Nursing care plan renal dialysis general considerations

I. Procedure
a. Process that substitutes for kidney function by removing
excess fluid and accumulated endogenous or exogenous toxins
b. 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

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

III. Types
a. Choice of dialysis is determined by three main factors.
i. Type of renal failure (acute or chronic)
ii. Client’s particular physical condition
iii. Access to dialysis resources
b. Two primary types of dialysis
i. Hemodialysis (HD)
1. Requires placement of a venous access and a machine
removing the blood from the body, running it through
a dialyzer, and then returning it to the body
2. Conventional HD may be done three times a week
over 3 to 4 hours, either at a facility or in the home;
or, daily dialysis may be done during the day or night
hours (nocturnal dialysis).
ii. Peritoneal dialysis (PD)
1. Requires a surgically placed abdominal catheter for
infusing dialysate fluid into the peritoneal cavity for a
predetermined dwell time and then draining it out
2. Procedure may be carried out at home through gravity
or automated pump.
IV. Statistics (National Kidney and Urologic Diseases
Information Clearinghouse [NKUDIC], 2005; U.S. Renal
Data System [USRDS], 2007)
a. Morbidity: In 2005, 341,319 individuals with ESRD
reportedly received dialysis in the United States, with
314,000 receiving HD (most of them in dialysis centers)
and approximately 26,000 receiving PD.
b. Mortality: The probability of survival of clients receiving
dialysis at 1 year is 78.3%; at 2 years, 63.6%; at 5 years,
32.1%; and at 10 years, 10.3% (NKUDIC, 2008).
c. Costs: In 2002, Medicare payments for outpatient HD and
PD were approximately $3.6 billion (USRDS, 2004).

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

Related Concerns
Anemias—iron deficiency, anemia of chronic disease, pernicious,
aplastic, hemolytic,
Heart failure: chronic,
Psychosocial aspects of care,
Total nutritional support: parenteral/enteral feeding,
Transplantation considerations—postoperative and lifelong,

Nursing Priorities
1. Promote homeostasis.
2. Maintain comfort.
3. Prevent complications.
4. Support client independence and self-care.
5. Provide information about disease process, prognosis,
and treatment needs.

Discharge Goals
1. Fluid and electrolyte balance maximized.
2. Complications prevented or minimized.
3. Discomfort alleviated.
4. Dealing realistically with current situation; independent
within limits of condition.
5. Disease process, prognosis, and therapeutic regimen
6. Plan in place to meet needs after discharge.

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