Example of a clinical decision using O’Neil’s

Joseph Jones arrives for dialysis. He is breathless and is puffing when talking. His blood pressure is high at 175/65, pulse is 85, temperature is 35.8C, respiratory rate is 20. He is alert. He has swelling on his lower legs and he says that he is finding it hard to get his shoes on. He has had a two-day break from dialysis which he has 3x a week. He usually removes 2 litres of fluid each time he attends dialysis, but recently his weight has increased from 85kgs (the weight he is when he comes off dialysis) to 89kgs. He becomes unwell if he takes too much fluid off during dialysis.

Patient may become unwell if remove this volume of fluid

Working knowledge:

Signs and symptoms suggest patient is fluid overloaded

Remove 1 Litre extra each dialysis over the next 3 sessions

Patient data:

Weight has increased

Blood pressure is high

Swelling in his feet

Remove fluid slowly over a couple of weeks and give education

Patient cannot remove large amounts of fluid

Remove 0.5Litres extra each dialysis over the next 2 weeks

Patient feels unwell

Patient has too much fluid.

Patient becomes unwell when excess fluid removed

A patient can become unwell if too much fluid is removed

Remove fluid to reach target weight (if tolerated)