NCP Nursing Care Plan Renal Dialysis

Dialysis treatment replaces the function of the Renal/kidneys, which normally serve as the body’s natural filtration system. Dialysis is performed as critical life support when someone suffers acute or chronic kidney failure. Process that substitutes for kidney function by removing excess fluid and accumulated endogenous or exogenous toxins. It is a mechanical way to cleanse the blood and balance body fluids and chemicals when the kidneys are not able to perform these essential functions. Because kidney function can be reversible in some cases, dialysis can provide temporary support until renal function is restored. Dialysis may also be used in irreversible or chronic kidney shutdown when transplantation is the medical goal and the patient is waiting for donated kidneys. Some critically ill patients, with life-threatening illnesses, such as cancer or severe heart disease, are not candidates for transplantation and dialysis may be the only option for treating what is called End Stage Renal Disease (ESRD).Type of fluid and solute removal depends on the client’s underlying Pathophysiology, current hemodynamic status, vascular access, availability of equipment and resources, and healthcare providers’ training. There are two types of dialysis treatment: hemodialysis and peritoneal dialysis 

Two primary types of Renal/kidneys dialysis 

Peritoneal Dialysis 

• Continuous Ambulatory Peritoneal Dialysis: Continuous ambulatory peritoneal dialysis (CAPD) is a form of intracorporeal dialysis that uses the peritoneum for the semi permeable membrane. 
• Continuous cyclic peritoneal dialysis (CCPD). Also called automated peritoneal dialysis (APD), CCPD is an overnight treatment that uses a machine to drain and refill the abdominal cavity; CCPD takes 10 to 12 hours per session. 
• Intermittent peritoneal dialysis (IPD). This hospitalbased treatment is performed several times a week. A machine administers and drains the dialysate solution, and sessions can take 12 to 24 hours. 

Hemodialysis 

Hemodialysis is a process of cleansing the blood of accumulated waste products. It is used for patients with end-stage renal failure or for acutely ill patients who require short-term dialysis. The treatment involves circulating the patient’s blood outside of the body through an extracorporeal circuit (ECC), or dialysis circuit. Two needles are inserted into the patient’s vein, or access site, and are attached to the ECC, which consists of plastic blood tubing, a filter known as a dialyzer (artificial kidney), and a dialysis machine that monitors and maintains blood flow and administers dialysate. Dialysate is a chemical bath that is used to draw waste products out of the blood. 

Indications 

• Treatment for acute renal failure (ARF) or chronic end-stage renal disease (ESRD) 
• Emergency removal of toxins due to drug overdose, acute life-threatening hyperkalemia, severe acidosis, and uremia 

Choice of dialysis is determined by three main factors. 

Type of renal failure (acute or chronic) 

Client’s particular physical condition 

Access to dialysis resources 

Nursing assessment for renal dialysis Refer to Acute Renal Failure or Chronic Renal Failure, for assessment here

Primary focus is at the community level at the dialysis center, although inpatient acute stay may be required during initiation of therapy. 

Nursing Diagnosis. 

Nursing Diagnoses That Could Be Found In Patient with Renal Dialysis 

• Imbalanced Nutrition: Less than Body Requirements 
• Impaired physical Mobility 
• Self-Care Deficit 
• Risk for Constipation 
• Risk for disturbed Thought Processes 
• Anxiety [specify level]/Fear 
• Disturbed Body Image/situational low Self-Esteem
• Deficient Knowledge regarding condition, prognosis, treatment, self-care, and discharge needs 

Nursing Care Plan for patient with Renal Dialysis Nursing diagnosis Imbalanced Nutrition Less than Body Requirements May be related to Gastrointestinal (GI) disturbances (result of uremia or medication side effects)—anorexia, nausea, vomiting, and stomatitis Sensation of feeling full—abdominal distention during continuous ambulatory peritoneal dialysis (CAPD) Dietary restrictions bland, tasteless food; lack of interest in food Loss of peptides and amino acids (building blocks for proteins) during dialysis 

Nursing Interventions

1. Monitor food and fluid ingested and calculate daily caloric intake. Rationale Identifies nutritional deficits and therapy needs, which are extremely variable, depending on client’s age, stage of renal disease, other coexisting conditions, and the type of dialysis being planned 
2. Recommend client keep a food diary, including estimation of ingested calories, protein, and electrolytes of individual concern—sodium, potassium, chloride, magnesium, and phosphorus Rationale Helps client realize “big picture” and allows opportunity to alter dietary choices to meet individual desires within identified restriction 
3. Note presence of nausea and anorexia Rationale Symptoms accompany accumulation of endogenous toxins that can alter or reduce intake and require intervention 
4. Encourage client to participate in menu planning Rationale May enhance oral intake and promote sense of control. 
5. Recommend small, frequent meals. Schedule meals according to dialysis needs Rationale Smaller portions may enhance intake. Type of dialysis influences meal patterns; for instance, clients receiving Hemodialysis HD might not be fed directly before or during procedure because this can alter fluid removal, and clients undergoing Peritoneal Dialysis PD may be unable to ingest food while abdomen is distended with dialysate. 
6. Encourage use of herbs and spices such as garlic, onion, pepper, parsley, cilantro, and lemon Rationale Adds zest to food to help reduce boredom with diet, while reducing potential for ingesting too much potassium and sodium 
7. Suggest socialization during meals Rationale Provides diversion and promotes social aspects of eating. 
8. Encourage frequent mouth care Rationale Reduces discomfort of oral stomatitis and metallic taste in mouth associated with uremia, which can interfere with food intake 
9. Refer to nutritionist or dietitian to develop diet appropriate to client’s needs Rationale Necessary to develop complex and highly individual dietary program to meet cultural and lifestyle needs. 
10. Perform complete nutrition assessment measure muscle mass via triceps skinfold or similar procedure. Determine muscle to fat ratio. Rationale Assesses need and adequacy of nutrient utilization by measuring changes that may suggest presence or absence of tissue catabolism. 
11. Provide a balanced diet, usually of 2,000 to 2,200 calories/day of complex carbohydrates and ordered amount of high-quality protein and essential amino acids. Rationale Provides sufficient nutrients to improve energy and prevent muscle wasting (catabolism); promotes tissue regeneration and healing and electrolyte balance. 
12. Restrict sodium and potassium as indicated; for example, avoid bacon, ham, other processed meats and foods, orange juice, and tomato soup Rationale these electrolytes can quickly accumulate, causing fluid retention, weakness, and potentially lethal cardiac Dysrhythmias. 

Sample Nursing Care Plan for patient with Renal Dialysis

DIAGNOSE	INTERVENTION	RATIONAL	EVALUATION
Imbalanced Nutrition: Less than Body Requirements May be related to Gastrointestinal (GI) disturbances (result of uremia or medication side effects)—anorexia, nausea, vomiting, and stomatitis Sensation of feeling full—abdominal distention during continuous ambulatory peritoneal dialysis (CAPD) Dietary restrictions—bland, tasteless food; lack of interest in food Loss of peptides and amino acids (building blocks for proteins) during dialysis	Nutrition Therapy Monitor food and fluid ingested and calculate daily caloric intake. Recommend client/significant other (SO) keep a food diary, including estimation of ingested calories, protein, and electrolytes of individual concern—sodium, potassium, chloride, magnesium, and phosphorus. Note presence of nausea and anorexia. Encourage client to participate in menu planning. Recommend small, frequent meals. Schedule meals according to dialysis needs. Encourage use of herbs and spices such as garlic, onion, pepper, parsley, cilantro, and lemon. Suggest socialization during meals. Encourage frequent mouth care. Refer to nutritionist or dietitian to develop diet appropriate to client’s needs. Perform complete nutrition assessment—measure muscle mass via triceps skinfold or similar procedure. Determine muscle to fat ratio. Provide a balanced diet, usually of 2,000 to 2,200 calories/day of complex carbohydrates and ordered amount of high-quality protein and essential amino acids. Restrict sodium and potassium as indicated; for example, avoid bacon, ham, other processed meats and foods, orange juice, and tomato soup. Administer multivitamins, including folic acid; vitamins B6, C, and D; and iron supplements, as indicated. Administer parenteral supplements, as indicated, or IDPN, as necessary. Monitor laboratory studies, for example:Serum protein, prealbumin or albumin levels Hemoglobin (Hgb), red blood cell (RBC), and iron levels Administer medications, as appropriate, for example: Antiemetics, such as prochlorperazine (Compazine) Histamine blockers, such as famotidine (Pepcid) Hormones and supplements as indicated, such as erythropoietin (EPO, Epogen) and iron supplement (Niferex) Insert and maintain nasogastric (NG) or enteral feeding tube, if indicated.	Identifies nutritional deficits and therapy needs, which are extremely variable, depending on client’s age, stage of renal disease, other coexisting conditions, and the type of dialysis being planned. Helps client realize “big picture” and allows opportunity to alter dietary choices to meet individual desires within identified restriction. Symptoms accompany accumulation of endogenous toxins that can alter or reduce intake and require intervention. May enhance oral intake and promote sense of control. Smaller portions may enhance intake. Type of dialysis influences meal patterns; for instance, clients receiving HD might not be fed directly before or during procedure because this can alter fluid removal, and clients undergoing PD may be unable to ingest food while abdomen is distended with dialysate. Adds zest to food to help reduce boredom with diet, while reducing potential for ingesting too much potassium and sodium. Provides diversion and promotes social aspects of eating. Reduces discomfort of oral stomatitis and metallic taste in mouth associated with uremia, which can interfere with food intake. Necessary to develop complex and highly individual dietary program to meet cultural and lifestyle needs within specific kilocalorie and protein restrictions while controlling phosphorus, sodium, and potassium. Assesses need and adequacy of nutrient utilization by measuring changes that may suggest presence or absence of tissue catabolism. Provides sufficient nutrients to improve energy and prevent muscle wasting (catabolism); promotes tissue regeneration and healing and electrolyte balance. Although client with kidney disease is often advised to limit protein intake, that changes with the start of dialysis. Protein-rich foods, such as fresh meats, poultry, fish and other seafood, eggs and egg whites, and small servings of dairy products are needed for building muscles, repairing tissue, and fighting infection. However, some protein-rich foods may contain a high level of phosphorus, so a dietitian’s input is essential in determining the right amount to eat (Paton, 2007). These electrolytes can quickly accumulate, causing fluid retention, weakness, and potentially lethal cardiac dysrhythmias. Note: PD is not as effective in lowering elevated Na+ level, necessitating tighter control of Na+ intake. Replaces vitamin and mineral deficits resulting from malnutrition, anemia, or lost during dialysis. Hyperalimentation may be needed to enhance renal tubular regeneration and resolution of underlying disease process and to provide nutrients if oral or enteral feeding is contraindicated. Indicators of protein needs. Note: PD is associated with significant protein loss. Serum albumin levels below 3.4 g/dL suggest need for IDPN infusions.Anemia is the most pervasive complication affecting energy levels in ESRD. Reduces stimulation of the vomiting center. Gastric distress is common and may be a neuropathy-induced gastric paresis. Hypersecretion can cause persistent gastric distress and digestive dysfunction. Although EPO is given to increase numbers of RBCs, it is not effective without iron supplementation. Niferex is preferred because it can be given once daily and has fewer side effects than many iron preparations. May be necessary when persistent vomiting occurs or when enteral feeding is desired.	Demonstrate stable weight or gain toward goal with normalization of laboratory values and no signs of malnutrition.
Impaired physical Mobility May be related to Restrictive therapies—lengthy dialysis procedure Fear of or real danger of dislodging dialysis lines or catheter Decreased strength and endurance; musculoskeletal impairment Perceptual or cognitive impairment	Bed Rest Care Assess activity limitations, noting presence and degree of restriction or ability. Encourage frequent change of position when on bedrest or chair rest; support affected body parts and joints with pillows, rolls, sheepskin, and elbow and heel pads, as indicated. Provide gentle massage. Keep skin clean and dry. Keep linens dry and wrinkle free. Encourage deep breathing and coughing. Elevate head of bed, as appropriate. Suggest and provide diversion as appropriate to client’s condition—visitors, radio or TV, and books. Take time to interact with client, showing interest in client’s life. Instruct in and assist with active and passive range-of-motion (ROM) exercises. Exercise Promotion Institute a planned activity or exercise program as appropriate, with client’s input. Bed Rest Care Provide foam, water, or air flotation mattress or soft chair cushion.	Influences choice of interventions. Decreases discomfort, maintains muscle strength and joint mobility, enhances circulation, and prevents skin breakdown. Stimulates circulation; prevents skin irritation. Mobilizes secretions, improves lung expansion, and reduces risk of respiratory complications, such as atelectasis or pneumonia. Decreases boredom; promotes relaxation. Maintains joint flexibility, prevents contractures, and aids in reducing muscle tension. Note: A high level of phosphorus may cause calcium-phosphorus crystals to build up in the joints, muscles, and other body organs, leading to bone and joint pain. To avoid these risks, client may be prescribed a phosphate binder such as Basalgel or Renagel (Leydig, 2005). Increases client’s energy and sense of well-being. Studies have shown that regular exercise programs have benefited clients with ESRD, both physically and emotionally. Stable clients have not been shown to have adverse effects (Goodman & Ballou, 2004). Reduces tissue pressure and may enhance circulation, thereby reducing risk of dermal ischemia and breakdown.	Maintain optimal mobility and function. Display increased strength and be free of associated complications—contractures and decubitus ulcers.
Self-Care Deficit (specify) May be related to Intolerance to activity, decreased strength and endurance, pain or discomfort Perceptual or cognitive impairment (accumulated toxins)	Self-Care Assistance Determine client’s ability to participate in self-care activities (scale of 0 to 4). Provide assistance with activities as necessary. Encourage use of energy-saving techniques: sitting, not standing; using shower chair; and doing tasks in small increments. Recommend scheduling activities to allow client sufficient time to accomplish tasks to fullest extent of ability.	Underlying condition dictates level of deficit, affecting choice of interventions. Note: Psychological factors, such as depression, motivation, and degree of support, also have a major impact on the client’s abilities. Meets needs while supporting client participation and independence. Conserves energy, reduces fatigue, and enhances client’s ability to perform tasks. Unhurried approach reduces frustration and promotes client participation, enhancing self-esteem.	Participate in ADLs within level of own ability and constraints of the illness.
Risk for Constipation Risk factors may include Decreased fluid intake, altered dietary pattern Reduced intestinal motility, compression of bowel (peritoneal dialysate), electrolyte imbalances, decreased mobility	Constipation/Impaction Management Auscultate bowel sounds. Note consistency and frequency of bowel movements (BMs) and presence of abdominal distention. Review current medication regimen. Ascertain usual dietary pattern and food choices. Suggest adding fresh fruits, vegetables, and fiber to diet within restrictions, when indicated. Encourage or assist with ambulation, when able. Provide privacy at bedside commode and bathroom. Administer stool softeners, such as Colace or bulk-forming laxatives, such as Metamucil, as appropriate. Keep client nothing by mouth (NPO) status; insert NG tube, as indicated.	Decreased bowel sounds; passage of hard-formed or dry stools suggests constipation and requires ongoing intervention to manage. Side effects of some drugs, such as iron products and some antacids, may compound problem. Although restrictions may be present, thoughtful consideration of menu choices can aid in controlling problem. Provides bulk, which improves stool consistency. Activity may stimulate peristalsis, promoting return to normal bowel activity. Promotes psychological comfort needed for elimination. Produces a softer, more easily evacuated stool. Decompresses stomach when recurrent episodes of unrelieved vomiting occur. Large gastric output suggests ileus, a common early complication of PD, with accumulation of gas and intestinal fluid that cannot be passed rectally.	Maintain usual or improved bowel function.
Risk for disturbed Thought Processes Risk factors may include Physiological changes—presence of uremic toxins, electrolyte imbalances, hypervolemia or fluid shifts, hyperglycemia (infusion of a dialysate with a high glucose concentration)	Delirium Management Assess for behavioral changes or change in level of consciousness (LOC)—disorientation, lethargy, decreased concentration, memory loss, and altered sleep patterns. Keep explanations simple and reorient frequently as needed. Provide “normal” day or night lighting patterns, clock, and calendar.\ Provide a safe environment, restrain as indicated, and pad side rails during procedure, as appropriate. Drain peritoneal dialysate promptly at end of specified equilibration period. Investigate reports of headache, associated with onset of dizziness, nausea and vomiting, confusion or agitation, hypotension, tremors, or seizure activity. Monitor changes in speech pattern, development of dementia, and myoclonus activity during HD.	May indicate level of uremic toxicity, response to or developing complication of dialysis such as “dialysis dementia,” and need for further assessment and intervention. Improves reality orientation. Prevents client trauma and inadvertent removal of dialysis lines or catheter. Prompt outflow will decrease risk of hyperglycemia or hyperosmolar fluid shifts affecting cerebral function. May reflect development of disequilibrium syndrome, which can occur near completion of or following HD and is thought to be caused by ultrafiltration or by the too-rapid removal of urea from the bloodstream not accompanied by equivalent removal from brain tissue. The hypertonic cerebrospinal fluid (CSF) causes a fluid shift into the brain, resulting in cerebral edema and increased intracranial pressure. Occasionally, accumulation of aluminum may cause dialysis dementia, progressing to death if untreated.	Regain usual or improved level of mentation. Recognize changes in thinking and behavior and demonstrate behaviors to prevent or minimize changes.
Anxiety [specify level]/Fear May be related to Situational crisis, threat to self-concept, change in health status, role functioning, socioeconomic status Threat of death, unknown consequences or outcome	Anxiety Reduction Assess level of fear of both client and SO. Note signs of denial, depression, or narrowed focus of attention. Explain procedures and care as delivered. Repeat explanations frequently, as needed. Provide information in multiple formats, including pamphlets and films. Acknowledge normalcy of feelings in this situation. Provide opportunities for client and SO to ask questions and verbalize concerns. Encourage SO to participate in care, as able and desired. Acknowledge concerns of client and SO. Point out positive indicators of treatment—improvement in laboratory values, stable BP, and lessened fatigue. Arrange for visit to dialysis center and meeting with another dialysis client, as appropriate. Address financial considerations. Refer to appropriate resources.	Helps determine the kind of interventions required. Fear of unknown is lessened by information and knowledge and may enhance acceptance of permanence of ESRD and necessity for dialysis. Alteration in thought processes and high levels of anxiety or fear may reduce comprehension, requiring repetition of important information. Note: Uremia can impair short-term memory, requiring repetition or reinforcement of information provided. Knowing feelings are normal can allay fear that client is losing control. Creates feeling of openness and cooperation and provides information that will assist in problem identification and solving. Involvement promotes sense of sharing, strengthens feelings of usefulness, provides opportunity to acknowledge individual capabilities, and may lessen fear of the unknown. Prognosis and possibility of need for long-term dialysis and resultant lifestyle changes are major concerns for this client and those who may be involved in future care. Promotes sense of progress in an otherwise chronic process that seems endless while client still is experiencing physical deterioration and depression. Interaction with others who have encountered similar problems may assist client and SO to work toward acceptance of chronic condition and focus on problem-solving activities. Treatment for kidney failure is expensive, although Medicare and other health insurance programs pay much of the cost.	Verbalize awareness of feelings and reduction of anxiety or fear to a manageable level. Demonstrate problem-solving skills and effective use of resources. Appear relaxed and able to rest and sleep appropriately.
Disturbed Body Image/situational low Self-Esteem May be related to Situational crisis, chronic illness with changes in usual roles and body image	Body Image [or] Self-Esteem Enhancement Assess level of client’s knowledge about condition and treatment and anxiety related to current situation. Discuss meaning of loss and change to client. Note withdrawn behavior, ineffective use of denial, or behaviors indicative of overconcern with body and its functions. Investigate reports of feelings of depersonalization or the bestowing of humanlike qualities on machinery. Assess for use of addictive substances, primarily alcohol, other drugs, and self-destructive or suicidal behavior. Determine stage of grieving. Note signs of severe or prolonged depression. Acknowledge normalcy of feelings. Encourage verbalization of personal and work conflicts that may arise. Active-listen concerns. Determine client’s role in family constellation and client’s perception of expectation of self and others. Recommend SO treat client normally and not as an invalid. Assist client to incorporate disease management into lifestyle. Identify strengths, past successes, and previous methods client has used to deal with life stressors. Help client identify areas over which he or she has some measure of control. Provide opportunity to participate in decision-making process. Recommend participation in local support group. Refer to healthcare and community resources, such as social service, vocational counselor, and psychiatric clinical nursespecialist.	Identifies extent of problem or concern and necessary interventions. Many clients and their families have difficulty dealing with changes in life and role performance as well as the client’s loss of ability to control own body. Indicators of developing difficulty handling stress of what is happening. Note: Client may feel tied to and controlled by the technology central to his or her survival, even to the point of extending body boundary to incorporate dialysis equipment. May reflect dysfunctional coping and attempt to handle problems in an ineffective manner. Identification of grief stage client is experiencing provides guide to recognizing and dealing appropriately with behavior as client and SO work to come to terms with loss and limitations associated with condition. Prolonged depression may indicate need for further intervention. Recognition that feelings are to be expected helps client accept and deal with them more effectively. Helps client identify problems and problem-solve solutions. Note: Home dialysis may provide more flexibility and enhance sense of control for clients who are appropriate candidates for this form of therapy. Long-term and permanent illness or disability alter client’s ability to fulfill usual role(s) in family and work setting. Unrealistic expectations can undermine self-esteem and affect outcome of illness. Conveys expectation that client is able to manage situation and helps maintain sense of self-worth and purpose in life. Necessities of treatment assume a more normal aspect when they are a part of the daily routine. Focusing on these reminders of own ability to deal with problems can help client deal with current situation. Provides sense of control over seemingly uncontrollable situation, fostering independence. Reduces sense of isolation as client learns that others have been where client is now. Provides role models for dealing with situation, problem-solving, and “getting on with life.” Reinforces that therapeutic regimen can be beneficial. Provides additional assistance for long-term management of chronic illness and change in lifestyle.	Identify feelings and methods for coping with negative perception of self. Verbalize acceptance of self in situation. Demonstrate adaptation to changes and events that have occurred, as evidenced by setting realistic goals and active participation in care and life in general.
Deficient Knowledge [Learning Need] regarding condition, prognosis, treatment, self-care, and discharge needs May be related to Lack of exposure or recall Unfamiliarity with information resources Cognitive limitations	Teaching: Disease Process Note level of anxiety or fear and alteration of thought processes.Time teaching appropriately. Review particular disease process, prognosis, and potential complications in clear concise terms, periodically repeating and updating information, as necessary. Encourage and provide opportunity for questions. Acknowledge that certain feelings and patterns of response are normal during course of therapy. Emphasize necessity of reading all product labels—food, beverage, and over-the-counter (OTC) drugs—and not taking medications or herbal supplements without checking with healthcare provider. Stress importance of establishing and adhering to medication schedule reflecting the specific form of renal disease, timing of dialysis, and properties of the individual medications. Discuss significance of maintaining nutritious eating habits, preventing wide fluctuation of fluid and electrolyte balance, and avoidance of crowds or people with infectious processes. Instruct client about epoetin (Epogen) or darbepoetin (Aransep), when indicated. Have client or SO demonstrate ability to administer and state adverse side effects and healthcare practices associated with this therapy. Identify healthcare and community resources, such as dialysis support group, social services, and mental health clinic. Teaching: Procedure/Treatment Discuss procedures and purpose of dialysis in terms understandable to client. Repeat explanations as required. Instruct client and SO in home dialysis, as indicated: Operation and maintenance of equipment (including vascular shunt), sources of supplies Aseptic or clean technique Self-monitoring of effectiveness of procedure Management of potential complications Contact persons Sources for supplies when away from home	These factors directly affect ability to access and use knowledge. In addition, during the dialysis procedure, client’s cognitive function may be impaired, and clients themselves state that they feel “fuzzy.” Therefore, learning may not be optimal during this time. Providing information at the level of the client’s and SO’s understanding will reduce anxiety and misconceptions about what client is experiencing. Note: Research suggests nocturnal home HD is associated with improved left ventricular function, decreased BP and pulse pressure, and reduced used of antihypertensive medications. Enhances learning process, promotes informed decision making, and reduces anxiety associated with the unknown. Client and SO may initially be hopeful and positive about the future, but as treatment continues and progress is less dramatic, they can become discouraged and depressed, and conflicts of dependence versus independence may develop. It is difficult to maintain electrolyte balance when exogenous intake is not factored into dietary restriction; for example, hypercalcemia can result from routine supplement use in combination with increased dietary intake of calcium-fortified foods and medicines. This is necessary to ensure that therapeutic levels of the drugs are reached and that toxic levels are avoided. Depressed immune system, presence of anemia, invasive procedures, and malnutrition potentiate risk of infection. Epogen is used for the management of the anemia associated with chronic renal failure (CRF) and ESRD. The drug is given to increase and maintain RBC production, which allows client to feel better and stronger. Darbepoetin is a non-natural recombinant protein that can stimulate RBC production, but the half-life is about three times longer than erythropoietin, resulting in less frequent dosing. Knowledge and use of these resources assist client and SO to manage care more effectively. Interaction with others in similar situation provides opportunity for discussion of options and making informed choices, including stopping dialysis or renal transplantation. A clear understanding of the purpose, process, and what is expected of client and SO facilitates their cooperation with regimen and may enhance outcomes. Home dialysis is associated with better outcomes in general and better survival rates as dialysis is usually performed 5 to 7 days/week and is more intensive. This decreases fluctuations in fluid, solute, and electrolyte balance, more closely mimicking renal function. However, specific criteria for client and SO participation and training, home resources, and professional oversight must be met in order to consider this option. Information diminishes anxiety of the unknown and provides opportunity for client to be knowledgeable about own care. Prevents contamination and reduces risk of infection. Provides information necessary to evaluate effects of therapy and need for change. Reduces concerns regarding personal well-being; supports efforts at self-care. Readily available support person can answer questions, troubleshoot problems, and facilitate timely medical intervention, when indicated, reducing risk and severity of complications.Note: Home dialysis clients usually are monitored by conventional dialysis center or interdisciplinary team. Home dialysis clients are often capable of travel, even overseas, with proper preplanning and support.	Verbalize understanding of condition and relationship of signs and symptoms of the disease process and potential complications. Verbalize understanding of therapeutic needs. Correctly perform necessary procedures and explain reasons for actions.

Patient Teaching Home Health Guidance for Patient with Renal Dialysis

Patient teaching discharge and home healthcare guidelines for Patient with Renal Dialysis. May require assistance with treatment regimen, transportation, activities of daily living (ADLs), homemaker and maintenance tasks, end-of life decisions, palliative care Explain to patient and be sure the patient understands All medications, including the dosage, route, action, and adverse effects. Encourage client to participate in menu planning. Recommend small, frequent meals. Schedule meals according to dialysis needs. Encourage use of energy-saving techniques: sitting, not standing; using shower chair; and doing tasks in small increments. Recommend scheduling activities to allow client sufficient time to accomplish tasks to fullest extent of ability. 

Lifestyle Management for Renal Dialysis 

Dietary management involves restriction or adjustment of protein, sodium, potassium, or fluid intake. Ongoing health care monitoring includes careful adjustment of medications that are normally excreted by the kidney or are dialyzable. Surveillance for complications. Arteriosclerotic cardiovascular disease, heart failure, disturbance of lipid metabolism (hypertriglyceridemia), coronary heart disease, stroke Intercurrent infection Anemia and fatigue Gastric ulcers and other problems Bone problems (renal osteodystrophy, aseptic necrosis of hip) from disturbed calcium metabolism Hypertension Psychosocial problems: depression, suicide, sexual dysfunction