Dialysis is a life-sustaining treatment for patients with end-stage renal disease (ESRD) or acute kidney injury. This nursing diagnosis focuses on identifying and addressing the complex care needs of patients undergoing hemodialysis or peritoneal dialysis, preventing complications, and promoting optimal outcomes.
Causes (Related to)
Dialysis patients face multiple challenges due to their condition and treatment requirements:
- End-stage renal disease (ESRD)
- Acute kidney injury
- Chronic health conditions such as:
- Diabetes mellitus
- Hypertension
- Cardiovascular disease
- Autoimmune disorders
- Treatment-related factors including:
- Vascular access complications
- Electrolyte imbalances
- Medication side effects
- Dialysis schedule demands
Signs and Symptoms (As evidenced by)
Patients undergoing dialysis present with various manifestations that require careful nursing assessment and intervention.
Subjective: (Patient reports)
- Fatigue and weakness
- Muscle cramps
- Nausea and vomiting
- Sleep disturbances
- Anxiety about treatment
- Dietary restrictions burden
- Changed body image
- Social isolation
Objective: (Nurse assesses)
- Fluid overload between treatments
- Blood pressure fluctuations
- Access site complications
- Electrolyte imbalances
- Anemia
- Skin changes
- Decreased urine output
- Weight changes
Expected Outcomes
Successful management of dialysis patients includes:
- Maintained fluid and electrolyte balance
- Prevention of complications
- Adequate nutrition status
- Functional vascular access
- Treatment adherence
- Quality of life improvement
- Self-management skills
- Reduced hospitalization rates
Nursing Assessment
Monitor Access Site
- Assess bruit and thrill
- Check for infection signs
- Evaluate maturation
- Document complications
- Monitor bleeding risk
Evaluate Fluid Status
- Track weight changes
- Monitor vital signs
- Assess edema
- Record intake/output
- Check breathing sounds
Assess Nutrition Status
- Monitor albumin levels
- Track dietary compliance
- Check appetite changes
- Document weight trends
- Evaluate supplement needs
Monitor Complications
- Check electrolyte levels
- Assess bleeding risk
- Monitor cardiovascular status
- Document infection signs
- Track anemia symptoms
Evaluate Psychosocial Status
- Assess coping mechanisms
- Check support systems
- Monitor depression signs
- Document adherence issues
- Evaluate the quality of life
Nursing Care Plans
Nursing Care Plan 1: Fluid Volume Excess
Nursing Diagnosis Statement:
Fluid Volume Excess related to decreased kidney function as evidenced by edema, weight gain, and increased blood pressure.
Related Factors:
- Impaired kidney function
- Sodium and water retention
- Dietary non-compliance
- Treatment non-adherence
Nursing Interventions and Rationales:
- Monitor daily weights
Rationale: Indicates fluid status changes - Assess edema and lung sounds
Rationale: Detects fluid overload complications - Educate about fluid restrictions
Rationale: Promotes adherence to treatment plan
Desired Outcomes:
- The patient will maintain dry weight between treatments
- The patient will demonstrate an understanding of fluid restrictions
- The patient will show reduced edema
Nursing Care Plan 2: Risk for Infection
Nursing Diagnosis Statement:
Risk for Infection related to vascular access presence as evidenced by increased risk of access-site complications.
Related Factors:
- Vascular access device
- Compromised immune system
- Repeated needle insertion
- Poor hygiene practices
Nursing Interventions and Rationales:
- Maintain a strict aseptic technique
Rationale: Prevents access-site infections - Monitor access site appearance
Rationale: Enables early detection of complications - Teach proper access to care
Rationale: Promotes self-management skills
Desired Outcomes:
- The patient will maintain infection-free access to the site
- The patient will demonstrate proper access to care
- The patient will identify infection signs early
Nursing Care Plan 3: Imbalanced Nutrition
Nursing Diagnosis Statement:
Imbalanced Nutrition: Less than body requirements related to dietary restrictions as evidenced by poor appetite and weight loss.
Related Factors:
- Dietary restrictions
- Uremia
- Medication side effects
- Altered taste sensation
Nursing Interventions and Rationales:
- Monitor nutritional intake
Rationale: Ensures adequate nutrition - Provide dietary education
Rationale: Promotes appropriate food choices - Collaborate with dietitian
Rationale: Optimizes nutritional planning
Desired Outcomes:
- The patient will maintain a stable weight
- The patient will follow the prescribed diet
- The patient will show an improved appetite
Nursing Care Plan 4: Activity Intolerance
Nursing Diagnosis Statement:
Activity Intolerance related to fatigue and anemia as evidenced by weakness and decreased exercise capacity.
Related Factors:
- Anemia
- Electrolyte imbalances
- Treatment schedule
- Muscle weakness
Nursing Interventions and Rationales:
- Assess activity tolerance
Rationale: Determines appropriate activity levels - Plan activities around treatment
Rationale: Maximizes energy use - Encourage regular exercise
Rationale: Improves strength and endurance
Desired Outcomes:
- The patient will increase activity tolerance
- The patient will maintain energy for daily activities
- The patient will participate in regular exercise
Nursing Care Plan 5: Ineffective Coping
Nursing Diagnosis Statement:
Ineffective Coping related to chronic illness demands as evidenced by expressed feelings of hopelessness and treatment burden.
Related Factors:
- Chronic illness stress
- Treatment demands
- Limited support system
- Life changes
Nursing Interventions and Rationales:
- Assess coping mechanisms
Rationale: Identifies areas needing support - Provide emotional support
Rationale: Promotes psychological well-being - Refer to support services
Rationale: Enhances coping resources
Desired Outcomes:
- The patient will demonstrate effective coping strategies.
- The patient will express a positive outlook
- The patient will utilize support resources
References
- Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2023). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.
- Aljawadi MH, Babaeer AA, Alghamdi AS, Alhammad AM, Almuqbil MS, Alonazi KF. Quality of life tools among patients on dialysis: A systematic review. Saudi Pharm J. 2024 Mar;32(3):101958. doi: 10.1016/j.jsps.2024.101958. Epub 2024 Jan 14. PMID: 38322149; PMCID: PMC10845059.
- Bonenkamp, A. A., Van Eck van der Sluijs, A., Hoekstra, T., Verhaar, M. C., Van Ittersum, F. J., Abrahams, A. C., & Van Jaarsveld, B. C. (2020). Health-Related Quality of Life in Home Dialysis Patients Compared to In-Center Hemodialysis Patients: A Systematic Review and Meta-analysis. Kidney Medicine, 2(2), 139-154. https://doi.org/10.1016/j.xkme.2019.11.005
- Harding, M. M., Kwong, J., & Hagler, D. (2022). Lewis’s Medical-Surgical Nursing: Assessment and Management of Clinical Problems, Single Volume. Elsevier.
- Herdman, T. H., Kamitsuru, S., & Lopes, C. (2024). NANDA International Nursing Diagnoses – Definitions and Classification, 2024-2026.
- Ignatavicius, D. D., Rebar, C., & Heimgartner, N. M. (2023). Medical-Surgical Nursing: Concepts for Clinical Judgment and Collaborative Care. Elsevier.
- Jayanti S, Rangan GK. Advances in Human-Centered Care to Address Contemporary Unmet Needs in Chronic Dialysis. Int J Nephrol Renovasc Dis. 2024 Mar 20;17:91-104. doi: 10.2147/IJNRD.S387598. PMID: 38525412; PMCID: PMC10961023.
- Silvestri, L. A. (2023). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.
