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:

Acute Pain

Acute Pain: Unpleasant sensory and emotional experience arising from actual or potential tissue damage or described in terms of such damage; sudden or slow onset of any intensity from mild to severe with anticipated or predictable end and a duration of <6 months.

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