ESRD: Palliative Care

Vishnu C

Deputy Nursing Superintendent, Kauvery Hospital, Hosur, Tamil Nadu

Definition of Palliative care

  • Specialized medical care focused on providing relief from symptoms and stress of serious illness.
  • Importance of palliative nursing in renal failure
  • Improves quality of life.
  • Provides physical, emotional, and psychosocial support.

Overview of Renal Failure

Types:

  • Acute Kidney Injury (AKI) – sudden onset, reversible.
  • Chronic Kidney Disease (CKD) – progressive, irreversible.

Common causes: Diabetes, hypertension, glomerulonephritis.

Symptoms: Fatigue, fluid retention, electrolyte imbalance, nausea, and confusion.

Goals of Palliative Care in Renal Failure

  • Symptom management.
  • Enhancing quality of life.
  • Supporting patients and families emotionally.
  • Respecting patient preferences and dignity.

Nursing Assessment in Palliative Care

  • Physical assessment:
  • Pain, fatigue, fluid overload, and skin integrity.
  • Psychosocial assessment:
  • Emotional state, coping mechanisms.
  • Spiritual assessment:
  • Addressing beliefs and values.
  • Family assessment:
  • Support system, family needs.

Symptom Management Strategies

  • Pain management:
  • Opioids and non-opioid analgesics.
  • Dyspnea (breathing difficulty):
  • Oxygen therapy, positioning.
  • Fluid management:
  • Fluid restriction, diuretics.
  • Skin moisturizers, antihistamines.

Nursing Interventions

  • Physical care:
  • Monitor vital signs, fluid balance, and electrolyte levels.
  • Administer prescribed medications.
  • Emotional support:
  • Provide counseling and psychological support.
  • Communication:
  • Engage in open, empathetic conversations with the patient and family.
  • End-of-life care:
  • Comfort-focused care, managing symptoms, and emotional support.

Psychosocial and Spiritual Support

  • Active listening and providing emotional reassurance.
  • Assisting patients with coping strategies.
  • Involving chaplain or spiritual counselor if requested.
  • Supporting family members through grief counselling

Ethical and Legal Considerations

Advance directives

  • Patient’s wishes regarding treatment preferences.
  • Do Not Resuscitate (DNR) orders:
  • Respecting patient choices.
  • Informed consent:
  • Ensuring clear communication about prognosis and treatment options.

Role of the Palliative Nurse

  • Advocating for patient dignity and preferences.
  • Collaborating with the interdisciplinary team.
  • Educating patients and families about the disease and palliative care options.
  • Providing compassionate and holistic care.

Conclusion

Palliative nursing care in renal failure focuses on improving the patient’s comfort, dignity, and quality of life. Nurses play a vital role in managing symptoms, providing emotional support, and ensuring compassionate end-of-life care.

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