6 Peritoneal Dialysis Nursing Care Plans

July 13, 2013

When your kidneys are healthy, they clean your blood. If your kidneys fail, you will need a life-saving treatment, this is when dialysis takes place. Dialysis is the process of removing fluid and waste products from the body, a function usually performed by the kidneys, through artificial means. Two types of dialysis: hemodialysis and peritoneal dialysis. Peritoneal dialysis accomplishes the removal of waste and excess fluid by using the abdominal lining, called the peritoneal membrane, as a filter a membrane across which fluids and dissolved substances (electrolytes, urea, glucose, albumin and other small molecules) are exchanged from the blood.

Peritoneal dialysis is similar in principle to hemodialysis. Both of these forms of renal replacement therapy depend upon the passive movement of water and dissolved substances (solutes) across a semipermeable membrane. This process is called diffusion. The direction of movement of solute is determined by the relative concentration on each side of the membrane, so that a substance goes from the side of greater to lesser concentration.

The peritoneum serves as the semipermeable membrane permitting transfer of nitrogenous wastes/toxins and fluid from the blood into a dialysate solution. Peritoneal dialysis is sometimes preferred because it uses a simpler technique and provides more gradual physiological changes than hemodialysis.

The manual single-bag method is usually done as an inpatient procedure with short dwell times of only 30–60 minutes and is repeated until desired effects are achieved. The most commonly used type of peritoneal dialysis is continuous ambulatory peritoneal dialysis (CAPD), which permits the patient to manage the procedure at home with bag and gravity flow, using a prolonged dwell time at night and a total of 3–5 cycles daily, 7 days a week. No machinery is required.

Continuous cycling peritoneal dialysis (CCPD) mechanically cycles shorter dwell times during night (3–6 cycles) with one 8-hr dwell time during daylight hours, increasing the patient’s independence. An automated machine is required to infuse and drain dialysate at preset intervals.

Nursing Care Plans

This post contains six (6) nursing care plans (NCP) and nursing diagnosis for peritoneal dialysis:

Risk for Deficient Fluid Volume

Risk for Deficient Fluid Volume: At risk for decreased intravascular, interstitial, and intracellular fluid.

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	Rationale
Measure and record intake and output, including all body fluids, such as wound drainage, nasogastric output, and diarrhea.	Provides information about the status of patient’s loss or gain at the end of each exchange.
Maintain record of inflow and outflow volumes and individual and cumulative fluid balance.	Provides information about the status of patient’s loss or gain at the end of each exchange.
Assess hb and hct and replace blood components, as indicated.	This is important in view of under dialysis in patients of normal or near normal hematocrit and suggests the need for modification of dialysis prescription in such situations.
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 vital signs. watch and report any signs of pericarditis (pleuritic chest pain, tachycardia, pericardial friction, rub), inadequate renal perfusion (hypotension), and acidosis.	Patients with end-stage renal disease (ESRD) may develop pericardial disease.
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 and hyperosmolar syndrome.
Inspect mucous membranes, evaluate skin turgor, peripheral pulses, capillary refill	Dry mucous membranes, poor skin turgor and diminished pulses and capillary refill are indicators of dehydration and need for increased intake and changes in strength of dialysate.
Monitor laboratory studies as indicated: Serum sodium and glucose levels;	Hypertonic solutions may cause hypernatremia by removing more water than sodium. In addition, dextrose may be absorbed from the dialysate, thereby elevating serum glucose.
Maintain proper electrolyte balance. Serum potassium levels. Watch for symptoms of hyperkalemia (malaise, anorexia, paresthesia, or muscle weakness) and electrocardiogram changes (tall peaked T waves, widening QRS segment, and disappearing P waves), and report them immediately.	Although a small percent of patients are chronically hypokalemic, hyperkalemia is by far the most common abnormality in dialysis patients.
Assess patient frequently, especially during emergency treatment to lower potassium levels. If the patient receives hypertonic glucose and insulin infusions, monitor potassium levels. If you give sodium polystyrene sulfonate rectally, make sure the patient doesn’t retain it and become constipated.	To prevent bowel perforation.
Maintain nutritional status. Provide a high-calorie, low-protein, low-sodium, and low-potassium diet, with vitamin supplements.	To balance nutritional intake.
Aggressively restore fluid volume after major surgery or trauma.	Dialysis dysequilibrium syndrome is a frequent complication of renal replacement therapy and seems to be related to changes in fluid balance.