الفهرس 
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Abstract
ESRD is the final, permanent stage of chronic kidney disease.The kidney function has declined to the point that the kidneys can no longer function normally. Patients with end stage renal disease must receive dialysis or kidney transplantation to sustain the life. Hemodialysis is a treatment to filter wastes as urea and creatinine as well as excess water from the blood in case of chronic renal failure. Nutrition is very important pre, during and post hemodialysis session to prevent nutritional complications. Nurses should monitor patient’s nutritional status frequently to detect any problems. Regular evaluation of nutritional status includes the measurement of the percent usual body weight and percent standard BMI.
The aim of this study is to:
Evaluate the effect of the implementation of nutritional educational module on biochemical and physiological parameters for patients on maintenance hemodialysis.
Research design:
The study followed a quasi experimental research design.
Setting: This study was conducted at the dialysis center at Damanhour Medical National Institute. The hospital serves El Behira governorates.
Subjects: Sixty adult patients scheduled for maintenance hemodialysis were included and assigned alternatively into two equal groups 30 patients in each
group. Based on the program of Epi info 7 which was used to estimate the sample size using a population size of 221, prevalence rate of 50%, confidence coefficient 95%, and acceptable error of 15%. The minimum sample size required is 40 patients. Those subjects were divided alternatively into two equal groups:
The control group (I): was exposed to routine hospital care only.
The study group (II): was exposed to nutritional educational module beside routine hospital care. Tools: Four tools were used for data collection
Tool I: Socio demographic and clinical data of patients on maintenance hemodialysis: Structured interview schedule:
This tool was developed by the researcher based on a review of relevant literature to collect base line data. It will include the following two parts:
Part I: Patient’s socio demographic data of the study subject.
Part II: Patients’ clinical data: Past and present medical history, dietary history related to the name of food intake per day, eating habits, discomfort pre and post eating, change in body weight, restriction of food or not.
Tool II: Patients’ knowledge regarding hemodialysis treatment and diet: Developed by the researcher based on a review of relevant literature Alikari et al. (2019).It was include of the following 5 parts:
Part I: Description of the normal kidney:Anatomy and kidney function.
Part II: End stage renal disease (ESRD):Definition, causes, risk factors, clinical manifestations, diagnostic procedures and treatment.
Part III: Hemodialysis treatment: Definition of hemodialysis, benefits, and preparations.
Part IV: Diet and fluid intake: Include questions about type of dietary intake, habits and components of diets, restricted food and drink, amount of fluid intake, daily requirements of caloric intake, specific dietary intake e.g. low protein, low phosphorus, restricted sodium, number of meals per day, allowed and prohibited food intake, type of snacks, intake of nutritional supplements.
PartV: Complications:Includes questions about malnutrition complications, causes, manifestations, prevention, and management.
Tool III: Nutritional assessment check list:It included 7 parts:
Part I: Food intake recall: It was include items related to dietary recall pre/post dialysis to collect data on the consumption of various food items.
Part II: Fluid intake recall: It was include items related to fluid intake pre/post dialysis days in house hold measurements.
Part III: Gastro intestinal symptoms: It was include symptoms affecting oral intake as pain on eating, anorexia, nausea, vomiting and diarrhea.
Part IV: Physical signs and symptoms of malnutrition: It was include items as low body weight, anorexia, weakness, fatigue, irritability and hypothermia.
Part V: Clinical manifestation of dehydration: It was include items as headache, weight loss, dizziness, muscle cramps, oliguria, anuria and hypotension.
Part VI: Clinical manifestation of edema: It was include items as arm, leg and ankle swelling, swelling around the eyes, hypertension, dyspnea, coughing and weight gain. Findings were compared against normal.
Tool IV: Biochemical and physiological data:
This tool was developed by the researcher based on a review of relevant literature. It was include two parts:
Part I: Biochemical parameters: It was include all routine lab investigations as complete blood count, blood urea (mg/dl),serum creatinine (mg/dl), sodium (mmol/l), potassium (mmol/l), uric acid (mg/dl), serum albumin (gm/dl), liver derived proteins, serum calcium (mg/dl), phosphorus (mg/dl), c-reactive protein and total cholesterol (mg/dl).Data obtained was compared against normal values.
Part II: physiological parameters: It included:
E. Vital signs: include temperature, respiratory rate, pulse, and blood pressure that provide critical information about a person’s health and help form the baseline for clinical care. Data obtained was compared against normal values.
F. Bodyweight: It was recorded pre/post hemodialysis session. Data obtained was compared against normal values.
G. Standing height: It was taken by a measuring tape, the reading was recorded to the nearest 0.1 cm; data obtained was compared against normal values.
H. Body mass index: BMI (kg/ m2) = weight (kg) / height (m2). Data obtained was compared against normal values. Ideal BMI for adults ranges from 18.5 to 24.9.
Method
An official letter was sent to Damanhour medical national institute to take the approval for data collection. Tool I& II& III& IV was developed by the researcher post reviewing of the relevant literatures. All tools were submitted to 5 experts in the field of medical surgical nursing and two experts in nephrology field for content validity and the necessary modifications were carried out accordingly.The reliability of all tools was tested using appropriate statistical test. A pilot study was conducted on 6 patients to test clarity, applicability and feasibility of the tools and necessary modifications was done. Data obtained was excluded from the actual study. A sample of 60 adult patients on maintenance hemodialysis was included and assigned alternatively into two equal groups; 30 patients in each group. The control group (I) was received routine hospital care without any interference from the researcher, and the group (II) was received a nutritional educational module by the researcher as approved by treating physicians. The study was carried out on four phases (assessment, planning, implementation, and evaluation).The main results obtained are as follows:
Regarding to age,the majority of patients in both studied groups were 50 to 60 years, and the majority of them were male, and the majority of patients were married (53.3%,73%).There was no statistically significant between two groups.
In relation to education,the majority of patients in the control group was illiterate(46.7%), and the majority of the study group was secondary education(36.7%).There was statistically significant between two groups.
Regarding their occupation,the majority of the control group was house wife and retired (40%,23%), and the equal numbers of the study group (33.3%) were employees and retired.There was no statistically significant between two groups.
Considering place of residence, equal numbers of the control group(50.0%) lived in urban and rural area,while the majority of the study group(70.0%) lived in urban.There was no statistically significant between two groups.
In relation to treatment, the majority of patients of both groups received treatment at the state expense (80%,60%),followed by health insurance (20%,40%).There was no statistically significant between two groups.
As regard to associated disease, the majority of both groups (73.3, 66.7) had no associated disease, and(86.7,80) take the prescribed medications according to doctor order.There was no statistically significant between two groups.
Concerning duration the patients affected with ESRD,the majority of patients in the control group (63.3%),was affected with ESRD from one to five years, while the majority of the study group (53.3%) was affected with ESRD from the period more than five years.There was no statistically significant between two groups.
Concerning first hemodialysis session,the majority of both groups (73.3%, 66.7%)started the first hemodialysis session from one to five years.Almost all patients(100%)in both groups received three hemodialysis sessions per week, and the majority of both groups (63.3%)feel better with the hemodialysis treatment.There was no statistically significant between two groups.
Regarding discomfort pre/during,and post eating,the majority of both groups(63.3%,70%)sometimes feels discomfort pre/during and post food intake, and majority of both groups(56.7%, 56.7%) didn’t eat special kinds of food, and the majority of both groups (77.8%,60%) suffered from weight gain.There was no statistically significant between two groups.
Regarding previous history of renal disease,that the majority of both groups (56.7%,66.7%) had the previous history of renal disease,and almost patients of both groups (100%,86.7%) had previous surgery. There was no statistically significant between two groups.
As regard with patient’s family history of chronic renal failure and hemodialysis,the majority of both groups (53.3%, 63.3%) didn’t have family history of chronic renal failure and hemodialysis.There was no statistically significant between two groups.
Concerning over all knowledge,it was found that there was no significant difference between two groups pre application of the nutritional educational module.However, there was a marked improvement in the knowledge as almost patients of the study group (96.7%) had good total knowledge level with a significant difference between two groups post application of the nutritional educational module (p<0.001*).