The nurse is caring for a patient who is experiencing disequilibrium syndrome during hemodialysis. Which of the following interventions will the nurse implement for this patient? (Select All That Apply)

Choice A reason: Holding medication if B-type natriuretic peptide (BNP) results are high is not a standard intervention when administering lisinopril. BNP levels are used to assess the severity of heart failure, but they do not directly influence the administration of lisinopril. Lisinopril is an angiotensin-converting enzyme (ACE) inhibitor that helps manage heart failure by reducing blood pressure and decreasing the workload on the heart.

Choice B reason: Checking serum potassium and creatinine levels is crucial when administering lisinopril. Lisinopril can affect kidney function and electrolyte balance. It may cause hyperkalaemia (elevated potassium levels) and increase serum creatinine levels, indicating impaired kidney function. Regular monitoring of these parameters helps ensure the patient's safety and the effectiveness of the medication.

Choice C reason: Encouraging the patient to add salt substitute with all meals is not recommended for patients taking lisinopril. Many salt substitutes contain potassium chloride, which can further increase the risk of hyperkalaemia in patients on ACE inhibitors like lisinopril. This intervention could lead to dangerous electrolyte imbalances.

Choice D reason: Documenting the extent of vision changes every shift is not related to the administration of lisinopril. Vision changes are not a common side effect of this medication. This intervention may be more relevant for patients on medications known to affect vision, but it is not specific to lisinopril.

Choice A reason: The ABG results of pH 7.21, PaCO2 36, HCO3 14 indicate metabolic acidosis, which is common in patients with end-stage kidney disease (ESKD). In ESKD, the kidneys lose their ability to excrete acid and maintain bicarbonate levels, leading to an accumulation of acid in the blood. This condition results in a low pH (acidic), normal PaCO2 (as the respiratory system attempts to compensate), and low HCO3 (bicarbonate).

Choice B reason: The ABG results of pH 7.50, PaCO2 29, HCO3 22 indicate respiratory alkalosis, which is not typically associated with ESKD. Respiratory alkalosis occurs when there is excessive exhalation of carbon dioxide, leading to a higher pH (alkaline). This condition is more likely to be seen in situations such as hyperventilation, anxiety, or certain lung diseases.

Choice C reason: The ABG results of pH 7.47, PaCO2 45, HCO3 33 indicate metabolic alkalosis, which is not typically associated with ESKD. Metabolic alkalosis occurs when there is an excess of bicarbonate or a loss of acid. This condition can result from factors such as vomiting, diuretic use, or excessive antacid consumption. It is not a common finding in patients with ESKD.

Choice D reason: The ABG results of pH 7.31, PaCO2 48, HCO3 24 indicate respiratory acidosis, which is not typically associated with ESKD. Respiratory acidosis occurs when there is an accumulation of carbon dioxide due to impaired respiratory function. This condition is more likely to be seen in chronic obstructive pulmonary disease (COPD) or other respiratory disorders. It is not a common finding in patients with ESKD.