Hemodialysis- is a medical procedure designed to remove wastes, toxins and fluids from the blood when the kidneys have failed. It is the most common treatment for end-stage renal disease (ESRD), more commonly known as kidney failure. This process usually lasts for about four hours and a patient has to undergo such procedure three times a week. HD may be done in the hospital, outpatient dialysis center, or at home.
Two types of dialysis
- Hemodialysis– blood is passed through an artificial kidney (hemodialyzer) to clean it.
- Peritoneal dialysis– uses a filtering process similar to hemodialysis, but the blood is cleaned inside the body rather than in a machine. The good thing about this process is that patient can do this at home three to four times a day, provided that he/she has knowledge in using the facility.
Nursing Diagnosis:Risk for excess Fluid Volume
Risk factors may include
- Rapid/excessive fluid intake: IV, blood, plasma expanders, saline given to support BP during dialysis
Possibly evidenced by
[Not applicable; presence of signs and symptoms establishes an actual diagnosis.]
- Maintain “dry weight” within patient’s normal range; be free of edema; have clear breath sounds and serum sodium levels within normal limits.
Hemodialysis Nursing Care Plan-Risk for excess Fluid Volume
|Measure all sources of I&O. Weigh routinely.||Aids in evaluating fluid status, especially when compared with weight. Weight gain between treatments should not exceed 0.5 kg/day.|
|Monitor BP, pulse.||Hypertension and tachycardia between hemodialysis runs may result from fluid overload and/or HF.|
|Note presence of peripheral/sacral edema, respiratory rales, dyspnea, orthopnea, distended neck veins, ECG changes indicative of ventricular hypertrophy.||Fluid volume excess due to inefficient dialysis or repeated hypervolemia between dialysis treatments may cause/exacerbate HF, as indicated by signs/symptoms of respiratory and/or systemic venous congestion.|
|Note changes in mentation. (Refer to CP: Renal Dialysis; ND: Thought Processes, risk for disturbed.)||Fluid overload/hypervolemia may potentiate cerebral edema (disequilibrium syndrome).|
|Monitor serum sodium levels. Restrict sodium intake as indicated.||High sodium levels are associated with fluid overload, edema, hypertension, and cardiac complications.
|Restrict PO/IV fluid intake as indicated, spacing allowed fluids throughout a 24-hr period.||The intermittent nature of hemodialysis results in fluid retention/overload between procedures and may require fluid restriction. Spacing fluids helps reduce thirst.|