After 2 hours of hemodialysis, a patient develops dizziness, hypotension (80/54 mmHg), tachycardia (HR 120/min), and altered level of consciousness. What is the priority nursing action?

1. A

   Stop or slow dialysis and start 0.9% normal saline

2. B

   Continue dialysis as prescribed

3. C

   Consider it a normal condition

4. D

   Give oral fluids immediately

Appeared in: NORCET 10 Mains

Explanation

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• The patient's symptoms are characteristic of dialysis-induced hypotension, a state of hypovolemia caused by excessive fluid removal during the procedure.
• The priority action must address both the cause and the effect immediately.
• Stopping or slowing the dialysis machine halts the ongoing fluid loss, preventing the condition from worsening.
• Administering 0.9% normal saline, an isotonic IV fluid, works to rapidly restore the circulating blood volume.
• This dual approach stabilizes blood pressure and restores perfusion to vital organs like the brain, which is critical given the patient's altered level of consciousness.

Why Other Options Were Wrong

• Option B: Continuing dialysis would continue to remove fluid from the patient's vascular space, directly worsening the hypovolemia, hypotension, and shock state.
• Option C: A systolic blood pressure of 80 mmHg with tachycardia and altered consciousness is a medical emergency. Treating it as normal would be a critical failure in patient safety.
• Option D: Administering anything by mouth to a patient with an altered level of consciousness is contraindicated due to the high risk of aspiration, which can lead to pneumonia or airway obstruction.

Related Visual

Clinical Relevance

• Nursing practice connection: Safe nursing care depends on performing Management of acute complications during hemodialysis, specifically dialysis-induced hypotension in the correct sequence, documenting the action clearly, and monitoring for the expected response.
• Dialysis-induced hypotension is the most frequent complication during hemodialysis sessions. Nurses must be able to recognize its signs and symptoms immediately.
• Rapid intervention is key to preventing progression to severe shock, cardiac ischemia, and other life-threatening events.
• This scenario highlights the nurse's crucial role in patient monitoring and safety during high-risk procedures.

How to Approach the Question

• First, analyze the clinical scenario. The patient is undergoing a procedure (hemodialysis) and develops acute symptoms.
• Identify the key signs and symptoms: dizziness, hypotension (80/54), tachycardia (120), and altered level of consciousness. This cluster points to a circulatory problem.
• Connect the symptoms to the procedure. Hemodialysis removes fluid, so these symptoms are classic for hypovolemia (fluid volume deficit).
• The question asks for the 'priority' action. This means you must choose the most immediate and life-saving intervention.
• Evaluate the options based on addressing the cause and effect. The cause is fluid removal, and the effect is hypovolemia. The correct action must stop the cause and reverse the effect.
• Option A (stop/slow dialysis and give saline) does both: it stops the fluid loss and replaces volume. The other options either worsen the problem, ignore it, or are unsafe.

Concept Tested & Keywords

• Concept Tested: Management of acute complications during hemodialysis, specifically dialysis-induced hypotension.
• Stem keywords: hemodialysis, dizziness, hypotension, tachycardia, altered level of consciousness
• Lead-in keywords: priority nursing action
• Clinical cues: The combination of hypotension (80/54 mmHg), tachycardia (120/min), and altered level of consciousness during a fluid-removing procedure is a classic presentation of hypovolemic shock.

Question ID

Q9Fp72pch6A_42TfJ_dnUq

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Reference Book

E6 Medicine Davidson Principles Practice 24e p. 444-446

E6 Pharmacology Nursing Lilley 11e Part 2 p. 172-174

E6 Nursing Fundamentals Taylor p. 834-836