Complications of dialysis

[Guest guest]

I tried posting this earlier but it apparently didn't go thru. I'm

sorry if it shows up twice.

The patient is a regular NH patient whom I have carried to dialysis

on numerous occasions. I have gotten to know him and on this day I

could see something was different. He is a 64YO male with diminished

mental capacity, normally responding to his name by turning his head

and grinning, but unable to communicate other than to nod or shake

his head. He is bedfast but normally pretty alert and animated.

This day he was less active, to the point of lethargy, and carried

his hands fisted over his epigastrum. Vitals were slightly off from

previous encounters. HR 90, BP 166/94, respirations more rapid and

shallow at 20-24 and a temp of 100.9. He was less responsive and

struggled with me when I tried to assess breath sounds. His abdomen

appeared somewhat distended but he would not allow me to access that

either. He was coughing so I was thinking he might have influenza or

some other viral infection.

All of this concerned me enough that I phoned dispatch to request to

divert to the ED so my patient could be seen by a physician, then I

contacted medical control at the hospital to advise. We arrived at

the hospital and I turned my patient over to staff.

Today I learned my patient had pericarditis, possibly secondary to

insufficient or ineffective dialysis, and apparently the symptoms I

saw are classic. My patient friend is responding to treatment and

appears to be doing better today. I found this a very interesting

learning experience.

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