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)Â nursing care plans (NCP) and nursing diagnosis for peritoneal dialysis:
- Risk for Deficient Fluid Volume
- Risk for Ineffective Breathing Pattern
- Risk for Infection
- Acute Pain
- Risk for Trauma
- Risk for Excess Fluid Volume
Acute Pain
Nursing Diagnosis
May be related to
- Insertion of catheter through abdominal wall/catheter irritation, improper catheter placement
- Irritation/infection within the peritoneal cavity
- Infusion of cold or acidic dialysate, abdominal distension, rapid infusion of dialysate
Possibly evidenced by
- Reports of pain
- Self-focusing
- Guarding/distraction behaviors, restlessness
Desired Outcomes
- Patient will verbalize decrease of pain/discomfort.
- Patient will demonstrate relaxed posture/facial expression, be able to sleep/rest appropriately.
| Nursing Interventions | Rationale |
|---|---|
| Investigate patient’s reports of pain; note intensity (0–10), location, and precipitating factors | Assists in identification of source of pain and appropriate interventions. |
| Explain that initial discomfort usually subsides after the first few exchanges. | Information may reduce anxiety and promote relaxation during procedure. |
| Monitor for pain that begins during inflow and continues during equilibration phase. Slow infusion rate as indicated. | Pain occurs at these times if acidic dialysate causes chemical irritation of peritoneal membrane. |
| Note reports of discomfort that is most pronounced near the end of inflow and instill no more than 2000 mL of solution at a single time. | Likely the result of abdominal distension from dialysate. Amount of infusion may have to be decreased initially. |
| Prevent air from entering peritoneal cavity during infusion. Note report of pain in area of shoulder blade. | Inadvertent introduction of air into the abdomen irritates the diaphragm and results in referred pain to shoulder blade. This type of discomfort may also be reported during initiation of therapy or during infusions and usually is related to stretching and irritation of the diaphragm with abdominal distension. Smaller exchange volumes may be required until patient adjusts. |
| Elevate head of bed at intervals. Turn patient from side to side. Provide back care and tissue massage | Position changes and gentle massage may relieve abdominal and general muscle discomfort. |
| Warm dialysate to body temperature before infusing | Warming the solution increases the rate of urea removal by dilating peritoneal vessels. Cold dialysate causes vasoconstriction, which can cause discomfort and excessively lower the core body temperature, precipitating cardiac arrest. |
| Monitor for severe or continuous abdominal pain and temperature elevation (especially after dialysis has been discontinued). |
May indicate developing peritonitis. |
| Encourage use of relaxation techniques | Redirects attention, promotes sense of control. |
| Administer analgesics. | Relieves pain and discomfort. |
| Add sodium hydroxide to dialysate, if indicated. | Occasionally used to alter pH if patient is not tolerating acidic dialysate |
See Also
You may also like the following posts and care plans:
- Nursing Care Plan: The Ultimate Guide and Database – the ultimate database of nursing care plans for different diseases and conditions! Get the complete list!
- Nursing Diagnosis: The Complete Guide and List – archive of different nursing diagnoses with their definition, related factors, goals and nursing interventions with rationale.
Genitourinary Care Plans
Care plans related to the reproductive and urinary system disorders:
- Acute Glomerulonephritis | 4 Care Plans
- Acute Renal Failure | 6 Care Plans
- Benign Prostatic Hyperplasia (BPH) | 5 Care Plans
- Chronic Renal Failure | 11Â Care Plans
- Hemodialysis | 3 Care Plans
- Hysterectomy | 6 Care Plans
- Mastectomy | 14+ Care Plans
- Menopause | 6 Care Plans
- Nephrotic Syndrome | 5 Care Plans
- Peritoneal Dialysis | 6 Care Plans
- Prostatectomy | 6 Care Plans
- Urolithiasis (Renal Calculi) | 4 Care Plans
- Urinary Tract Infection | 6 Care Plans
- Vesicoureteral Reflux (VUR) | 5 Care Plans
Really helpful information thank you very much was struggling to get the appropriate interventions for my nursing diagnosis in renal failure and nurses slabs gave them at once