Dialysis: Overview and Nursing Case Study for Nursing School and NCLEX Prep

Learning about Dialysis

Dialysis is a critical medical procedure that plays a vital role in the lives of individuals with compromised kidney function. When the kidneys are unable to effectively filter waste and excess fluids from the blood, dialysis steps in as a lifeline.

This procedure replicates the essential functions of healthy kidneys by purifying the blood, removing toxins, and regulating electrolyte levels. Dialysis helps maintain fluid balance and prevents the buildup of harmful substances that could lead to serious health complications.

For those with end-stage renal disease or advanced chronic kidney disease, dialysis becomes a routine necessity. Whether it’s hemodialysis, where blood is cleansed using a machine, or peritoneal dialysis, which occurs internally using the abdomen’s lining, this procedure significantly improves the quality of life for patients, granting them more time and vitality while they navigate their medical journey

My uncle underwent dialysis three times a week due to end-stage renal disease. Something he has been battling for years already. But witnessing his dedication and resilience in facing the challenges of treatment was inspiring. Despite the physical and emotional toll, he remained positive, cherishing every moment with family. His journey taught me the importance of empathy and compassion in providing support to individuals undergoing dialysis. 

Overview on Dialysis

General:

1. Hemodialysis
   a. The purpose is to clear waste and toxins (urea, creatinine, uric acid) from the blood and regulates electrolytes
   b. Complications
       i. Hypotension / Hypovolemic Shock – pulling off 1-4 L of fluid in 2-4 hours
      ii. Air embolus
     iii. Electrolyte Imbalance
     iv. Sepsis
      v. Hemorrhage from site
  c. Medication Precautions
      i. HOLD antihypertensives and medications that might drop blood pressure (verify with the provider)
     ii. HOLD medications that will be removed by dialysis (contact pharmacy with questions, verify with the provider)
  d. Nursing Priorities
     i. Monitor vital signs and EKG closely throughout (risk for hypotension or EKG changes)
    ii. Monitor labs values closely
   iii. Weigh the client before and after dialysis to estimate fluid loss (1 kg = 1L)
    iv. Assess for bleeding from the site
 e. Vascular Access
     i. Types
1. Graft (artificial ‘vessel’ loop)
2. Fistula (allows higher velocity/volume in veins)
3. External Dialysis Catheter (usually temporary)
     ii. Do NOT insert IVs or take NIBP on the extremity with active fistula or graft
    iii. Assess pulses and capillary refill in the affected extremity
    iv. Monitor fistulas and grafts closely for clots
1. Bruit: listen for a swooshing sound
2. Thrill: feel the vibrations
3. If bruit and thrill are absent notify the provider
     v. Protect Vascular Access → their LIFELINE!

2. Peritoneal Dialysis
   a. Peritoneum acts as a semipermeable membrane for dialysis
        i. Contraindications are peritonitis and abdominal surgery
       ii. Can be continuous (24/7) or intermittent and can be done at home
   b. The client is at risk for peritonitis (infection of the peritoneum) which can be prevented with strict sterile technique and will show as a cloudy outflow

Nursing Case Study for Dialysis

Patient Profile:

Name: Mr. Chad Anderson
Age: 58 years old
Gender: Male
Medical History: End-Stage renal disease (ESRD) due to hypertension and diabetes

Presenting Symptoms:

• Fatigue and weakness 
• Fluid retention with swelling in the legs and ankles 
• Elevated blood pressure 
• Elevated serum creatinine and blood urea nitrogen (BUN) levels 

Medical Examination and Diagnostics:

• Physical Examination: Mr. Anderson displayed pitting edema in the lower extremities and elevated blood pressure 
• Laboratory Tests: Elevated serum creatinine and BUN levels, indicating impaired kidney function 
• Renal Ultrasound: Confirmed end-stage renal disease with minimal kidney function 

Medical History:
Mr. Anderson had a long-standing history of poorly controlled hypertension and diabetes, which led to end-stage renal disease 

Diagnosis: 
Mr. Anderson was diagnosed with end-stage renal disease (ESRD) and required renal replacement therapy in the form of dialysis. 

Treatment Plan: 

1. Hemodialysis Initiation:
Prepared Mr. Anderson for hemodialysis by creating an arteriovenous fistula or using a central venous catheter 
2. Dialysis Schedule and Monitoring:
Coordinated dialysis sessions, monitored vital signs, and assessed access site regularly during dialysis 
3. Fluid and Electrolyte Management:
Monitored fluid and electrolyte balance, adjusting fluid removal during dialysis sessions
4. Nutritional Support:
Collaborated with a dietician to provide a renal-friendly diet and manage nutritional needs 
5. Blood Pressure Control:
Administered antihypertensive medications to maintain target blood pressure levels

Outcome:

With diligent nursing care and regular dialysis sessions, Mr. Anderson’s symptoms improved significantly. His fluid retention decreased, and his blood pressure was stabilized. Regular dialysis sessions helped manage his renal function and maintained his overall well-being. 

Conclusion and Free Download

This dialysis review provides essential knowledge for approaching the NCLEX with confidence. Understanding its prevention, management, and interventions empowers nurses to provide adequate care and save lives.

Looking for more must-know NCLEX review topics? Download our free eBook, “NCLEX Flash Notes: 77 Must-Know Nursing Topics for the NCLEX,” by simply providing your email address below. I’ll send you a complimentary copy straight to your inbox!

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Happy Nursing!