The patient is getting hemodialysis for the second time when he complains of a headache and nausea and,a little later,of becoming confused.The nurse realizes these are symptoms of

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Dialysis disequilibrium syndrome often occurs after the first or second dialysis treatment or in patients who have had sudden,large decreases in BUN and creatinine levels as a result of the hemodialysis.Because of the blood-brain barrier,dialysis does not deplete the concentrations of BUN,creatinine,and other uremic toxins in the brain as rapidly as it does those substances in the extracellular fluid.An osmotic concentration gradient established in the brain allows fluid to enter until the concentration levels equal those of the extracellular fluid.The extra fluid in the brain tissue creates a state of cerebral edema for the patient,which results in severe headaches,nausea and vomiting,twitching,mental confusion,and occasionally seizures.Dialyzer membrane incompatibility may cause hypotension.Hyperthermia,not hypothermia,may result if the temperature control devices on the dialysis machine malfunction.Potassium shifts may occur but would be manifested in cardiac dysrhythmias.

The Patient Is Getting Hemodialysis for the Second Time When