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 Ineffective Breathing Pattern

Risk for Ineffective Breathing Pattern: The state in which an individual is at high risk to experience an actual or potential loss of adequate ventilation.

Risk factors may include

Abdominal pressure/restricted diaphragmatic excursion; rapid infusion of dialysate; pain
Inflammatory process (e.g., atelectasis/pneumonia)

Desired Outcomes

Display an effective respiratory pattern with clear breath sounds, ABGs within patient’s normal range.
Experience no signs of dyspnea/cyanosis

Nursing Interventions	Rationale
Monitor respiratory rate and effort. Reduce infusion rate if dyspnea is present.	Tachypnea, dyspnea, shortness of breath, and shallow breathing during dialysis suggest diaphragmatic pressure from distended peritoneal cavity or may indicate developing complications.
Auscultate lungs, noting decreased, absent, or adventitious breath sounds: crackles, wheezes, rhonchi.	Decreased areas of ventilation suggest presence of atelectasis, whereas adventitious sounds may suggest fluid overload, retained secretions, or infection.
Note character, amount, and color of secretions.	Patient is susceptible to pulmonary infections as a result of depressed cough reflex and respiratory effort, increased viscosity of secretions, as well as altered immune response and chronic and debilitating disease.
Elevate head of bed or have patient sit up in chair. Promote deep-breathing exercises and coughing	Facilitates chest expansion and ventilation and mobilization of secretions.
Review ABGs and pulse oximetry and serial chest x-rays.	Changes in Pao2 and Paco2 and appearance of infiltrates and congestion on chest x-ray suggest developing pulmonary problems.
Administer supplemental O2 as indicated.	Maximizes oxygen for vascular uptake, preventing or lessening hypoxia.
Administer analgesics as indicated.	Alleviates pain, promotes comfortable breathing, maximal cough effort.
Maintain nutritional status. Provide a high-calorie, low-protein, low-sodium, and low-potassium diet, with vitamin supplements.	To balance nutritional intake.