machines, policies and procedures vary from place to place. <
><
>I hope that we can help in furthering your dialysis education.
>Thank you!<
>Founding RN <
><
>P.S. I work full time so I may not be able to answer your questions right away. But I will get to them ASAP! <
>

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realdialysisethics



Joined: 06 Jan 2003
Posts: 41

   
PostPosted: 05 Mar 2003 20:08    Post subject: Re: Educational Questions, Part 44    

Bill<
>Unregistered User<
>(3/5/03 1:39:24 pm)<
>209.240.198.61<
>Reply | Edit | Del All Bloodwork<
>--------------------------------------------------------------------------------<
> Is it just the bun that they are taking blood for post tx? Is the KT/v, URR and other labs taken at put on? <
><
>If it is more accurate to take the labs at the midweek tx do they take them on the first tx so they will look better?<
><
>I am not at all a science person, but I have really enjoyed learning about my dialysis tx. through this board. The very clear rationale you give for each tx question
ings the subject alive.


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Founding RN



Joined: 10 Jan 2003
Posts: 172

   
PostPosted: 05 Mar 2003 20:15    Post subject: Bill    

Yes, it is just the BUN that is being drawn. The other labs are drawn at the begining of the run. The reason most places draw the labs on the first run of the week is that they ship them across country and need to process them that week. If they draw them on the second run of the week, they can't get the job done. No, the labs do not look better, you have the extra day of food and fluids in those lab results.<
>Bill, the reason for this column is just for people like you! I am very glad that this is helping you. <
>

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Lynn



Joined: 01 Mar 2003
Posts: 6

   
PostPosted: 06 Mar 2003 20:25    Post subject: Sodium modeling    

I tried sodium modeling as you suggested starting at 145, ending with 140, cutting off the sodium the last 30 min. I still had the last hour strain I usally feel, but it semed a little gentler. And then the last 30 min was good as I coasted to the end without strain at all. It did not affect my bps. I thought from things I've read that it would keep my bp up more, but it didn't. I also, did not experience any thirst which was good. It was a partial improvement, but I believe dialysis can be better than this as I've had txs that were free of this strained feeling. I even lowered my goal .2, but the machine still
ought me out .2 below my goal. Maybe lowering my goal a little more will provide a better adjustment. I also only removed 2.3, yet I've removed a max. of 3.6 with no strain when other features of the tx were apparantly in balance. Thank you for giving me the confidence/education to try sodium modeling. I believe I'm going to get to the bottom of what this strained feeling is and will be so glad when I do.

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Founding RN



Joined: 10 Jan 2003
Posts: 172

   
PostPosted: 07 Mar 2003 03:16    Post subject: Lynn    

It sounds like you are one of those people who release fluid easily. Do set your goal .5 above your dry weight and see how you feel. If you come off at your dry weight and feel good, then that may be what is happening. You could even try starting your sodium modeling higher, like 148 and end it at 140 to see what that does for you. You could also try fluid profiling if it is available on your machine. Set it on a program that will pull the majority of your fluid off in the first 2/3rds of you run so you can pretty much coast to the end. Play around with what you have available and see what works for you. Good Luck!

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Mover



Joined: 08 Mar 2003
Posts: 1

   
PostPosted: 08 Mar 2003 14:23    Post subject: question from tx gal    Reply with quote Edit/Delete this post Delete this post View IP address of poster
<
>--------------------------------------------------------------------------------<
> i have been following (and been arguing with) a discussion in the administrators forum website, located at BRUMLEY.COM. a "nurse" on there had been
agging about how she shorts patients on the epogen amt. so she/he could stretch the medication. this THING (can't call it a person!) said that they would even push air bubbles or saline and call it epogen. i got mad of course and wrote back (my posting is called -left behind) ANYWAY..i was told later that he/she was not actually helping the company as i thought and was helping the pt. because of the effects of epogen. now i am really confused!!

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Founding RN



Joined: 10 Jan 2003
Posts: 172

   
PostPosted: 09 Mar 2003 14:25    Post subject: Mover    

The RN is required to give that patient the amount of EPO ordered by the Dr. or perscribed by the written and approved policy of that unit. This is fraud and if it can be proved and they have been charging not only Medicare for the entire dose, but also the insurance company, then they could be held legally liable. By not doing so that RN is in violation of her nursing license and could lose it. Someone in that clinic should report that RN to not only the state, but also to the state RN licensing organization. She is not helping that patient at all by shorting them of their EPO. <
><
>Just a couple weeks ago it was reported on this site that a clinic back East had been investigated and shut down to this very thing. EPO has been the subject of many investigations as these companies have written up policies that manipulate EPO dosing to the financial advantage of the companies, not to the benefit of the patients. <
>

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Sheila



Joined: 09 Mar 2003
Posts: 1

   
PostPosted: 09 Mar 2003 19:32    Post subject: Broken blood vessel    

My eye felt dry so I put in some eye drops. The next day I woke up with
oken blood vessels I guess. The white part of my eye is very red. Could this in any way be related to dialysis? It does not hurt at all, butlooks terrible. I've never had this before. I will see my neph soon and ask him too.

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Founding RN



Joined: 10 Jan 2003
Posts: 172

   
PostPosted: 10 Mar 2003 01:38    Post subject: Sheila    

It might be a reaction to something in the eye drops. Do ask your neph when you go in next to see him.<
><
>What you might try is a tiny bit of Johnson's Baby No Tears shampoo to clean the tear ducts. Gently massage the shampoo in that area to help unplug dirt and rinse very well. It does give a slight sting, but not uncomfortable. It helps to get your ducts open and adequate moisture to your eyes. It may make your eyes a bit red, but soon goes away. I usually do this when in the shower and it really helps me. The dialysis enviorment is a prime contributor to this.

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Jean



Joined: 10 Mar 2003
Posts: 1

   
PostPosted: 10 Mar 2003 07:58    Post subject: low bp    

When I go on dialysis my bp is usually 120-140. When I get off my bps drop into the 90's. It goes into the 90's most of time whether my goal is 2.0 or 3.0, or whether I go to my dw or come out .5 above my dw. Is this normal, because I can not feel good comming off this low? Is there anything I can or should do?

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Founding RN



Joined: 10 Jan 2003
Posts: 172

   
PostPosted: 11 Mar 2003 02:57    Post subject: Jean

If you feel bad each time when your BP is in the 90's,

 then please talk to your Neph about this. Is there a possibility of you gaining real weight? If so your DW may need to be changed.<
> If not, you may be one of the few patients out there who may benefit from one of the medications that keeps your BP up. Your Dr. will need to evaluate this and perscribe it if it is appropriate.

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JK



Joined: 11 Mar 2003
Posts: 1

   
PostPosted: 11 Mar 2003 18:55    Post subject: high pulse    

What causes the pulse to rise at the end of tx? My pulse is in the 90's most of tx and then goes into the 100.s towards the end. Then the standing pulse jumps up to 110-130. Is this in any way damaging? Do most patients experience this?

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patient



Joined: 30 Oct 2002
Posts: 137

   
PostPosted: 11 Mar 2003 19:13    Post subject: UF Profiling    

I asked my nurse if I could try UF Profiling and she said that UF Profiling is only for big fluid gainers and I'd have to get permission from my doctor if I wanted to try it. Is this erroneous info, because I asked my doctor and he said I could try it. Can UF modeling be done with straight sodium or must it be done along with sodium modeling?

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Bev



Joined: 11 Mar 2003
Posts: 1

   
PostPosted: 11 Mar 2003 19:27    Post subject: Company protocols    

Let's say a company's protocol is you can not have the prime dumped, but as a patient you feel it is in your best interests to have it dumped. I was in a unit that did not dump the prime. Then another co. bought the unit and their policy was to dump the prime on every patient. So there is certainly a difference in opinion on protocols. But what about the patient's opinion/choice for his own care? Must co. protocols make it impossible for patients to have a choice in how they'd like their tx carried out?

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Founding RN



Joined: 10 Jan 2003
Posts: 172

   
PostPosted: 12 Mar 2003 04:41    Post subject: JK    

The most common reason the pulse goes up at the end of treatment is that the patient is getting too dry. You may need to reevlauate your DW and increase it. If you decide to do so, just increase by 0.5 kilos. That usually is enough to tell you if it is real weight you have gained or a possible heart problem that your Dr. needs to check out.

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Founding RN



Joined: 10 Jan 2003
Posts: 172

   
PostPosted: 12 Mar 2003 04:45    Post subject: Patient    

UF profiling can be used even for small gainers. I have used it on the elderly patients to help them remove fluid at a more comfortable rate. Your unit may have a policy that requires a Dr's order. If you want to try it, get a Dr's order and go for it.<
><
>UF profiling can be used with or without sodium modeling. I would recomend that you use it with sodium modeling.

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Founding RN



Joined: 10 Jan 2003
Posts: 172

   
PostPosted: 12 Mar 2003 04:49    Post subject: Bev    

Staff must follow company protocol otherwise they can get in trouble not only with the company, but also with state inspectors if they are found not to follow company protocol. Only your Dr can override company protocol with an order. If you want your prime dumped, you will need an order from your Dr.
« Last Edit: August 30, 2009, 12:14:04 PM by Administrator »
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