Nursing care of Chronic Hemodialysis with Mineral and Bone Disorder : A case study

Abstract

Chronic Kidney Disease (CKD) is well-defined by abnormal structure or lose of kidney functions, by decreased GFR less than 60 ml/min/1.73m²/yrcontinueously more than 3 months. When CKD is progressing more to End Stage Renal Disease (ESRD) the kidneys cannot get rid of waste products and lose control of water, mineral and acid-base balance in the body. The patient requires Renal Replacement Therapy (RRT) such as Hemodialysis for survival.  Dialysis nurse must has the significant role to care for the patient by doing assessment, monitoring and reduce complications. Including continouous holistic care for improve quality of patient life appropriately.

The purpose of this case study was to report the significant nursing care for chronic hemodialysis patient with mineral and bone disorder. The Thai male, 28 years old, Buddhist monk has been treating  bychronic hemodialysis for ten years, was admitted to Praphutthabat hospital on November 7, 2016.  The patient has moderate pain at the left thigh from crashing ground between taking to restroom.  The X-rays result showed close fracturesubtrochanter of Lt. femur.  The orthopidist treated by skin traction and consulted to hemodialysis treatment.  The patient got hemodialysis procedure 3 sessions/week.  The nursing care for the patient included pre dialysis assessments, monitoring early warning signs of intradialytic complications,  immediate management to reduce complications and post dialysis care.  Due to the long-term complication such as mineral and bone disorder has causing osteitisfibrosa and bone fracture,  the patient has impaired physical mobility and inappropriate to chronic hemodialysis. The nurse must be counselor to educate and empower for decision making and change to Continuous Ambulatory Peritoneal Dialysis (CAPD), provide training program, education and completing for patient’s discharge planning. The continuous holistic care should be provide to the patient and caregivers, although they can self care at home and get better of quality of life.