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Pt.2
“ So Mrs.AW… let us begin by first getting your standing blood pressure and we will follow by getting your sitting blood pressure!”, Okay, which arm will you place the blood pressure on?”, “ Since you have a left lower fistula, as per policy we will always place the blood pressure cuff opposite of your access arm. This is so we do not damage your access and continue to make sure it is long lasting. We have a saying in the Dialysis World,” Your access is your baby, and you must take care of your baby!”, Mrs.AW laughs , and replies shaking her head,” If you say so!” … Yeeeeeoooww!!! “Why does it squeeze sooo tight??” Me smiling,” Well either a few things are happening: your blood pressure may possibly be elevated and I can readjust the cuff. The cuff settings in the machine could be set to pediatric mode. The blood pressure cuff could be too small. The blood pressure cuff detects some type of movement… as she looked with a guilty look, ”Well, I did scratch my other arm while your head was turned!” Sorry! As I laughed ,” It’s quite alright, with all this mental, physical, and visual stimulation that is presented to us in an Outpatient Chronic Facility, it’s kinda hard to be completely still. Okay, you can now have a seat and I will take your blood pressure sitting. Mrs. AW replies,” Dwelyn, can I ask a question?” Sure…. “ What is the purpose of taking my blood pressure twice? Well as a result of being safe and following policy and procedure, here it’s beyond a standard rule. So let me paint a picture for you…. Take a look around you within this facility. We all are different. Meaning we all feel different from time to time, and it’s human nature to sometimes don’t know how we feel. With that being said, a person’s blood pressure is a Bonus of Communication when it comes to the relationship of a patient and a healthcare professional. For example, your blood pressure could be fine sitting down, but when you get up to stand up it’s a possibility you could feel weak. Really,? Explain how or give me an example!” Indeed, have you ever hung upside down when you were younger or closed your eyes and spun around real fast?” She replied ,” Yes”,,,, so tell how did it make you feel once you stood up from hanging upside down or opened your eyes from being spun around drastically ?” “Oh my!!, I felt dizzy, weak, and slightly sick! ” “Bingo!” I replied. Hemodialysis is an emotional, physical, mental roller coaster, but as a passenger we here will do our best to conduct your Renal Journey. “Dwelyn I really appreciate your analogy!” Since we are on the subject, what was my standing and sitting blood pressure?” “Standing your blood pressure was 148/68 heart rate 92, respirations 18, sitting blood pressure 167/92 heart rate 84.” “Okay is that good or bad?” Well it depends on an individual’s definition.” What maybe good to you, maybe bad to the next person.” “How do you feel? “ Well, to be honest, I am beyond nervous!” “I seriously dreaded coming here and had my doubts. This is a major change for me.! “ I see, well I suggest just try to relax and think of happy thoughts. Speaking of your blood pressure, theoretically a professional would say you’re possibly borderline hypertension. “Hyper who?!?!” Lol, “ Sorry , hypertension is the medical term for someone who’s blood pressure is on the high side or slightly elevated. Hypotension is totally the opposite…. Remember,” Hypo means Low, and Hyper means Higher!” Get it ? That’s a little saying to tell my patients to keep it simple and it rhymes,” Hee Hee!” “ Dwelyn you’re a pure clown , but I’m glad you can make me laugh. Thank you, I’m so glad I can take this blood pressure cuff off now, whew!!! “ Well, not quite. AW replies “ Huh!!!!”, aren’t done taking it? My blood pressure is okay, you said so yourself, correct? “ Your blood pressure is fine, however your Hemodialysis treatment is for three hours and thirty minutes and unfortunately our policy is for our patients to keep the blood pressure cuff on throughout the whole treatment. Mrs AW gives a blank stare and replies,”Wooooo!! Three Hours and Thirty Minutes????“ My!!! Why so long? What’s being done in that long time? “Man!”” “ I apologize, but those are the Physicians documented orders for you to spend on the Dialysis Machine. “Where’s he at?“ Who Mrs .AW?” The Doctor”!! I have to tell him that it’s too long for me to sit here, I have to be picked up by my family from here today. “Ah I see, we will definitely contact your family to let them know what time for them to pick you up. “Okay good!”, I replied,” As for the Doctor, he will not be in here today!” What???? “ where is he? On vacation, playing golf?” “I need to speak to him”! “ Once again I apologize , but as a Renal Physician, sometimes,…… seemingly all the time, they have an overwhelming ratio of patients to take care of and tend too and it’s unfortunate that he cannot be here on a daily basis, however he does make rounds weekly.!” “Ah man, well I guess I will not see him then!” “Why do you say that?” Mrs AW replies, “ Well after I finish the, three hours and thirty minutes you all will clean me out and get my kidneys back to working!” …and I walked in the door here forty five minutes ago so technically I only have about two hours and forty five minutes, give or take left with my treatment process……Right?” With a look of sadness and despair, I replied ”Mrs. AW, I’m very sorry but to my knowledge you are considered ESRD in which that means you’re in End Stage Renal Disease. Your current stage of Renal Failure, which also means Kidney Failure defines that per your Renal Physicians order, you will have to visit us every Monday, Wednesday, Friday for three hours and thirty minutes each time.” “I will get my Charge Registered Nurse to come and do your assessment and also talk to you as well, please excuse me for a brief few minutes….. As I walked away, Mrs AW put her head down as if her world was shattered and no sense of hope. And from a far I could literally see a sparkling teardrop from her face as it hit the floor.
To be continued…..
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