| 👀 Peritoneal Dialysis Care – Preparation before dialysis, monitoring during dialysis, post-dialysis care, and infection prevention. 👀 Hemodialysis Care – Checking vascular conditions before dialysis, monitoring vital signs during dialysis, post-dialysis bleeding prevention, patient lifestyle guidance, and AV fistula care education. 👀 Common Nursing Precautions – Infection prevention, complication management, and the importance of patient education. |
Hemodialysis Nursing Care
Scenario Title: Holistic Hemodialysis Patient Monitoring and Education
Setting: Hospital dialysis unit
Characters:
- Nurse (RN) – Hemodialysis-trained nurse
- Mr. Kim (Patient) – Adult male undergoing regular hemodialysis treatments
Phase 1: Pre-Dialysis Nursing Care
Nurse: Welcome, Mr. Kim! Let’s confirm your dialysis schedule first. Your session is scheduled for 2:00 PM today, correct?
Mr. Kim: Yes, that’s right.
Nurse: Great. Did you finish your meal at least two hours before the session?
Mr. Kim: Yes, I had lunch around 11:00 AM.
Nurse: Excellent. Let’s check your weight before dialysis. Please step on the scale.
Mr. Kim: (After weighing) It’s 70.5 kg.
Nurse: Got it. This pre-dialysis weight helps us calculate the target fluid removal. Let’s examine your arteriovenous (AV) fistula next.
Mr. Kim: Sure.
Nurse: Please extend your arm. I’ll check for redness, swelling, warmth, pain, or any signs of infection. (Examining) The site looks healthy. Now, can you lightly touch the fistula area and tell me if you feel a vibration?
Mr. Kim: Yes, I feel it.
Nurse: That’s the thrill. I’ll now use my stethoscope to check the bruit. (Listens) Blood flow sounds good. If the vibration weakens or disappears, let the hospital know right away.
Mr. Kim: Understood.
Nurse: Remember to keep the area clean and dry, avoid rubbing it excessively, and wash with soap and water daily.
Mr. Kim: I’ve been careful about that.
Nurse: Excellent. Also, never use this arm for blood pressure measurements, injections, or blood draws. Avoid lifting heavy objects and sleeping on that arm.
Mr. Kim: Yes, I’ve been mindful.
Nurse: Light hand exercises like squeezing a rubber ball are helpful. Combine this with a low-sodium, low-fat, and low-potassium diet. Stick to the fluid limits prescribed by your doctor.
Mr. Kim: I follow those instructions.
Nurse: If you experience bleeding at the fistula site, press with sterile gauze firmly. If it doesn’t stop, seek help immediately.
Mr. Kim: Got it.
Nurse: All checks are complete. You’re ready for the session. Any questions?
Mr. Kim: Not at the moment. Thanks for the explanation.
Nurse: You’re welcome. Please rest here until the session begins.
Phase 2: Nursing Care During Hemodialysis
Nurse: Mr. Kim, your session has begun. I’ll monitor your vital signs regularly. Are you feeling any discomfort right now?
Mr. Kim: No, I feel okay.
Nurse: Let me check your vitals. (Measures) Your blood pressure is 120/80, pulse is 75 bpm, and temperature is 36.5°C — all normal. I’ll recheck every 15 to 30 minutes.
Mr. Kim: Thank you.
Nurse: (Checks dialysis machine) The machine is running normally. I’ll check your vascular access.
Mr. Kim: Is everything fine?
Nurse: Yes, the access site is working well, and the blood flow is strong. No machine alerts.
Mr. Kim: That’s good to hear.
Nurse: If you feel nausea, cramping, or headache, let me know immediately.
Mr. Kim: I will.
Nurse: (15 minutes later) Time to recheck vitals. (Measures) Still stable—excellent.
Mr. Kim: I’m feeling fine.
Nurse: Great. Be aware that some patients may experience low blood pressure or arrhythmias. Alert me if anything feels unusual.
Mr. Kim: Understood.
Nurse: (Checks machine) Blood flow and alarms are normal.
Mr. Kim: Thank you.
(30 minutes later)
Mr. Kim: Nurse, I feel a little dizzy.
Nurse: I’ll check your BP. (Measures) It’s slightly low — a sign of hypotension. I’ll recline your chair and elevate your legs.
Mr. Kim: Okay, thank you.
Nurse: (After adjustment) How do you feel now?
Mr. Kim: It’s getting better.
Nurse: Good. I’ll keep observing your vitals. If needed, I’ll notify the doctor.
Mr. Kim: Alright.
Nurse: (Rechecks) Blood pressure is stabilizing. Let me know if you feel any other symptoms.
Mr. Kim: Will do.
Phase 3: Post-Dialysis Nursing Care
Nurse: Mr. Kim, your session is complete. Are you feeling okay?
Mr. Kim: I feel tired but not too bad.
Nurse: Let’s check your post-dialysis vitals. (Measures) BP is 115/75, pulse 72, temperature 36.5°C — all good. What was your pre-dialysis weight?
Mr. Kim: 70.5 kg.
Nurse: Your post-dialysis weight is 69.5 kg. That’s a 1 kg fluid removal — within the expected range. Any dizziness or nausea?
Mr. Kim: Just a bit dizzy.
Nurse: Please lie down for a while and don’t move by yourself. Rest is important.
Mr. Kim: Okay.
Nurse: I’ll now apply pressure on the fistula site for bleeding control using sterile gauze. This will take about 20 minutes.
Mr. Kim: Understood.
Nurse: (Applies pressure) I’ll monitor for bleeding or swelling. If anything unusual happens at home, report immediately.
Mr. Kim: I will.
Phase 4: Education and Lifestyle Guidance
Nurse: Let’s review AV fistula care. Keep the site clean and dry. Wash with soap, rinse, and pat dry. No scratching or friction.
Mr. Kim: I’ve been following that routine.
Nurse: Good. Check for a vibration (thrill) or sound (bruit) daily. If either is absent, report to the hospital.
Mr. Kim: Got it.
Nurse: Never allow blood pressure or injections on that arm. Avoid carrying heavy items and sleeping on it.
Mr. Kim: I’m aware.
Nurse: Light hand exercises like squeezing a soft ball help strengthen the vein.
Mr. Kim: I’ll continue doing that.
Nurse: Keep your diet low in sodium, potassium, and fat. Stay hydrated as advised by your doctor, and never exceed fluid limits.
Mr. Kim: I track my intake carefully.
Nurse: Follow your dialysis schedule strictly. If you feel unwell or see changes at the access site, call us immediately.
Mr. Kim: I’ll keep that in mind.
Nurse: Today’s session went well. Rest up, and if dizziness or fatigue persists, seek help.
Mr. Kim: Thank you for all your care today.
Nurse: You’re welcome. See you at your next session!
Learning Objectives for Nurse Trainees:
- Conduct comprehensive pre-, during-, and post-dialysis assessments
- Recognize complications such as hypotension, infection, or access malfunction
- Apply aseptic technique and proper site care
- Deliver clear, supportive patient education for home care and lifestyle
- Document and respond to patient symptoms promptly using clinical judgment
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