CDN Complications and Emergency Management 2 — Questions and Answers
Question 1: A dialysis patient develops sudden severe headache, visual changes, and confusion during treatment. What complication should be considered first?
- Dialysis disequilibrium syndrome or hypertensive emergency (Correct answer)
- Air embolism
- Hypoglycemia
- Anaphylaxis
Correct answer: Dialysis disequilibrium syndrome or hypertensive emergency
Sudden severe headache, visual disturbances, and altered mental status during dialysis suggest either dialysis disequilibrium syndrome from rapid urea removal or hypertensive emergency requiring urgent evaluation.
Question 2: What is the most appropriate nursing action when a patient reports severe muscle cramps during hemodialysis?
- Stop dialysis immediately
- Reduce ultrafiltration rate and administer hypertonic saline or glucose (Correct answer)
- Increase blood flow rate
- Administer IV potassium chloride
Correct answer: Reduce ultrafiltration rate and administer hypertonic saline or glucose
Muscle cramping during dialysis is caused by hypovolemia and electrolyte shifts; reducing ultrafiltration and administering hypertonic saline (23.4% NaCl) or 50% dextrose relieves symptoms.
Question 3: Which type of dialyzer reaction is characterized by dyspnea and chest/back pain occurring within the first 5 minutes of dialysis?
- Type B reaction (non-specific)
- Type A reaction (anaphylactic — IgE-mediated) (Correct answer)
- Pyrogenic reaction
- Hemolytic reaction
Correct answer: Type A reaction (anaphylactic — IgE-mediated)
Type A (anaphylactic) dialyzer reactions occur within 5 minutes of treatment initiation due to IgE-mediated hypersensitivity, often to ethylene oxide sterilant or membrane components, and can be life-threatening.
Question 4: What is the correct response when a Type A (anaphylactic) dialyzer reaction is suspected?
- Slow the blood pump and give antihistamines
- Stop dialysis, clamp blood lines, do NOT return blood, administer epinephrine and supportive care (Correct answer)
- Return blood and switch to a new dialyzer
- Administer IV diphenhydramine and continue treatment at reduced flow
Correct answer: Stop dialysis, clamp blood lines, do NOT return blood, administer epinephrine and supportive care
In a Type A anaphylactic reaction, the blood must not be returned (it contains the causative agent), dialysis is stopped, and epinephrine with full anaphylaxis management is initiated immediately.
Question 5: A patient begins dialysis and their blood in the arterial line appears bright pink or 'cherry red.' What condition should be suspected?
- Polycythemia
- Carbon monoxide poisoning from hemolysis in water treatment failure (Correct answer)
- Oxygenation from the dialyzer membrane
- Normal appearance after heparin administration
Correct answer: Carbon monoxide poisoning from hemolysis in water treatment failure
Cherry-red or bright pink blood during dialysis suggests hemolysis, which can occur from water treatment failure with chloramine breakthrough, overheated dialysate, or hypotonic dialysate.
Question 6: What is the most likely cause of repeated clotting in the extracorporeal circuit during hemodialysis despite adequate heparin dosing?
- High blood flow rate
- Heparin-induced thrombocytopenia (HIT) or inadequate anticoagulation monitoring (Correct answer)
- Low dialysate temperature
- High dialyzer surface area
Correct answer: Heparin-induced thrombocytopenia (HIT) or inadequate anticoagulation monitoring
Repeated clotting despite heparin therapy should raise suspicion for heparin-induced thrombocytopenia (HIT), where heparin paradoxically causes platelet aggregation and thrombosis.
CDN Complications and Emergency Management 2
A dialysis patient develops sudden severe headache, visual changes, and confusion during treatment.
What complication should be considered first?