Nutritional support for the patient with renal failure.

Renal failure presents patients and caregivers alike with numerous dilemmas in nutritional management. Too much protein, phosphate, or electrolytes, and the patient's renal failure becomes more symptomatic; too little of these nutrients and the patient is at great risk of developing fluid and electrolyte imbalances and of becoming protein-calorie malnourished. Dietary manipulation and often vigorous nutritional intervention (i.e., parenteral nutrition) are a must for these patients' survival. The nurse needs to understand the rationales behind nutritional care choices made by the physician and dietitian, and to be able to convey these rationales to the patient. The nurse also needs to be aware that the patient will use food, eating, and diet as a focus for acting out anxiety, fear, hopelessness, and anger. The nurse should also realize that these emotions are due, in part, to the metabolic derangements induced by the renal disease itself.