Managing Dialysis Patients

1. Hemodialysis

      a. Shunt

      b. Fistula

      c. Graft

      d. Blood filtered through dialysate

2. Peritoneal dialysis

3. Special considerations for hemodialysis patients

      a. Obtaining B/P

      b. IV site, blood draw

4. Complications/Adverse effects of dialysis

      a. Hypotension

      b. Muscle cramps

      c. Nausea/Vomiting

      d. Disequilibrium syndrome

      e. Hemorrhage especially from access site

      f. Air embolism

      g. Myocardial ischemia

      h. Infection at access site

      i. Electrolyte imbalance

5. Missed dialysis treatment

      a. Hyperkalemia with associated ECG changes

      b. Weakness

      c. Pulmonary edema

      d. Uremic frost

Management for a patient with acute renal condition, chronic renal conditions

with acute exacerbations or dialysis problems, or end stage renal disease.

1. Management

      a. ABCs, support ventilation, intubate if necessary

      b. Stop bleeding from shunt as needed

      c. IV— restrict fluids or give fluids based

      d. Pharmacological interventions

III. Urinary System Conditions

      A. Urinary retention—pathophysiology, incidence, causes

1. Assessment findings and symptoms

      a. Unable to urinate

      b. Bladder enlargement/distention

      c. Lower abdominal pain

      d. Delirium, especially in elderly

2. Management

      a. Primarily supportive

      b. Transport

      c. IV KVO if abdominal pain

      d. Insert catheter if local medical director approval

B. Urinary tract infection (UTI)-- pathophysiology, incidence, causes

      1. Urinary bladder infection (cystitis)

      2. Pyelonephritis

      3. Assessment findings and symptoms

            a. Burning sensation or pain when urinating

            b. Increased urgency and frequency of urination

            c. Cloudy or rust-colored urine

            d. Unusual or foul odor to urine

            e. Febrile in pyelonephritis

            f. Back or flank pain in pyelonephritis

            g. Blood in urine

            h. abdominal pain--suprapubic

      4. Management

            a. Primarily supportive, IV if febrile or abdominal pain

            b. Transport

C. Renal calculi (kidney stones) - pathophysiology, incidence, causes.

      1. Assessment findings and symptoms

            a. Severe flank or back pain

            b. Abdominal pain

            c. Pain may radiate to pelvis, groin, or genitals

            d. Increased urgency of urination

            e. Painful urination

            f. Blood in urine

            g. Febrile

            h. skin pale and clammy

      2. Management

Content Creator: Carli Wymore
CAPCE Course Number: 20-EMTP-F3-1206
Total CE Hours: 1
Level: Advanced
EMT-CE uses the NEMSES guidelines as the foundation for every course outline.