A holistic protocol for management of fluid volume excess in hemodialysis patients

Patients on hemodialysis as treatment for end stage renal disease (ESRD), are at high risk for ineffective management of their therapeutic regimen because it entails pervasive changes in lifestyle. This article describes the experiences of five patients who participated in a nursing protocol of 8-10 therapeutic interviews associated with dialysis treatment over a 5-week period. The Dungan Model of Dynamic Integration provided the conceptual framework for holistic management strategies of teaching, counseling, and social support to assist patients to integrate required changes into their lifestyles. Fluid volume excess (FVE) was used as an indicator of ineffective management of therapeutic regimens. Presence of FVE, indicated by weight gain, presence of peripheral edema, and abnormal lung sounds were assessed before each dialysis treatment. Findings confirmed that these patients were at high risk for ineffective self-management and that the approach of augmented professional support used in the protocol was valuable to patients and families during this difficult transition.