Question

describe the   Experience of End-Stage Renal Disease Patients Concerning the Provided Nursing Care and 5 terms associated with end-stage renal disease.

Answer 1

The patient with ESRD requires astute nursing care to avoid the complications of reduced renal function and the stresses and anxieties of dealing with a life-threatening illness.

Nursing Assessment

Assessment of a patient with ESRD includes the following:

• Assess fluid status (daily weight, intake and output, skin turgor, distention of neck veins, vital signs, and respiratory effort).
• Assess nutritional dietary patterns (diet history, food preference, and calorie counts).
• Assess nutritional status (weight changes, laboratory values).
• Assess understanding of cause of renal failure, its consequences and its treatment.
• Assess patient’s and family’s responses and reactions to illness and treatment.
• Assess for signs of hyperkalemia.

Diagnosis

Based on the assessment data, the following nursing diagnoses for a patient with chronic renal failure were developed:

• Excess fluid volume related to decreased urine output, dietary excesses, and retention of sodium and water.
• Imbalanced nutrition less than body requirements related to anorexia, nausea, vomiting, dietary restrictions, and altered oral mucous membranes.
• Activity intolerance related to fatigue, anemia, retention of waste products, and dialysis procedure.
• Risk for situational low self-esteem related to dependency, role changes, changes in body image, and change in sexual function.

Planning & Goals

Main Article: 6 Chronic Renal Failure Nursing Care Plans

The goals for a patient with chronic renal failure include:

• Maintenance of ideal body weight without excess fluid.
• Maintenance of adequate nutritional intake.
• Participation in activity within tolerance.
• Improve self-esteem.

Nursing Priorities

1. Maintain homeostasis.
2. Prevent complications.
3. Provide information about disease process/prognosis and treatment needs.
4. Support adjustment to lifestyle changes.

Nursing Interventions

Nursing care is directed towards the following:

• Fluid status. Assess fluid status and identify potential sources of imbalance.
• Nutritional intake. Implement a dietary program to ensure proper nutritional intake within the limits of the treatment regimen.
• Independence. Promote positive feelings by encouraging increased self-care and greater independence.
• Protein. Promote intake of high-biologic –value protein foods: eggs, dairy products, meats.
• Medications. Alter schedule of medications so that they are not given immediately before meals.
• Rest. Encourage alternating activity with rest.

Evaluation

A successful nursing care plan has achieved the following:

• Maintained ideal body weight without excess fluid.
• Maintained adequate nutritional intake.
• Participated in activity within tolerance.
• Improved self-esteem.

Discharge and Home Care Guidelines

The nurse should promote home and self-care to increase the esteem of the patient.

• Vascular access care. The patient should be taught how to check the vascular access device for patency and appropriate precautions, such as avoiding venipuncture and blood pressure measurements on the arm with the access device.
• Problems to report. The patient and the family need to know what problems to report: nausea, vomiting, change in usual urine output, ammonia odor on breath, muscle weakness, diarrhea, abdominal cramps, clotted fistula or graft, and signs of infection.
• Follow-up. The importance of follow-up examinations and treatment is stressed to the patient and family because of changing physical status, renal function, and dialysis requirements.
• Home care referral. Referral for home care gives the nurse an opportunity to assess the patient’s environment and emotional status and the coping strategies used by the patient and family.

Documentation Guidelines

The documentation in a patient with chronic renal failure should focus on the following:

• Existing conditions contributing to and degree of fluid retention.
• I&O and fluid balance.
• Results of laboratory tests.
• Caloric intake.
• Individual cultural or religious restrictions and personal preferences.
• Level of activity.
• Plan of care.
• Teaching plan.
• Response to interventions, teaching, and actions performed.
• Attainment or progress toward desired outcomes.
• Modifications to plan of care.
• Long term needs.