Nursing Diagnosis
- Risk for Deficient Fluid Volume
Risk Factors
- Use of hypertonic dialysate with excessive removal of fluid from circulating volume
Desired Outcomes
- Will achieve desired alteration in fluid volume and weight with BP and electrolyte levels within acceptable range.
- Will experience no symptoms of dehydration.
Nursing Interventions & Rationales
| Interventions | Rationale |
| Maintain record of inflow/outflow volumes and individual/cumulative fluid balance. | Provides information about the status of patient’s loss or gain at the end of each exchange. |
| Adhere to schedule for draining dialysate from abdomen. | Prolonged dwell times, especially when 4.5% glucose solution is used, may cause excessive fluid loss. |
| Weigh when abdomen is empty, following initial 6–10 runs, then as indicated | Detects rate of fluid removal by comparison with baseline body weight. |
| Monitor BP (lying and sitting) and pulse. Note level of jugular pulsation | Decreased BP, postural hypotension, and tachycardia are early signs of hypovolemia |
| Note reports of dizziness, nausea, increasing thirst. | May indicate hypovolemia/hyperosmolar syndrome. |
| Inspect mucous membranes, evaluate skin turgor, peripheral pulses, capillary refill | Dry mucous membranes, poor skin turgor and diminished pulses/capillary refill are indicators of dehydration and need for increased intake/changes in strength of dialysate. |
| Monitor laboratory studies as indicated, e.g.: Serum sodium and glucose levels; | Hypertonic solutions may cause hypernatremia by removing more water than sodium. In addition, dextrosemay be absorbed from the dialysate, thereby elevating serum glucose. |
| Serum potassium levels. | Hypokalemia may occur and can cause cardiac dysrhythmias. |
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