DIALYSIS NURSING: Assessment of Adverse Symptom: DIALYSIS DISEQUILIBRIUM SYNDROME (DDS)

DIALYSIS NURSING: Assessment of Adverse Symptom: DIALYSIS DISEQUILIBRIUM SYNDROME (DDS)
Dialysis Disequilibrium Syndrome (DDS)


- This is something you need to be familiar with as an acute or chronic dialysis nurse

But 1st, What the heck is DDS?

1. ACUTE NEUROLOGICAL DYSFUNCTION from hemodialysis that can be FATAL
1. Symptoms are: malaise, headache, hypertension, nausea, vomiting, muscle cramps, treors, blurred vision,
1. Lead to seizures, convulsions, altered consciousness, coma, and even death

OMG SO scary right!? some of these are symptoms of ESRD! How could I possibly tell the difference?

Great News, I'm going to help you. So please like and subscribe so you can help me help others too!

By the end of this video your questions about

1. How/Why DDS happens
2. Who is most at risk for developing DDS
3. How to prevent DDS from happening to your dialysis patients
4. What to do if you suspect DDS

*WHY DDS HAPPENS*

Pathophysiology of DDS

- Cause is not well understood, there are 3 main theories amongst experts:

*Reverse Urea Effect*

*Changes of Intracellular Organic Osmolytes*

*Changes in regards to pH/Metabolic Acidosis*

- The pathophys is complicated, but the end result: (cerebral edema) & prevention/treatment (inadequate dialysis) are the same regardless.

WHO IS MOST AT RISK FOR DDS

1. Severe Azotemia (BUN above 100)
2. First Hemodialysis Treatments

HOW DO WE PREVENT DDS IN OUR NEW DIALYSIS PATIENTS

HINT: Inadequate dialysis, poor removal of BUN, gentle dialysis

Oh good! There is ur first aha moment!

This is why, 1st dialysis treatments are short, have a low blood flow, low dialysate flow and low fluid goals

Goal is the same regardless if their 1st dialysis is in the hospital or the clinic:

Goal of 1st dialysis treatments is **inadequate dialysis***, to safely remove urea and correct metabolic acidosis ***slowly**

Acute Nurses:

From my experience:

Will take care of patients in the hospital with new ESRD and will have their 1st dialysis treatments in the hospital:

And this happens often...

Why?

1. Poor outpatient follow up or DENIAL
2. infection or disease process that accelerated their kidney disease
3. AKI (daily assessment)

Chronic Nurses:

From my experience will have dialysis on their regular schedule:

MWF OR TTHS

If u are caring for someone for their first dialysis treatments you need to be thorough with their assessment.

**Have you had dialysis before?**

- Yes/no, how many times, how did it go?
- If NO or if it is their first couple dialysis treatment:
- Is their prescription appropriate for them?
- Their HD treatment should be short (2 hour, 2.5 hour), with low blood flow, low dialysate, usually fluid removal is minimal (depending on ur assessment)
- Always have a Crit line (acutes or chronics).
- You will learn a lot about new dialysis patients with a Crit line. U will see the plasma refill can be a challenge for new hd patients, even with minimal fluid removal

What to do if you suspect DDS

- Towards the end of treatment 30 min left of treatment, you patient starts having nausea, vomiting, headache?
- This is when you don't want to go straight to treating the symptoms, you need to look at the cause?
- Could this be DDS?
- Are they no longer tolerating dialysis well?
- DId they have a high BUN?
- Any of these things are true? If my answer is yes and the patient is stable, (early symptoms) I will page the physician and tell them my assessment findings
- If the patient is not stable, actively vomiting, high blood pressure, headache, restless, I will end treatment and then page then physician. And follow provider orders from there.

#dialysisnursing

Disclaimer: This video is intended for education purposes only and is not intended as medical advice

00:00 Start of Go Live!
00:30 DDS Defined
02:00 Who is at Risk for DDS
09:00 Chat with DNSN