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
- 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 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.
- 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 Diagnosis Renal dialysis. Primary focus is at the community level at the dialysis center, although inpatient acute stay may be required during initiation of therapy.
Nursing assessment for renal dialysis
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. Common nursing diagnosis found in nursing Care Plan 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 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 Nursing Care Plan for patient with Renal Dialysis
- 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
- 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
- Note presence of nausea and anorexia Rationale Symptoms accompany accumulation of endogenous toxins that can alter or reduce intake and require intervention
- Encourage client to participate in menu planning Rationale May enhance oral intake and promote sense of control.
- 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.
- 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
- Suggest socialization during meals Rationale Provides diversion and promotes social aspects of eating.
- Encourage frequent mouth care Rationale Reduces discomfort of oral stomatitis and metallic taste in mouth associated with uremia, which can interfere with food intake
- 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.
- 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.
- 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.
- 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.
Complete Sample Nursing Care Plan for patient with Renal Dialysis
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
- Psychosocial problems: depression, suicide, sexual dysfunction
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