6 Peritoneal Dialysis Nursing Care Plans

Risk for Deficient Fluid Volume

One of the potential risks associated with peritoneal dialysis is deficient fluid volume. This can occur if too much fluid is removed during the dialysis process, leading to dehydration and electrolyte imbalances.

Nursing Diagnosis

• Risk for Deficient Fluid Volume

Risk Factors

• Use of hypertonic dialysate with excessive removal of fluid from circulating volume

Desired Outcomes

• The patient will achieve desired alteration in fluid volume and weight with BP and electrolyte levels within acceptable range.
• The patient will experience no symptoms of dehydration.

Nursing Assessment and Rationale

1. 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.

2. 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.

3. 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.

Nursing Interventions and Rationales

1. Adhere to schedule for draining dialysate from abdomen.
Prolonged dwell times, especially when 4.5% glucose solution is used, may cause excessive fluid loss.

2. Weigh when the abdomen is empty, following initial 6–10 runs, then as indicated
Detects rate of fluid removal by comparison with baseline body weight.

3. 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.

4. Monitor BP (lying and sitting) and pulse. Note level of jugular pulsation
Decreased BP, postural hypotension, and tachycardia are early signs of hypovolemia

5. Note reports of dizziness, nausea, and increased thirst.
May indicate hypovolemia and hyperosmolar syndrome.

6. 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.

7. 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.

8. 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 percentage of patients are chronically hypokalemic, hyperkalemia is by far the most common abnormality in dialysis patients.

9. 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 becomes constipated.
To prevent bowel perforation.

10. Maintain nutritional status. Provide a high-calorie, low-protein, low-sodium, and low-potassium diet, with vitamin supplements.
To balance nutritional intake.

11. Aggressively restore fluid volume after major surgery or trauma.
Dialysis disequilibrium syndrome is a frequent complication of renal replacement therapy and seems to be related to changes in fluid balance.