Dietary management of a patient undergoing dialysis.

Managing patients undergoing dialysis.

In a patient undergoing dialysis commonly there may be electrolyte alterations. Therefore daily assessment is necessary. Nurse is responsible to collect blood samples as necessary. All the IV infusions and medications are adjusted according to the patient's electrolyte levels.  Specially the dietary management is necessary for the patient's undergoing hemodialysis.

 

Dietary management

As the patient's ability to get rid of the waste products have compromised, special attention should be given for the diet. Always a balanced diet is needed with adequate amounts of protein, vitamin and minerals.

               From the studies , It has proven accumulation of toxins in the body will suppress the appetite. so they tend to take less amount of calories. Protein energy malnutrition is very common among these patients.  This happen when the patient complete most of his calories with carbohydrates without taking enough amount of protein. The recommended protein amount is 1.2g/kg of body weight per day.

                         These patients can face micro nutrients malnutrition too.[ Micro nutrients -Vitamins , minerals, trace elements] .

                                       During the dialysis process water soluble vitamins get removed from the body. so this can lead to vitamin deficiency. at the same way the kidneys are unable to remove micro nutrients properly from the body. so it can cause to end up in excessive amounts of micro nutrients.

Vitamin A - is a fat soluble vitamin which will not get removed during dialysis .

Phosphorus - Phosphorus is not removed by dialysis. therefore there may be increase phosphorus levels in blood.  This can cause bone dissolving and release calcium from bones and make the bones weaker. Accumulation of phosphorus in blood can make calcium phosphorus crystals in joints,muscles, blood and even in heart. if we don't manage the phosphorus level it can cause bone pain, poor blood circulation and heart damage. so what we have to do is limit foods rich in phosphorus.

foods rich in phosphorus - Dairy products, nuts,  beans. lentils, cola drinks, beer, bear.

Impaired kidney function can elevate the potassium level in blood . This can mange by limiting the foods rich in potassium.

Foods rich in potassium - Banana, melon, orange, potatoes, milk, poultry, fish

Sodium should be avoided because sodium increase thirst and increase fluid intake by accumulating fluid. we can advice the patient to stop adding salt to food, and advice to practice species and herbs to make the food taste. If fluid accumulate this can increase blood pressure, weight gain, shortness of breath, swelling of lower extremities.

Nurse should advice the patient to take limited amount of fluid to the body, should avoid beverages,and foods like ice cream, fizzy drinks which convert them to fluid at room temperature.

Dietary supplementation should be taken according to the doctor's advice. to avoid nutritional deficiencies.
Above foods are not good for dialysis patients . and there are some good foods recommended for dialysis patients.

Dietary tips.

• Consume fresh vegetables without adding salt
• Practice to have canned fruits as they contain less potassium
• Use non diary products as they contain less phosphorus
• Avoid using common salt instead add spices.

Foods recommended for end stage renal disease or the patients undergoing dialysis. 

• Grapes 
• Cabbage
• Red bell pepper
• Blue berries
• onion
• One medium apple 

Patient caring

Pain and discomfort management

Management of pain is important and also the management complications like pluritis. Correct administration of analgesics and antihistamines as prescribed is essential. Pluritis can occur due to accumulation of uremic acid. So advice the patient to keep the skin clean , moisturized and avoid scratching. Teach the patient to keep the nails short.

Monitoring the symptoms of uremia

Due to the accumulation of uremic acid the uremic symptoms worsen.

Protecting the vascular access

Care should be given to the vascular access. Nurse should avoid using the side with the vascular access for measuring the blood pressure and to obtain blood specimens. Monitoring of the clotting ,blockages is important. clotting increase due to infection as the viscosity of blood increases.  Redness swelling rise of temperature in the vascular site may indicate infections.

Alert about the cardiac and respiratory complications.

Continuous assessment is necessary as there is a risk of fluid overload. as a result there may be pulmonary edema. As uremic acid accumulate it can be a reason to develop pericarditis. Substernal pain will be a sign of pericarditis or pericardial effusion.  This can progress to serious conditions like cardiac temponade which can be detected by chest -ray.

Monitor the blood pressure

Hypertension is very common in dialysis patients. This may be due to fluid accumulation and over secretion of rennin. As the patients use anti hypertensive drugs teaching the patient about the side effects is essential. Anti hypertensive drugs should withhold on the dialysis day to prevent hypo tension as dialysis reduce the blood pressure too. Limited fluid intake is important as well as restriction the salt.

Job and family life.

The patient should not return to work until he get medically stable properly. Family members should support the patient in daily activities and emotional support is very important. After taking the doctor's permission the patient can return to work. And the workplace should be sympathetic to provide sick leaves when necessary.

You can speak with the employer in an open manner about the disease and the condition. You can discussed about the changes that you want to do in the work schedule before starting the job. At the same time you can arrange your dialysis schedules compatible with the work schedules.

The nurse can advice the family members about the condition and about the dietary changes that patient should undergo. Ask the grand children to stay close with the patient or anyone to share the patient's emotions.

Discharge education

The patient and the family should be educated about the dietary changes and the medications the patient should undergo. and the possible side effects.

The patient can engaged in the exercises as recommended by the doctor.

If the patient want to travel the arrangements should be taken for the dialysis.

Should educate about the fallow up care. And when to see the physician and the adverse symptoms.

The patient may undergo changes in physical appearance. So it is important to make the patient's mind ready to accept the changes.

Additional medications

Dietary supplements should be taken to avoid nutritional deficiencies.

Antihistamine creams can be kept in the pocket to use in an emergency