A dialysis nurse is treating a client with newly diagnosed acute renal failure who is receiving dialysis for the first time. Which common complication must the nurse look out for?


• Headache, nausea, and confusion are signs and symptoms of dialysis disequilibrium syndrome (DDS).

• This is a complication of hemodialysis, when the concentration of blood urea nitrogen level in the blood (BUN) is being reduced more rapidly than the urea nitrogen level in the cerebrospinal fluid and brain tissue. Because of the slow transport of urea across the blood-brain barrier, it creates a large urea concentration gradient, which results in reverse osmosis, causing temporary cerebral edema during and after hemodialysis. Pupillary changes, headache, nausea, along with changes in mental status, suggest the condition.

• The other signs and symptoms are not indicative of DDS.

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