Problem 2: To what extent do kidney failure patients response to hemodialysis

treatment regimen in terms of six dimensions of wellness namely: physical,

intellectual, social, emotional, spiritual and occupational?

Table 2.1.1 Mean Distribution of Physiological Reponses grouped according to

Integumentary Reactions.
Indicators
I have experienced abnormal redness of the
skin
I have experienced darkening of skin and nails
I have experienced redness of the skin upon
exposure to sunlight
General Weighted Mean

Weighted
Mean

Interpretation

1.49

No extent at all

1.46

No extent at all

1.36

No extent at all

1.44

No extent at all

Legend: 4.21- 5.00= Very High Extent, 3.41- 4.20= High Extent, 2.61- 3.40= Moderate Extent,
1.81- 2.60= Minimal Extent, 1.00- 1.80= No Extent at all.

Table 2.1.1 explicates the general mean score of x= 1.44 of the variable
integumentary reactions where most of the patients agreed that there is no extent at all
any of the following signs and symptoms in the above table. Taken singly, the table also
illustrates that indicator I have experience abnormal redness of the skin obtained the
highest weighted mean of x= 1.49 which interpreted as no extent at all.
According to the study of Avermaete et. al. (2011) about skin changes in dialysis
patients, pruritus, with an increasing deteriorating renal function, is a form of abnormal
redness of skin that is accompanied by itching, is a very frequent complaint among the
hemodialysis patients.
The indicator I have experienced redness of the skin upon exposure to sunlight
accumulated the lowest mean of x= 1.36 which interpreted as no extent at all.

Redness of skin upon exposure to sunlight is called urticaria. According to the

study of Sanai (2010) about the dermatologic manifestations in hemodialysis patients, it
is said that other dermatological changes such as vitiligo, melasma, hyperkeratosis and
fissures on the soles, chronic dermatitis of leg, varicose eczema and Urticaria are
reported but their association with CRF cannot be assured definitely.
Table 2.1.2 Mean Distribution of Physiological Response grouped according to
Gastrointestinal Reactions.
Indicators
I have experienced nausea
I have experienced vomiting
General Weighted Mean

Weighted Mean

Interpretation

2.44
Minimal Extent
2.38
Minimal Extent
2.41
Minimal Extent
Legend: 4.21- 5.00= Very High Extent, 3.41- 4.20= High Extent, 2.61- 3.40= Moderate Extent,
1.81- 2.60= Minimal Extent, 1.00- 1.80= No Extent at all.

Table 2.1.2 expounded the general mean score of x= 2.41 under the variable
gastrointestinal response which interpreted as minimal extent. Taken individually, the
indicator I have experienced nausea obtained the highest mean of x= 2.44 which
interpreted as minimal extent.
According to the study of Claxton et. al (2010) about the undertreatment
symptoms of patients undergoing maintenance hemodialysis, one of the most prevalent
symptom reported by the respondents is nausea.
The respondents affirmed that at minimally manifested they experienced the
indicator I have experienced vomiting which obtained the lowest mean of x= 2.38 which
interpreted as minimal extent. (insert rrl here)
While according to the study of Caplin et. al (2011) about the patients
perspective about hemodialysis-associated symptoms, vomiting has the least number of

occurrence among the symptoms observed such as fatigue, hypotension, cramps,

dizziness, headache, pruritus, backache, nausea, and dyspnea.
According in an article entitled Why Dialysis Patients Have Nausea and
Vomiting published last 2013 from www.kidneyfailureweb.com, mostly due to dialysis
disequilibrium syndrome, hemodialysis patients experience nausea and vomiting. It
might also be caused by continuous deterioration of the kidney functions.
Table 2.1.3 Mean Distribution of Physiological Responses grouped according to
Hematological Reactions.
Indicators
I have experienced anemia
I have experienced
thrombocytopenia
I have experienced fatigue
I have experienced neutropenia
General Weighted Mean

Weighted Mean
2.62

Interpretation
Moderate Extent

1.80

No Extent at all

3.28
Moderate Extent
1.59
No Extent at all
2.32
Minimal Extent
Legend: 4.21- 5.00= Very High Extent, 3.41- 4.20= High Extent, 2.61- 3.40= Moderate Extent,
1.81- 2.60= Minimal Extent, 1.00- 1.80= No Extent at all.
Table 2.1.3 demonstrated the general weighted mean of x= 2.32, in which the
respondents agreed that at minimal extent they experienced the hematological reactions. Taken
individually, the respondents affirmed that at moderate extent they experienced the indicator I
have experienced fatigue and ranked as highest which obtained the mean of x= 3.28.
Also according to Caplin et. al. (2011), fatigue is the commonest symptom reported by
the patients surveyed. In relation to this, according to the study of Jhamb et. al (2013) about the
fatigue in patients receiving hemodialysis, fatigue is a common and complex phenomenon that
significantly decreases the quality of life among dialysis patients. It is also often unrecognized
and under-treated symptom in patients.
The indicator I have experienced neutropenia obtained the lowest mean score of x= 1.59
which interpreted as no extent at all.

According to the study of Smith et. al (2010), the first 30 minutes of hemodialysis, in
patients with chronic kidney failure, there is a dramatic fall in total neutrophil count in the
peripheral blood. But after an hour, neutrophil count returns to normal.

Table 2.1.4 Mean Distribution of Physiological Responses grouped according to

Neurologic Toxicity/ Motor Reactions
Indicators
I have experienced memory loss
I have experienced fever
I have experienced sleep
disturbance
I have experienced muscle cramps
I have experienced decrease in
sexual functioning
General Weighted Mean

Weighted Mean
1.80
2.02

Interpretation
No Extent at all
Minimal Extent

3.46

High Extent

3.16

Moderate Extent

2.23

Minimal Extent

2.53
Minimal Extent
Legend: 4.21- 5.00= Very High Extent, 3.41- 4.20= High Extent, 2.61- 3.40= Moderate Extent,
1.81- 2.60= Minimal Extent, 1.00- 1.80= No Extent at all.

Table 2.1.4 illustrated the general mean score of x= 3.52, in which the
respondents perceived that at minimal extent they experienced the neurologic reactions.
Taken singly, the respondents agreed that at high extent they experienced the indicator
I have experienced sleep disturbance which acquired the highest mean score of x=
3.46.
According to the study of Merlino et. al. (2012) about sleep disturbances in
dialysis patients, sleep disorders are common to hemodialysis patients where majority
of them were experiencing specifically insomnia but the exact pathogenic mechanism
remains unknown for sleeping problems.
The indicator I have experienced memory loss achieved the lowest mean score
of x= 1.80, in which at no extent respondents verbalized that they did not experienced
the above reaction.

According to the study of Sernak et. al. (2012) about frequency and risk factors
for poor cognitive performance in hemodialysis patients, they had significantly poorer
executive function but not memory performance compared with population norms
therefore there is a low rate on patients undergoing hemodialysis who is experiencing
memory loss.

Table 2.1.5 Mean Distribution of Physiological Responses grouped according to

Cardiovascular Reactions.
Indicators
I have experienced palpitation
I have experienced chest pain
I have experienced skip beats
I have experienced frequent heart
burn
I have experienced swelling in my
hands, arms, ankles and feet
I have experienced high blood
pressure
I have experienced low blood
pressure
General Weighted Mean

Weighted Mean
3.07
2.69
1.61

Interpretation
Moderate Extent
Moderate Extent
Not Manifested

2.00

Minimal Extent

3.20

Moderate Extent

3.49

High Extent

2.36

Minimal Extent

2.63
Moderate Extent
Legend: 4.21- 5.00= Very High Extent, 3.41- 4.20= High Extent, 2.61- 3.40= Moderate Extent,
1.81- 2.60= Minimal Extent, 1.00- 1.80= No Extent at all.

Table 2.1.5 displayed the general weighted mean score of x= 2.63 in which the
respondents affirmed that at moderate extent they experienced the cardiovascular
reactions of hemodialysis treatment regimen. Taken singly, the indicator I have
experienced high blood pressure obtained the highest mean score of x= 3.49, in which
at high extent the respondents affirmed that they experienced the said reaction.
According to the study of Stern et. al. (2014) about the high blood pressure in
dialysis patients, researchers found out that majority of the hemodialysis patients were

suffering from hypertension. This is due to the progressive nephron loss which causes
extracellular fluid expansion and results in sodium retention that might be caused by the
Hypervolemia. Hypertension might also be caused by the renin angiotensin over activity.
Hyperparathyroidism is another cause of increase Blood Pressure in patients with CKD.
Meanwhile, the indicator I have experienced skip beats ranked as the lowest,
which obtained the mean score of x= 1.61 which interpreted as no extent at all.
According in an article published by Metronic Inc. (2014) where it was presented
on Kidney Week 2014: the American Society of Nephrology 47th Annual Meeting. in
Philadelphia, Irregular heartbeats were found in the Monitoring in Dialysis (MiD) Study
using the Medtronic Reveal XT Insertable Cardiac Monitor (ICM). Analysis of the study
found out that heart arrhythmias were strongly associated with the hemodialysis
schedule: Patients' risk for cardiac rhythm problems peaked during the 12-hour interval
beginning with each session, decreased for the next 12 hours, and then gradually
increased during the remainder of the interdialytic interval (the interval between dialysis
sessions). Therefore, skip heartbeats were only felt during the course of hemodialysis
but not often like even after the hemodialysis session.

Table 2.1.6 Mean Distribution of Physical Responses grouped according to

Respiratory Reactions.
Indicators
I have experienced difficulty in
breathing
I have experienced loss of breath
I have experienced tachypnea
I have experienced cough

Weighted Mean

Interpretation

2.80

Moderate Extent

2.51
2.13
2.51

Minimal Extent
Minimal Extent
Minimal Extent

General Weighted Mean

2.49
Minimal Extent
Legend: 4.21- 5.00= Very High Extent, 3.41- 4.20= High Extent, 2.61- 3.40= Moderate Extent,
1.81- 2.60= Minimal Extent, 1.00- 1.80= No Extent at all.

Table 2.1.6 revealed the general mean score of x= 2.49, in which the
respondents affirmed that at minimal extent they experience respiratory reactions.
Taken individually, the indicator I have experienced difficulty in breathing obtained the
highest rank with accumulated mean score of x= 2.80, which interpreted as moderate
extent.
According to the book of Brunner and Suddarths Medical- Surgical Nursing
(2010), episode of difficulty of breathing often occur as fluid accumulated between
dialysis treatments. Where difficulty of breathing is one of the most common symptom of
respiratory problems.
Meanwhile, the indicator I have experienced tachypnea ranked as the lowest with
accumulated mean of x= 2.13, which interpreted as minimal extent.
According to the study of Pierson (2010) about respiratory consideration in the
patient with renal failure undergoing hemodialysis, it is said that a large number of
diseases affects both lungs and kidneys but it is uncommon or rare. Therefore, there is
a small number of respondents answered that they are experiencing tachypnea.

Table 2.1.7 Mean Distribution of Physical Response grouped according to Other

Reactions.
Indicators
I have experienced loss of
appetite
I have experienced weight loss
I have experienced blurring
vision
General Weighted Mean

Weighted Mean

Interpretation

2.46

Minimal Extent

2.54

Minimal Extent

2.89

Moderate Extent

2.63

Moderate Extent

Legend: 4.21- 5.00= Very High Extent, 3.41- 4.20= High Extent, 2.61- 3.40= Moderate Extent,
1.81- 2.60= Minimal Extent, 1.00- 1.80= No Extent at all.

Table 2.6 displayed the general mean score of x= 2.63, in which the respondents
affirmed that at moderate extent they experienced the other reactions. The indicator I
have experienced blurring of vision ranked as the highest with accumulated mean score
of x= 2.89, which interpreted as moderate extent.
According to the study of Mehmood (2016) about the intradialytic complications
found in hemodialysis patients, results shows that the major cause of hemodialysis is
diabetes. Wherein, one of the most common and chronic effect of diabetes is blurring of
the eye vision due to high blood sugar levels.
Also from the study of Dilena (2011) about central nervous system disorder that
occurs during and after hemodialysis, where it is called dialysis disequilibrium syndrome
which is caused by brain edema as neurological symptoms such as headache, emesis,
blurring of vision, disturbed consciousness, tremors and seizures, and in severe cases,
death.
The indicator I have experienced loss of appetite ranked as the lowest with
accumulated mean score of x= 2.46, which interpreted as minimal extent.
According to the research of Molfino et. al (2016) about validating the appetite
assessment tools among patients receiving hemodialysis, were reported to have poor
food intake and ha a prevalence of anorexia.
Table 2.1.8 Over all Mean Distribution of Physical Dimension
Indicators
Integumentary Reactions
Gastrointestinal Reactions
Hematological Reactions
Neurologic Toxicity/ Motor Reaction

Weighted Mean
1.44
2.41
2.32
2.53

Interpretation
No Extent at all
Minimal Extent
Minimal Extent
Minimal Manifested

Cardiovascular Reactions
Respiratory Reactions
Others
General Weighted Mean

2.63
2.49
2.63
2.35

Moderate Extent
Minimal Extent
Moderate Extent
Minimal Extent

Legend: 4.21- 5.00= Very High Extent, 3.41- 4.20= High Extent, 2.61- 3.40= Moderate Extent,
1.81- 2.60= Minimal Extent, 1.00- 1.80= No Extent at all.

Table 2.1.8 displayed the general mean score of x= 2.35, in which the respondents
revealed that at minimal extent they experienced the above stated physical dimension.
Sharing the highest mean score of x= 2.63, in which interpreted as moderate extent is
the cardiovascular reactions and other reactions.
According to the study of Dou (2011) about vascular incompetence of
hemodialysis patients, Chronic Kidney Disease have a much higher risk of
cardiovascular disease than the general population. In relation to this, Cardiovascular
risk factors that have been linked to chronic kidney disease include heightened states of
inflammation, oxidative stress, activation of the reninangiotensinaldosterone system
and the sympathetic nervous system, endothelial dysfunction, retention of uremic toxins
promoting

atherosclerosis

and

arteriosclerosis, abnormalities

in

platelet

aggregation, anemia, and disorders of bone and mineral metabolism, including

hyperphosphatemia, hypercalcemia, and secondary hyperparathyroidism.
Meanwhile, the respondents affirmed that at the mean score of x= 1.44, the
integumentary reactions have no extent at all.
According to the study of Markova et. al (2012) about the diagnosis of common
dermophaties in hemodialysis patients, it is said that Cutaneous abnormalities in
patients with end-stage renal disease (ESRD) receiving hemodialysis or peritoneal
dialysis may demonstrate signs of their underlying condition or reveal associated
disease entities. While a thorough examination of the scalp, skin, mucosa, and nails is

integral to establishing a diagnosis, certain conditions will resolve only with dialysis or
improvement of their renal disease and others may not require or respond to
treatment. Therefore, the occurrence of integumentary reactions were treated upon the
course of treatment of hemodialysis.