Tnx for pointing that out. It is not within the scope of nursing practice to say what meds should be held and which ones should be given, each patient is different with different disease states. @ home as on a non dialysis day. In our institution, hypertensive patients are usually given clonidine 75mg or 150mg SL while on dialysis. Usually dialysis pts receive a renal vitamin which I tell them to take after dialysis. Postulating that Lantus, a long-acting insulin, would continue to exert its effect until the next dialysis treatment and thereby improve glycemic control, they persuaded the patient to allow the dialysis nurse to give him his insulin after his dialysis … When post-dialysis the patient is still hypertensive, we give nifedipine 5mg SL. He had had type 2 diabetes for 20 years, Dr. Janga said.“His fasting glucose was more than 200 mg/dL, and greater than 250 mg/dL prelunch. The NHS reports that there is a shortage of available kidneys for transplantation. Postulating that Lantus, a long-acting insulin, would continue to exert its effect until the next dialysis treatment and thereby improve glycemic control, they persuaded the patient to allow the dialysis nurse to give him his insulin after his dialysis session.The patient was 72 years old and had been on maintenance hemodialysis for 3 years. “It's like the straw that broke the camel's back. Sometimes, people with type 2 diabetes or gestational diabetes need insulin therapy if other treatments haven't been able to keep blood glucose levels within the desired range. Diabetics on 5 and a half hour dialysis do need a light meal. Those symptoms can occur even if you don't take insulin, because they're simply your body's way of saying it needs more fuel. Managing diabetes doesn’t mean you need to sacrifice enjoying foods you crave. “Giving them their insulin when they show up at the dialysis center reduces the cost and complexity burden to these patients … If we can at least take care of their diabetes, we can do something of major importance” for them. While it is customary to hold the anti-hypertensives, this may not be the case for every patient, since there are some patients who …
from my understanding we should not give water soluble vitamins ( Vit B and Vit C)prior to dialysis as theyare going to dialyse out. Missed dose: -If it is more than 12 hours since a dose should have been used, skip the missed dose and resume dosing with next scheduled dose, an extra dose or increase in dose should not be taken to make up for a missed dose.
“His wife donated a kidney. Ensure that there are no contra-indications to restarting the previous diabetes treatment (eg, changes in eGFR).Prescribing VRIII without substrate – risk of hypoglycaemia!Wrong insulin infusion rate or not adjusting according to hourly CBG readingDelays in VRIII starting Errors with IV to SC switchUse of VRIII infusion pump with no label on it / insulin expiredAccidental overdose due to setting incorrect pump rateAccidental disconnection of infusion – risk of DKA for patients with type 1 diabetes! Obviously if the pt doesn't dialyze till 6 at night you wouldnt necessarily hold all am meds. Our mission is to Empower, Unite, and Advance every nurse, student, and educator. allnurses is a Nursing Career Support and News Site. The insulin flow rate was …
IMO, before holding any meds you have to get a physician's order. While it is customary to hold the anti-hypertensives, this may not be the case for every patient, since there are some patients who once they start HD their BP goes sky high. If it is necessary to stop VRIII but the mixed insulin is not due for several hours, give half the usual dose of the insulin with lunch. Within this group, the average delay between an initial insulin recommendation and actually starting on the therapy was 790 days, or over two years.