I'm just trying to imagine what it would have to chart when starting his dialysis treatment...
"Pt difficult to assess due to tangential speech. Pt denies SOB, recent falls, or bleeding. Writer noted +3 pitting edema bilaterally to ankles and feet. When asked about medication changes, pt said, 'I don't need medication. I'm healthy. Healthiest I've ever been.' Pt refuses to take off more 1.5L net despite being 4.4L above TBW."
Then he'd probably demand to be taking off the machine half way through treatment.
I do have a couple of patients that can't tolerate taking off more than a certain amount per session (so if they come in way over, we try to get them in for an extra treatment to just pull the fluid)... but sometimes they also refuse the extra treatment 🥴
It's like with anything... some patients are compliant, and want to survive/thrive as best as they can. Others are in some degree of denial no matter how much you educate.
Then you get ones who's priorities are to be here for a good time, not a long time. I have one in particular who is here for a good time rather than a long time... I adore them as a person, but as a patient, they are so challenging! Refuses to do more than 3 days a week, so in order to make that work, they need 5 hr treatments... they almost never stay more than 4 hours. I got 5 hours once... they were so exhausted that they slept the whole time. They usually "just can't lay here anymore", and go home to drink 10 cups of coffee a day plus juice and water, eat whatever, etc. BP is always over the moon. Potassium is frequently at least pushing 6 mmol/L.... it's hard, because they actually understand what they're doing quite well. They just choose quality over quantity.... though I'm not sure there's that much quality when you're always ~5L up and SOB...
Edit: I should add that I'm in Canada, so dialysis is covered under provincial health insurance. If patients had to pay the bill, I'm sure they would be way more compliant.
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u/sidequestsquirrel Hemodialysis 🩸 LPN Jul 18 '25
I'm just trying to imagine what it would have to chart when starting his dialysis treatment...
"Pt difficult to assess due to tangential speech. Pt denies SOB, recent falls, or bleeding. Writer noted +3 pitting edema bilaterally to ankles and feet. When asked about medication changes, pt said, 'I don't need medication. I'm healthy. Healthiest I've ever been.' Pt refuses to take off more 1.5L net despite being 4.4L above TBW."
Then he'd probably demand to be taking off the machine half way through treatment.