Nursing Care of Malnourished Hemodialysis Patients: A Case Study

Authors

  • Chiraphorn Phrakhunanan Faculty of Nursing, Kaserm Bundit University
  • Sasipim Pairojkittrakul Registered Nurse, Senior Professional Level, Thammasat University Hospital
  • Surasit Chouyboon Faculty of Nursing, Kaserm Bundit University

Keywords:

End stage renal disease, Hemodialysis, Malnutrition

Abstract

Chronic kidney disease (CKD) involves permanent abnormalities for kidney structure or function. Disease severity is progressive to stage V, known as end-stage kidney disease, at which point patients should receive renal replacement therapy. Hemodialysis is a high quality renal replacement therapy and very popular in Thailand. However, hemodialysis can result in a catabolic state and loss of amino acids during dialysis. Furthermore, the patient may experience uremia symptoms that cause anorexia, nausea, and vomiting. Thus, hemodialysis patients are more likely to develop malnutrition. The purpose of this article is to present a case study on nursing care for malnourished hemodialysis patients, involving a patient who had been on hemodialysis for seven years and was malnourished. However, the patient refused a feeding tube. The patients’ nutritional status was determined by dietary assessment, clinical assessment, and a nutrition assessment tool. This information was collected to determine the related nursing diagnosis followed by modifications to the nursing care plan and provision of nursing care. In addition, an evaluation of nursing care and patient responses were continuously analyzed.

References

Carrero, J. J., Severs, D., Aguilera, D., Fiaccadori, E., Gonzalez, M. G., Haufe, C. C, Teta, D., Molina, P., & Visser, W. (2022) Intradialytic parenteral nutrition for patients on hemodialysis: When, how and to whom? Clinical Kidney Journal, 16(1), 5–18. https://doi.org/10.1093/ckj/sfac171

Carrero, J. J., Thomas, F., Nagy, K., Arogundade, F., Avesani, C. M., Chan, M., Chmielewski, M., Cordeiro, A. C., Espinosa-Cuevas, A., Fiaccadori, E., Guebre-Egziabher, F., Hand, R. K., Hung, A. M., Ikizler, T. A., Johansson, L.R., Kalantar-Zadeh, K., Karupaiah, T., Lindholm, B., Marckmann, P., … Kovesdy, C. P. (2018). Global prevalence of protein-energy wasting in kidney disease: A meta-analysis of contemporary observational studies from the international society of renal nutrition and metabolism. Journal of Renal Nutrition, 28(6), 380-392. https://doi.org/10.1053/j.jrn.2018.08.006

Chaiarj, J. (2021). Nursing care for hematologic disorders. In P. Soivong (Ed.), Medical nursing (2nd ed., pp. 209-227). NPT printing. (in Thai)

Chinnoros, S. (2019). Malnutrition status of hemodialysis patients. Journal of Health and Health Management, 5(1), 1-8. (in Thai)

Chinnoros, S., Khueankham, P., & Channorm, P. (2021). Factors predicting malnutrition in hemodialysis patients. Journal of Health and Health Management, 7(2), 93-100. (in Thai)

Chinnoros, S., Khueankham, P., & Sitthapirom, W. (2022). Correlation between malnutrition and quality of life of hemodialysis patients. Royal Thai Army Medical Journal, 75(1), 3-13. (in Thai)

Chirananthavat, T. (2021). Urea kinetic modeling and adequacy of hemodialysis. In A. Nongnuch, K. Tiranathanakul, K. Srisuwan, & O. Ophascharoensuk (Eds.), Essential in hemodialysis (4th ed., pp. 110-138). Text and Journal Publication. (in Thai)

Hendriks, F. K., Smeets, J. S. J., Broers, N. J. H., van Kranenburg, J. M. X., van der Sande, F. M., Kooman, J. P., & Loon, L. J. C. (2020). End-stage renal disease patients lose a substantial amount of amino acids during hemodialysis. The Journal of Nutrition, 150(5), 1160–1166. https://doi.org/10.1093/jn/nxaa010

Jiwakanon, S., Warodomwichit, D., Supasyndh, O., Chattranukulchai, P., Pisprasert, V., Nongnuch, A., Trongtrakul, K., Kiattisunthorn, K., Pachotikarn, C., Rungprai, D., Wichansavakun, S., Limkunakul, C., Termpornlert, N., Kittisakulnam, P., Tejavanija, S., Laocharoenkeat, A., Boonpattararaksa, J., Boonyagarn, N., Klyprayong, P., & Keawtanom, S. (2020). Clinical practice recommendation for nutritional management in adult kidney patients 2018. Thai JPEN, 28(2), 18-67. https://he02.tcithaijo.org/index.php/ThaiJPEN/article/view/248367/168872 (in Thai)

Kim, S., Kang, B. C., Kim, H., Kyung, M., Oh, H. J., Kim, J., Kwon, O., & Ryu, D. (2020). Comparison of hemodialysis and peritoneal dialysis patients’ dietary behaviors. BMC Nephrology, 21(1), 91. https://doi.org/10.1186/s12882-020-01744-6

Miyamoto, Y., Hamasaki, Y., Matsumoto, A., Doi, K., & Nangaku, M. (2018). A case of refeeding syndrome during intradialytic parenteral nutrition. Renal Replacement Therapy, 4, 35. https://doi.org/10.1186/s41100-018-0176-5

Nephrology and Dialysis Unit, Thammasat University Hospital. (2023). Guideline for nutrition in hemodialysis patients. Thammasat University Hospital. (in Thai)

Nichachotesalid, P., & Boonmung, K. (2019). Refeeding syndrome: Nursing role of refeeding syndrome prevention. Journal of Nursing, Siam University, 20(39), 110-120. (in Thai)

Phutthanachiawit, N. & Pajaree, T. (2021). Management of anemia in hemodialysis patients. In A. Nongnuch, K. Tiranathanakul, K. Srisuwan, & O. Ophascharoensuk (Eds.), Essential in hemodialysis (4th ed., pp. 383-411). Text and Journal Publication. (in Thai)

Pungchompoo, W. (2016). Nursing care of persons with chronic kidney disease receiving hemodialysis (2nd ed.). Chiang Mai University press. (in Thai)

Sahathevan, S., Khor, B. H., Ng, H. M., Gafor, A. H. A., Daud, Z. M., Mafra, D., & Karupaiah, T. (2020). Understanding development of malnutrition in hemodialysis patients: A narrative review. Nutrients, 12(10), 3147. https://doi.org/10.3390%2Fnu12103147

The BC Renal Hemodialysis Committee. (2021). Provincial standards and guidelines: Intradialytic parenteral nutrition (IDPN). http://www.bcrenal.ca/resource-gallery/Documents/Intradialytic_Parenteral_Nutrition(IDPN).pdf

The Kidney Foundation of Thailand. (2019). Hemodialysis and nursing care (5th ed.). Bangkok Medical. (in Thai)

The Nephrology Society of Thailand. (2020). Thailand renal replacement therapy 2020. https://www.nephrothai.org/wp-content/uploads/2022/06/Final-TRT-report-2020.pdf (in Thai)

The Nephrology Society of Thailand. (2022). Hemodialysis clinical practice recommendation 2022. Text and Journal Publication. (in Thai)

Taiwong, A., Baothong, K., & Supsung, A. (2018). Anemia and nurses’ roles in anemia management among pre-dialysis of chronic kidney disease patients. Journal of Research in Nursing–Midwifery and Health Sciences, 38(2), 149-157. (in Thai)

Visiedo, L., Rey, L., Rivas, F., López, F., Tortajada, B., Giménez, R., & Abilés, J., (2022). The impact of nutritional status on health-related quality of life in hemodialysis patients. Scientific Report, 12(1), 3029. https://doi.org/10.1038/s41598-022-07055-0

Wi, J. W., & Kim, N. H. (2017). Assessment of malnutrition of dialysis patients and comparison of nutritional parameters of CAPD and hemodialysis patients. Biomedical Science Letters, 23(3), 185-193. https://doi.org/10.15616/BSL.2017.23.3.185

Wilson, B., Fernandez-Madrid, A., Hayes, A., Hermann, K., Smith, J., & Wassell, A. (2001). Comparison of the effects of two early intervention strategies on the health outcomes of malnourished hemodialysis patients. Journal of Renal Nutrition, 11(3), 166-171. https://doi.org/10.1053/jren.2001.24364

Yonata, A., Islamy, N., Taruna, A., & Pura, L. (2022). Factors affecting quality of life in hemodialysis patients. International Journal of General Medicine, 15, 7173–7178. https://doi.org/10.2147/IJGM.S375994

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Published

2024-03-27

How to Cite

Phrakhunanan, C., Pairojkittrakul, S., & Chouyboon, S. (2024). Nursing Care of Malnourished Hemodialysis Patients: A Case Study. Nursing Journal CMU, 51(1), 284–296. Retrieved from https://he02.tci-thaijo.org/index.php/cmunursing/article/view/264764

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Section

Academic Article