HemodialysisHemodialysis- is a medical procedure designed to remove wastes, toxins and fluids from the blood when the kidneys have failed. It is the most common treatment for end-stage renal disease (ESRD), more commonly known as kidney failure. This process usually lasts for about four hours and a patient has to undergo such procedure three times a week. HD may be done in the hospital, outpatient dialysis center, or at home.

Two types of dialysis

  • Hemodialysis– blood is passed through an artificial kidney (hemodialyzer) to clean it.
  • Peritoneal dialysis– uses a filtering process similar to hemodialysis, but the blood is cleaned inside the body rather than in a machine. The good thing about this process is that patient can do this at home three to four times a day, provided that he/she has knowledge in using the facility.

Nursing Diagnosis:Risk for excess Fluid Volume

Risk factors may include

  • Rapid/excessive fluid intake: IV, blood, plasma expanders, saline given to support BP during dialysis

Possibly evidenced by
[Not applicable; presence of signs and symptoms establishes an actual diagnosis.]

Desired Outcomes

  • Maintain “dry weight” within patient’s normal range; be free of edema; have clear breath sounds and serum sodium levels within normal limits.

Hemodialysis Nursing Care Plan-Risk for excess Fluid Volume

Nursing actionsRationale
Measure all sources of I&O. Weigh routinely.Aids in evaluating fluid status, especially when compared with weight. Weight gain between treatments should not exceed 0.5 kg/day.
Monitor BP, pulse.Hypertension and tachycardia between hemodialysis runs may result from fluid overload and/or HF.
Note presence of peripheral/sacral edema, respiratory rales, dyspnea, orthopnea, distended neck veins, ECG changes indicative of ventricular hypertrophy.Fluid volume excess due to inefficient dialysis or repeated hypervolemia between dialysis treatments may cause/exacerbate HF, as indicated by signs/symptoms of respiratory and/or systemic venous congestion.
Note changes in mentation. (Refer to CP: Renal Dialysis; ND: Thought Processes, risk for disturbed.)Fluid overload/hypervolemia may potentiate cerebral edema (disequilibrium syndrome).
Monitor serum sodium levels. Restrict sodium intake as indicated.High sodium levels are associated with fluid overload, edema, hypertension, and cardiac complications.


Restrict PO/IV fluid intake as indicated, spacing allowed fluids throughout a 24-hr period.The intermittent nature of hemodialysis results in fluid retention/overload between procedures and may require fluid restriction. Spacing fluids helps reduce thirst.

Image credits:kundankidneycare.com

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