NCP Renal Dialysis

Dialysis is a process that substitutes for renal function by removing excess fluid and/or accumulated endogenous or exogenous toxins. Dialysis is most often used for patients with ARF and chronic (end-stage) renal disease. The two most common types are hemodialysis and peritoneal dialysis. Dialysis therapies include intermittent hemodialysis (IHD), continuous arteriovenous hemodialysis (CAVHD), continuous venovenous hemodialysis (CVVHD), and peritoneal dialysis.

Patients with ARF are sometimes so hemodynamically unstable that they cannot tolerate conventional hemodialysis. These patients may benefit from continuous renal replacement therapy (CRRT), which more slowly removes plasma water and compensates for the loss of intravascular volume. Ultrafiltration methods include continuous arteriovenous hemofiltration (CAVH) and continuous venovenous hemofiltration (CVVH).

The chosen type of fluid and or solute removal depends on the patient’s cause for renal failure, current hemodynamic status, vascular access, and healthcare providers’ equipment and training.

CARE SETTING

Community level/dialysis center, although inpatient acute stay may be required during initiation of therapy.

RELATED CONCERNS

Anemias (iron deficiency, pernicious, aplastic, hemolytic)
Heart failure: chronic
Peritonitis
Psychosocial aspects of care
Sepsis/septicemia
Total nutritional support: parenteral/enteral feeding
Transplantation: (postoperative and lifelong)

Patient Assessment Database

Refer to CPs: Renal Failure: Acute; Renal Failure: Chronic, for assessment information.

Discharge plan considerations:
DRG projected mean length of inpatient stay: 2.2 days to initiate therapy
May require assistance with treatment regimen, transportation, activities of daily living (ADLs), homemaker/maintenance tasks

Refer to section at end of plan for postdischarge considerations.

DIAGNOSTIC STUDIES

Studies and results are variable, depending on reason for dialysis (e.g., removal of excess fluid or toxins/drugs), degree of renal involvement, and patient considerations (e.g., distance from treatment center, cognition, available support).

NURSING PRIORITIES

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

DISCHARGE GOALS

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

GENERAL CONSIDERATIONS

This section addresses the general nursing management issues of patient receiving some form of dialysis.