Patient Assessment, Nutrition and Medication Management
The Patient Assessment, Nutrition and Medication Management domain tests dry-weight assessment, laboratory interpretation, dietary counseling and safe medication timing in dialysis patients.
Core rules
- Assess volume status, weight, BP, edema and intradialytic symptoms to set dry weight.
- Nutrition: adequate protein, limited sodium, potassium and phosphorus; fluid restriction based on urine output and UF.
- Phosphate binders with meals; adjust timing for dialyzable drugs; monitor potassium, calcium, phosphorus, albumin and hemoglobin.
- Review dialyzability before administering a drug near treatment.
Worked example
A patient has potassium 6.2 mmol/L with peaked T waves. Treat urgently: calcium gluconate for cardiac stabilization, insulin with glucose and/or albuterol to shift potassium, arrange urgent dialysis and review diet and medications. Do not rely on a potassium binder alone in an emergency.
Traps
Do not give phosphate binders on an empty stomach; do not advise salt substitutes because they are potassium-based; do not ignore residual renal function when setting fluid limits.