Metaparadigm of Nursing

Link the theory you developed in Weeks 2 and 5 with the Metaparadigm of Nursing.  Each of the elements of the Metaparadigm should be represented in your theory. Revise your theory if necessary to include each of the components of the Metaparadigm.


Citations: At least one high-level scholarly reference in APA from within the last 5 years.


Week 2:

           Healthy kidneys filter the blood and excrete unwanted substances through urination. When kidney failure occurs, dialysis replaces various kidney functions. There are subsequent dialysis forms that include continuous renal replacement therapy (CRRT), peritoneal dialysis (PD), and hemodialysis (HD). One of the most common adverse effects during dialysis is intradialytic hypotension; therefore, comprehensive control of blood pressure is essential during and after hemodialysis treatment (Concept A) to prevent intradialytic hypotension and cardiovascular mortality (Concept B). The model provides prominence to the patient in the continued effect of intradialytic adverse reactions. 

          Dialysis patients possess an increased risk of developing hypertension because of sodium and volume excess. Other factors, such as arterial stiffness, activation of the renin-angiotensin-aldosterone and sympathetic nervous systems, endothelial dysfunction, sleep apnea, and ESA use, may also be involved (Sarafidis et al., 2017). Over time, hypertension, usually universal among patients with end-stage renal disease, may damage the blood vessels and arteries regulating the heart. Notably, the blood vessels impaired by hypertension may narrow, leak, or rupture, leading to congestive heart failure and heart attack (Ettehad et al., 2016). High blood pressure can further lead to blood clots forming in arteries to the brains, causing blood circulation blocking to the brains leading to stroke. 

          However, during hemodialysis, one of the most common adverse reactions is intradialytic hypotension. Hypotension occurs when the blood pressure is lower than usual and is characterized by readings below 60 mmHg diastolic or below 90 mmHg systolic (Ahmadmehrabi & Tang, 2018). Patients with hypotension may experience nausea, vomiting, dizziness, dehydration, cold and pale skin, and syncope. Low blood pressure that leads to insufficient blood flow to body organs may cause cardiovascular conditions such as heart attack and stroke. When extreme amounts of fluid are removed from the bloodstream during the hemodialysis process, the blood pressure drops, leading to hypotension. Hence hypotension is an intradialytic effect and must be prevented by ensuring accurate management of the patient’s dialysis treatment by regulating fluid removal, sodium and ultrafiltration profiling, or cooler dialysate temperature may be effective strategies to reduce intradialytic hypotension incident.


Ahmadmehrabi, S., & Tang, W. W. (2018, May). Hemodialysis‐induced cardiovascular disease. In Seminars in dialysis (Vol. 31, No. 3, pp. 258-267).

Ettehad, D., Emdin, C. A., Kiran, A., Anderson, S. G., Callender, T., Emberson, J., Callender, T., & Rahimi, K. (2016). Blood pressure-lowering for prevention of cardiovascular disease and death: a systematic review and meta-analysis. The Lancet387(10022), 957-967.

Sarafidis, P.A., Persu, A., Agarwal, R., Burnier, M., Leeuw, P., Ferro, C.J., Halimi, J., Heine, G.H., Jadoul, M., Jarraya, F., Kanbay, M., Mallamaci, F., Mark, P.B., Ortiz, A., Parati, G., Pontremoli, R., Rossignol, P., Ruilope, L., Niepen, P., Vanholder, R., Verhaar, M.C., Wiecek, A., Wuerzner, G., London, M.G.,… Zoccali, C. (2017). Hypertension in dialysis patients. Nephrology Dialysis Transplantation.

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