Hemodialysis
Hemodialysis
Hemodialysis
Nursing Diagnosis
Nutrition: imbalanced, less than body requirements GI disturbances (result of uremia/medication side effects): anorexia, nausea/vomiting, and stomatitis Sensation of feeling full (abdominal distension during continuous ambulatory peritoneal dialysis [CAPD]) Dietary restrictions (bland, tasteless food); lack of interest in food Loss of peptides and amino acids (building blocks for proteins) during dialysis Inadequate food intake, aversion to eating, altered taste sensation Poor muscle tone/weakness Sore, inflamed buccal cavity; pale conjunctiva/mucous membranes Demonstrate stable weight/gain toward goal with normalization of laboratory values and no signs of malnutrition.
May be related to
Possibly evidenced by
Desired Outcomes
Dialysis Nursing Care Plan: Imbalanced Nutrition: Less Than Body Requirements Nursing Interventions Rationale
Recommend patient/SO keep a food diary, including estimation of ingested calories, electrolytes of individual concern (e.g., sodium, potassium, chloride, magnesium), and protein.
Helps patient realize big picture and allows opportunity to alter dietary choices to meet individual desires within identified restriction.
Measure muscle mass via triceps skin fold or similar procedure. Determine muscle-to-fat ratio.
Assesses adequacy of nutrient utilization by measuring changes in fat deposits that may suggest presence/absence of tissue catabolism.
Symptoms accompany accumulation of endogenous toxins that can alter/reduce intake and require intervention.
Smaller portions may enhance intake. Type of dialysis influences meal patterns, e.g., patients receiving hemodialysis might not be fed directly before/during procedure because this can alter fluid removal, and patients undergoing peritoneal dialysis may be unable to ingest food while abdomen is distended with dialysate.
Reduces discomfort of oral stomatitis and undesirable/metallic taste in mouth, which can interfere with food intake
Refer to dietitian.
Necessary to develop complex and highly individual dietaryprogram to meet cultural/lifestyle needs within specific kilocalories and protein restrictions while controlling phosphorus, sodium, potassium.
Administer multivitamins, including ascorbic acid (vitamin C), folic acid, vitamins B6 and D, and iron supplements, as indicated.