Dialysis Nursing Diagnosis and Nursing Care Plan

Dialysis Nursing Care Plans Diagnosis and Interventions

Dialysis Nursing Care Plans Diagnosis and Interventions

Dialysis is a medical procedure that eliminates excess fluid and waste products from the blood when the kidney’s functions start to deteriorate. It frequently entails redirecting blood to a machine for purification. Dialysis has two different types: hemodialysis and peritoneal Dialysis.

What is Hemodialysis?

In hemodialysis, a machine with a specific filter purifies the blood. This medical apparatus is known as a dialyzer or artificial kidney. During the procedure, the patient’s blood flows into the dialyzer from a dialysis access point (typically in the arm).

The machine filters the blood via a membrane. Waste materials in the blood enter through the membrane and are flushed away by dialysate, a fluid. The waste materials are removed before the cleansed blood is reintroduced to the body.

Hemodialysis patients often require treatment three times each week. Each therapy lasts around four hours.

While this may be uncomfortable, hemodialysis benefits many individuals with impaired kidney function. Some individuals may be able to receive hemodialysis at home.

What is Peritoneal Dialysis?

Peritoneal dialysis is another kind of dialysis that eliminates waste substances from the blood when the kidneys are not fully functional.

The primary distinction between hemodialysis and peritoneal dialysis is that hemodialysis necessitates using an artificial kidney machine to filter the blood, whereas peritoneal dialysis does not.

Dialysate passes through a catheter into a portion of the abdomen during peritoneal dialysis. The peritoneum, or lining of the abdomen, works as a natural filter, removing waste items from the blood.

The fluid containing the filtered waste items flows through the catheter after a specified “dwelling” duration, allowing it to be securely eliminated.

This type of dialysis is an excellent alternative for those who meet specific health criteria and prefer fewer restrictions than hemodialysis. However, peritoneal dialysis is only suitable for some individuals.

Indications of Dialysis

If the patient’s kidneys no longer function properly, the doctor may require them to undergo dialysis. Kidney damage often worsens over time as a result of long-term conditions such as:

Related Factors to Dialysis

The doctor will determine which type of dialysis is most appropriate for the patient. Some related factors to consider are as follows:

  • The renal function of the patient
  • The general health of the patient
  • Personal preferences of the patient
  • The patient’s home circumstances
  • The patient’s lifestyle
  • Symptoms and signs of the patient
  • The patient’s quality of life

Complications of Dialysis

A. Hemodialysis

  • Hypotension. A common side effect of hemodialysis is a reduction in blood pressure.
  • Anemia. Anemia (a lack of red blood cells in the blood) is a common consequence of renal failure and hemodialysis.
  • Bone disorders. The bones may deteriorate if the patient’s damaged kidneys are not consistently capable of absorbing vitamin D, which aids in calcium absorption.
  • Access site complications. Infection, constriction or swelling of the blood vessel walls (aneurysm), or blockage are all potentially harmful complications that might affect the quality of the hemodialysis.
  • Amyloidosis. Dialysis-related amyloidosis occurs when proteins in the blood accumulate on tendons and joints, producing discomfort, inflammation, and fluids in the joints.

B. Peritoneal Dialysis

  • Infections. Peritonitis (infection of the stomach lining) is a common consequence of peritoneal dialysis. Infections occur when the catheter is implanted to transport the cleansing fluid (dialysate) into and out of the abdomen.
  • Weight gain. Sugar or dextrose is present in the dialysate. Absorbing some of the dialysates may cause the patient to consume numerous additional calories daily, resulting in weight gain. Extra calories can also result in elevated blood sugar levels, especially if the patient has diabetes.
  • Hernia. Long periods of holding liquids in the abdomen may cause muscle strain.
  • Inadequate dialysis. After a few years, peritoneal dialysis can become ineffective. The patient may need to undergo hemodialysis.

Procedures of Hemodialysis and Peritoneal Dialysis

A. Hemodialysis

  • Preparation. Before the procedure, the nurse monitors and checks the patient’s weight, blood pressure, pulse, and temperature.
  • Start of the procedure. Two needles are put into the patient’s arm through the access site and must be secured to keep them stable during hemodialysis. Each needle is connected to a dialyzer through a thin, flexible tube. The dialyzer filters the blood a few ounces at a time through one tube, permitting wastes and unnecessary fluids to pass from the blood into a cleansing liquid called dialysate. The second tube returns the filtered blood to the body.
  • Observation of side effects. As excess fluid is removed from the body, the patient may experience nausea and abdominal pains, mainly if they have acquired a substantial quantity of fluid between those dialysis sessions. That is why monitoring the side effects is beneficial to prevent severe complications.
  • After-care procedure.  After the hemodialysis session, the nurse withdraws the needles from the access site and puts a pressure dressing to stop the bleeding. The nurse will also measure the patient’s weight and record it in the patient’s chart. Then the patient can resume their regular daily routines until their subsequent session.

B. Peritoneal Dialysis

  • Preparation
    • Before receiving a peritoneal dialysis catheter, a doctor would advise the patient not to eat or drink anything after midnight.
    • The nurse should consult a healthcare practitioner about the supplies needed for the catheter insertion site.
    • The doctor will sedate the patient for the implantation of the catheter.
  • During the procedure. The procedure may differ depending on the approach taken by the doctor. However, the general steps are as follows:
    • Before performing an incision, a surgeon will clean the abdominal area.
    • The surgeon will create an incision in the abdomen, usually just below the belly button and to the right or left.
    • The surgeon will insert the peritoneal dialysis catheter into the peritoneal cavity.

Nursing Management of Dialysis Patients

A. Hemodialysis

The following outlines what the nursing team should do while dealing with a hemodialysis patient:

  • The nurse should limit the patient’s fluid consumption and continuously monitor the input and output. Patients on hemodialysis have minimal to no urine output at all. Thus they will be on fluid restriction, and anything they consume must be compensated, which is why constant monitoring of input and output is beneficial.
  • The nurse should administer the prescribed antihypertensive before the procedure. Due to the greater body volume directly affecting the heart, hemodialysis patients should be given hypertensive medications.
  • The nurse should remind the patient to withhold medications before the procedure. Patients with chronic renal failure who are scheduled to undergo hemodialysis are not allowed to take any medications one hour before the procedure.
  • The nurse should monitor the patient’s blood and electrolyte panels. Electrolyte levels in hemodialysis patients are unstable. The patient’s potassium, BUN, and creatinine levels are also elevated.

B. Peritoneal Dialysis

The following outlines what the nursing team should do while dealing with a peritoneal dialysis patient:

  • The nurse should examine the mucosal membranes, skin turgor, pulse pressure, and capillary refill. Dehydration is indicated by dry mucous membranes, low skin turgor, decreased pulses, and capillary refill, as well as the requirement for higher intake and changes in dialysate concentration.
  • The nurse should keep track of the patient’s respiration rate and exertion. If dyspnea is prevalent, the nurse should also reduce the infusion rate. Respiratory distress, dyspnea, shortness of breath, and shallow breathing during dialysis may imply diaphragmatic pressure from a swollen peritoneum or the development of complications.
  • During catheter insertion, dressing changes, and any other time the system is open, the nurse should observe strict aseptic practices and use masks. The nurse should also change the tubing according to protocol. The goal of this nurse management is to avoid the entry of organisms and airborne contaminants that could lead to infection.
  • The nurse should thoroughly monitor the patient for complaints of pain that starts during inflow and persists through the equilibration phase.
  • In addition, the nurse must slow the infusion rate as directed. This nursing management must be strictly followed because pain arises when acidic dialysate produces chemical irritation of the peritoneal membrane.
  • The nurse should take note of reports of the patient’s acute desire to urinate or significant urine production following the start of the dialysis run. As directed, the nurse should also test the urine for sugar.
  • This condition implies that the dialysate flows into the bladder due to bladder perforation. The accumulation of glucose-containing dialysate in the bladder raises the glucose concentration in the urine.
  • The nurse should inspect the tubing for kinks, note the arrangement of bottles and bags, and secure the catheter to ensure appropriate inflow and outflow. Improper equipment operation may result in trapped fluid in the abdomen and incomplete toxin removal.
  • The nurse should observe the patient’s vital signs. Pericarditis symptoms include pleuritic chest discomfort, palpitations, pericardial friction, rub, insufficient renal perfusion (hypotension), and acidosis. End-stage renal disease (ESRD) patients benefit from this nursing management since they are more likely to develop pericardial damage.

Nursing Diagnosis for Dialysis

Nursing Care Plan for Dialysis Patient 1

Acute Pain

Nursing Diagnosis: Acute Pain related to irritation within the peritoneal cavity secondary to End-Stage Kidney Disease as evidenced by complaints of pain with a pain scale of 7 out of 10 and restlessness.

Desired Outcomes:

  • The patient will express a reduction in pain from 7/10 to 3/10.
  • The patient will display a relaxed posture/facial appearance and can go to bed or rest comfortably.
Dialysis Nursing InterventionsRationale
Evaluate the patient’s complaints of pain; record the severity (0–10), location, and contributing variables.  Help identify the cause of the pain and plan suitable treatments.
Discuss that the initial discomfort typically subsides after a few treatments. During the treatment, information might help to alleviate anxiety and promote calmness.
Monitor for pain that starts during inflow and lasts through the equilibration phase. The infusion rate should be slow as prescribed.Pain develops when acidic dialysate produces chemical irritation of the peritoneal membrane.  
When instilling solution, use no more than 2000 mL at a time and note any complaints of pain most noticeable near the conclusion of the inflow.Dialysate use is most likely to be responsible for abdominal distension. The volume of infusion may need adjustment before starting the treatment.  
Avoid air from entering the peritoneal cavity during infusion. Monitor complaints of pain in the shoulder blade. Introducing air accidentally into the abdomen may irritate the Diaphragm and may cause shoulder blade pain.Abdominal distension and strain of the diaphragm during infusions at the start of therapy are the usual cause of Discomfort. Until the patient adjusts, smaller exchange volumes could be necessary.  
Raise the head of the bed at regular intervals. Turn the patient from side to side.Positioning modifications and light massage may ease stomach and general muscular pain.  
Warm the dialysate at body temperature before administering.Warming the solution enhances urea elimination’s efficacy through dilating peritoneal vessels. Vasoconstriction caused by cold dialysate can be uncomfortable and result in a decrease in body temperature, which can lead to cardiac arrest.  

Nursing Care Plan for Dialysis Patient 2

Fluid Volume Excess

Nursing Diagnosis: Fluid Volume Excess related to saline solution infused to support blood pressure secondary to End-Stage Renal Failure as evidenced by shortness of breath, edema, high blood pressure, electrolytes imbalance, and weakness.

Desired Outcomes:

  • The patient will have average fluid volume as shown by balanced intake and output
  • The patient will have no visible edema or unexpected weight gain.
  • The patient will have a standard respiratory rate and clear breath sounds.
Dialysis Nursing InterventionsRationale
Measure I&O from all sources. Weigh the patient regularly.  Assists in determining the fluid condition, particularly when matched to weight. Weight gain should not exceed 0.5 kg/day between treatments.    
Monitor vital signs, specifically blood pressure and pulse rate.Fluid overload and heart failure can cause high blood pressure and palpitations between hemodialysis sessions.  
Take note of lung sounds.The presence of crackles lung sounds can be a sign of worsening pulmonary congestion.
Take note of any peripheral or sacral edema, respiratory rales, difficulty breathing, orthopnea, swollen neck veins, or ECG abnormalities that indicate ventricular hypertrophy.Fluid volume excess caused by ineffective dialysis or repeated hypervolemia between dialysis treatments can develop or worsen HF, as evidenced by clinical manifestations of respiratory and systemic venous congestion.  
Note any changes in mental activities.  Fluid excess or hypervolemia may aggravate cerebral edema (disequilibrium syndrome).
Check blood sodium levels. Limit the salt intake as directed.There is a link between High sodium levels and fluid overload, edema, high blood pressure, and heart problems.  
Limit PO/IV fluid intake according to the guidelines, divided over 24 hours.Hemodialysis’s intermittent nature causes fluid retention or overload between sessions, which may necessitate fluid restriction. Dividing out liquids helps to quench thirst.  
Check the lab results.Electrolytes may be diluted in excess fluid volume, resulting in low sodium (hyponatremia). Overhydration will result in a reduction in serum osmolality. With an increase in circulating blood volume, hematocrit will drop as well. Excessive fluid intake will decrease BUN levels, which measures renal function.

Nursing Care Plan for Dialysis Patient 3

Risk for Ineffective Breathing Pattern

Nursing Diagnosis: Risk for Ineffective Breathing Pattern related to rapid infusion of dialysate secondary to Peritoneal Dialysis.

Desired Outcomes:

  • The patient will demonstrate a properly functioning respiratory pattern with audible breath sounds and ABGs within the patient’s normal range.
  • The patient will not indicate dyspnea or cyanosis.
Dialysis Nursing InterventionsRationale
Observe the patient’s respiratory rate and intensity. If dyspnea is present, reduce the infusion rate.  Indications of diaphragmatic pressure from a distended peritoneum may include rapid respiration, difficulty breathing, shortness of breath, and shallow breathing during dialysis and may development further complications.  
Note any diminished, absent, or abnormal breath sounds such as crackles, wheezes, and rhonchi when auscultating the lungs.Indications of Atelectasis include decreased breathing, but audible abnormalities may indicate infection, fluid overload, or residual secretions.  
Raise the head of the bed or have the patient seated in a chair. Encourage deep breathing exercises and coughing.These measures allow for easier chest expansion, ventilation, and secretion mobilization.
Analyze the ABGs, pulse oximetry, and multiple chest x-rays.Infiltrates and congestion can be present on chest x-rays and changes in Pao2 and Paco2, which point to the occurrence of pulmonary issues.  
Maintain a healthy nutritional status. Offer vitamin supplements along with a diet high in calories, low in protein, low in salt, and low in potassium.To maintain a balanced diet.  
Encourage the patient to practice relaxation techniques.Relaxation techniques ease breathing difficulties and tension in the muscles.
Regularly practice breathing exercises, coughing, and changing postures with the patient.These measures promote the mobilization of secretions, reducing the probability of lung infections.
Let the patient rest for an adequate time.thorough, maintaining the patient’s Strength and adequate rest periods reduce the workload of the lungs
Elevate the legs to reduce pressure underneath the knees or to a comfortable position for the patient.Leg elevation decreases venous return and preload, which might support in preventing the formation of thrombi and emboli.
Administer medications such as diuretics as directed by the physician.Diuretics are the recommended first-line treatment for all individuals with fluid overload signs. Reduced blood volume lowers cardiac dilatation, pulmonary edema, peripheral edema, and blood vessel pressure. Additionally, it quickly eases discomfort and lessens fluid retention.

Nursing Care Plan for Dialysis Patient 4

Risk for Injury

Nursing Diagnosis: Risk for Infection related to Contamination of the AV Fistula Needle upon placement secondary to Hemodialysis.

Desired Outcomes:

  • The patient access site will be free from infection, as shown by typical vital signs and a lack of infection-related symptoms and abnormalities.
  • The patient will identify early infection detection to carry-out immediate treatment
Dialysis Nursing InterventionsRationale
Assess the vascular access area for inflammation, an audible bruit, and palpable pulse or vibration.The most frequent issues impacting the access point in hemodialysis patients are thrombus development and infection.
Apply sterile techniques when changing bandages or caring for the access area.The sterile technique reduces the possibility of infection at the access point.
Be sure to wash and pat dry any skin folds thoroughly. Apply moisture and hydration to all vulnerable surfaces.The most significant way to maintain skin Healthy is to keep it supple and moist. Inflammation, excoriations, and potential infection episodes can result from dry skin.
  
Advise the patient and family that any symptoms of infection that they notice must report to the health provider as soon as possible (e.g., redness; warmth; swelling; tenderness or pain; new onset of drainage or change in drainage from the wound; increase in body temperature).Participating the patient and their family in the treatment plan promotes teamwork and independent self-care. Additionally, educating them about reportable symptoms enables early detection.
Inform the patient and their family regarding the importance of a healthy diet (particularly one high in protein) and adequate sleep for a strong immune system.A healthy diet and adequate sleep are also crucial for enhancing immune function and lowering the risk of infection.  
Instruct the patient in taking their antibiotics as directed.Maintaining a consistent blood level during medication administration for antibiotics function best. The nurse should inform patients that some foods prevent the absorption of various medications.

Nursing Care Plan for Dialysis Patient 5

Risk for Fluid Volume Deficit

Nursing Diagnosis: Risk for Fluid Volume Deficit related to Decreased Urine Output and fluid retention secondary to End-Stage Renal Failure.

Desired Outcomes:

  • The patient will achieve fluid balance within the normal range.
  • The patient will comply with treatments to maintain an adequate fluid balance.
Dialysis Nursing InterventionsRationale
Evaluate and record the patient’s status of the vascular access point, weight, and vital signs.During dialysis, rapid fluid and solute outflow can cause orthostatic hypotension, cardiac abnormalities, and weight loss.
Maintain that daily weights are taken at the same time each day, with the patient in the same attire.Weight changes are useful to measure fluid volume in the body. To make a reliable comparison, weighing oneself during the same time of day is recommended.
Between dialysis sessions, keep track of the BUN, serum creatinine, serum electrolytes, and hematocrit levels.These levels evaluate the treatment’s effectiveness, the required fluid and dietary restrictions, and the scheduling of future dialysis treatments.
Instruct the patient to Follow the prescribed fluid intake guidelines.To ensure that the patient is getting the right amount of fluids, maintaining them hydrated and reducing the chance that they’ll consume too much fluid, which could lead to congestion afterward.
Evaluate the patient for dialysis disequilibrium syndrome, which includes headache, nausea, vomiting, changed level of awareness, and hypertension.While on dialysis, rapid fluctuations in BUN, pH, and electrolyte levels can cause cerebral edema and elevated intracranial pressure.
Evaluate the patient for further dialysis side effects, including dehydration, nausea, vomiting, cramping, or seizure activity. Notify the attending physician immediately.Excessive fluid withdrawal and fast changes in electrolyte balance can result in a fluid deficit, nausea, vomiting, and seizure activity.   

Nursing References

Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.  Buy on Amazon

Gulanick, M., & Myers, J. L. (2022). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon

Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2020). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier.  Buy on Amazon

Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.  Buy on Amazon

Disclaimer:

Please follow your facilities guidelines, policies, and procedures.

The medical information on this site is provided as an information resource only and is not to be used or relied on for any diagnostic or treatment purposes.

This information is intended to be nursing education and should not be used as a substitute for professional diagnosis and treatment.

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Anna Curran. RN, BSN, PHN

Anna Curran. RN, BSN, PHN
Clinical Nurse Instructor

Emergency Room Registered Nurse
Critical Care Transport Nurse
Clinical Nurse Instructor for LVN and BSN students

Anna began writing extra materials to help her BSN and LVN students with their studies and writing nursing care plans. She takes the topics that the students are learning and expands on them to try to help with their understanding of the nursing process and help nursing students pass the NCLEX exams.

Her experience spans almost 30 years in nursing, starting as an LVN in 1993. She received her RN license in 1997. She has worked in Medical-Surgical, Telemetry, ICU and the ER. She found a passion in the ER and has stayed in this department for 30 years.

She is a clinical instructor for LVN and BSN students and a Emergency Room RN / Critical Care Transport Nurse.

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