Drugstudy And Ncp Of Hemodialysis

Generic Name/ Trade Name/ Form of Medication

Epoetin Beta (Recormon)

Date Ordered

Classific a-tion

Dosage And Frequen cy

Mechanism Of Action

Haematop oietic drugs

500 units subcutane ous twice a week Peak: 5-24 hrs.

Mimics effect of erythropoietin. Functions as growth factor, enhancing RBC production

Indication

Contraindication

Adverse Reaction

Treatment of anemia associated with chronic renal failure on or not on dialysis and malignancy on or not on chemotherapy

-Poorly controlled HTN -Not to be used if the indication is for increasing the yield of autologous blood if mth preceding treatment of patient suffered MI, stroke, unstable angina pectoris, or at risk of DVT,history of thromboembo lic disease.

CNS: Headache, seizures, paresthesia, fatigue, dizziness, asthenia CV: hypertension, edema, increased clotting of arteriovenous grafts EENT: Pharyngitis G.I: Nausea, vomiting, abdominal pain Metabolic: Hyperuricemia, hyperkalimia, hyperphosphate mia

Nursing Responsiblity

-Before starting therapy, evaluate patient’s iron status. Patient should receive adequate iron supplementation beginning no later than when epoetin treatment starts and continuing throughout therapy. Patient also may need vitamin B12 and folic acid -Monitor BP before therapy. Most patients with chronic renal failure have hypertension. BP may Increase, especially when

Respiratory: Cough, shortness of breath Skin : Rash, infection site reactions, urticaria Other: pyrexia

hematocrit increases in the early part of therapy -institute diet restrictions or drug therapy to control BP -monitor hemoglobin level twice weekly until it stabilizes in the target range (10 to 12 g/dl for most patients) and maintenance dose is established, then continue to monitor at regular intervals. Resume twice weekly testing following any dosage adjustments -reduce dosage in patients who have an increase in hemoglobin level of more than 1 g/dl in any 2 week period -monitor blood counts; elevated hematocrit may cause excessive clotting -patient may

need additional heparin to prevent clotting treatments -evaluate patient who experiences a lack or loss of effect for pure red cell aplasia Patient teaching -inform patient that pain or discomfort in limbs (long bones) and pelvis, and coldness and sweating may occur after injection (usually within 2 hours) symptoms may last for 12 hours and then disappear -advise patient to avoid driving or operating heavy machinery at start of therapy. There may be a relationship between too rapid increase hematocrit and seizures -Tell patient to monitor BP at home and adhere

dietary restrictions

Nursing Problem: Injury risk for (loss of vascular access)

Assessm ent

Diagno sis

Inference

Not applicable; presence of signs and symptoms establishes an actual diagnosis of the shunt

Injury risk for (loss of vascular access) related to clotting

Loss of vascular access is inability to administer therapy or obtaining blood for testing in the vascular system Reference: http://medicaldictionary.thefreedi ctionary.com/vascul ar+access

Planning After 4 hours of duty patient will be able to maintain patent vascular access

Intervention Independent Evaluate reports of pain, numbness/tingling ; note extremity swelling distal to access Avoid trauma to shunt: e.g handle tubing gently, maintain cannula alignment. Limit activity of extremity. Avoid taking BP or drawing blood supplies in shunt extremity. Instruct patient not to sleep on side with shunt or carry packages, books, purse of the

Rational Evaluatio e n May indicate blood supply

Decreases the risk of clotting / disconnecti on

Goal met Patient is able to maintain patent vascular access.

affected extremity Collaborative: Administer medication as indicated, e.g: Heparin (low dose)

Infused on arterial side of filter to prevent clotting in the filter without systemic side effects