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Caring for the patient with end-stage renal disease poses many chat lenges for the bedside nurse. Yet, how do we care for patients who continue to seek hemodialysis with a guarded prognosis? A discussion about palliative care and specific interventions used to help improve quality of life for the end-stage renal patient is provided. A case example accompanies this article, and highlights the interventions used successfully for one such patient.
Objectives
This educational activity is designed for nurses and other health care professionals who care for and educate patients regarding endstage renal disease (ESRD). The multiple choice examination that follows is designed to test your achievement of the following educational objectives. After studying this offering, you will be able to:
1. Define palliative care.
2. List three common symptoms experienced by patients with ESRD.
3. Describe the assessment and possible interventions for several common symptoms experienced by patients with ESRD.
What happens to patients with chronic illnesses who frequently fall "through the cracks" when seeking traditional medical interventions, yet who would clearly benefit from palliative care? Who carries out such conversations with these patients and their families? When do palliative care and quality of life issues surpass the curative medical model?
The following discussion of advanced directives and palliative care, and common interventions used for the patient with end-stage renal disease (ESRD), will be highlighted. Because patients often have more than one chronic disease (for example, chronic obstructive pulmonary disease [COPD], heart failure, and cancer), various end-of-life symptoms and related management beyond what may be experienced by patients with ESRD are also discussed.
Advanced Directives
"We plan for births, for new jobs, for weddings, for many events in life, but one of the things we don't plan for is our own death. One of the biggest tragedies in the hospital setting is not giving people that opportunity" Erica Perry, MSW (Shears, 1990).
While advanced planning is important to everyone it is particularly important for the kidney failure patient. Advanced medical technology, such as dialysis, is often used to prolong the dying process and, unfortunately, patients and their families are often not informed that they have the option of either not starting, or deciding to stop treatment (Dombrouski, Joy, Perry, & Smith-- Wheelock,...