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 is experiencing dialysis-induced hypotension, a critical complication from rapid fluid removal.
• The priority is to correct the hypovolemia and stabilize circulation.
• Stopping or slowing the dialysis immediately halts the cause of the fluid loss.
• Administering 0.9% normal saline, an isotonic IV fluid, rapidly restores intravascular volume, raising blood pressure and improving organ perfusion.

Why Other Options Were Wrong

• Option B: Continuing dialysis would remove more fluid, worsening the hypotension and potentially leading to cardiovascular collapse.
• Option C: A combination of severe hypotension, tachycardia, and altered mental status is a medical emergency, not a normal finding during dialysis.
• Option D: Giving oral fluids to a patient with an altered level of consciousness poses a significant risk of aspiration. Additionally, oral rehydration is too slow to correct acute, severe hypotension.

Related Visual

• Visual 1: Flowchart: Steps for managing dialysis-induced hypotension, starting with recognizing symptoms, stopping ultrafiltration, administering saline, and monitoring the patient.
• Visual 2: Infographic: Illustrating the signs and symptoms of hypovolemic shock (hypotension, tachycardia, cool/clammy skin, altered LOC) in the context of dialysis.

Clinical Relevance

• Nursing practice connection: Safe nursing care depends on performing Management of Complications during Hemodialysis in the correct sequence, documenting the action clearly, and monitoring for the expected response.
• Dialysis-induced hypotension is the most common complication during hemodialysis, and nurses must be able to recognize and intervene immediately to prevent severe adverse outcomes like shock or cardiac events.
• The nurse's role includes frequent monitoring of vital signs and patient symptoms throughout the dialysis treatment to allow for early detection and intervention.
• What if? If the patient was hypotensive but fully conscious and alert, the nurse would still slow the dialysis and administer saline, but would also place the patient in a Trendelenburg position (legs elevated) to enhance venous return to the heart.

How to Approach the Question

• First, analyze the patient's clinical presentation. The key signs are dizziness, severe hypotension (BP 80/54), compensatory tachycardia (HR 120), and altered level of consciousness.
• Recognize that this cluster of symptoms points to a state of circulatory compromise or shock, likely caused by the dialysis procedure itself (rapid fluid removal).
• Apply the principle of prioritization: address the most life-threatening problem first. The immediate threat is circulatory collapse due to hypovolemia.
• Evaluate the options based on this priority. The correct action must stop the cause and reverse the problem.
• Option A directly addresses both: it stops the fluid removal (the cause) and starts fluid replacement (the solution).
• Eliminate other options: Continuing dialysis (B) worsens the problem. Ignoring it (C) is negligent. Giving oral fluids (D) is dangerous and too slow.

Concept Tested & Keywords

• Concept Tested: Management of Complications during Hemodialysis
• Stem keywords: hemodialysis, dizziness, hypotension, tachycardia, altered level of consciousness, priority nursing action
• Lead-in keywords: What is the priority
• Clinical cues: BP 80/54 mmHg indicates severe hypotension.
• Clinical cues: HR 120/min is a compensatory response to low blood pressure.

Question ID

Q9Fp72pch6A_42TfJ_dnUq

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