A 36-year-old woman is married and has two adopted children. She is diagnosed with polycystic kidney disease (PKD), and she will soon have to go on dialysis or consent to a renal transplant.
1. What additional data should the nurse collect to help the patient make the best decision for herself?
The nurse would need to collect previous health records of the patient. Gathering information on the cause of kidney failure and the medications used would help the nurse analyze the health issue in a precise manner. Gathering information on the patient’s psychological health and family would help the nurse. Information on the work environment of the patient would enable the nurse to provide healthcare inputs in an appropriate manner. Prior to treatment, the patient should disclose any information about previous disease, vaccinations or therapeutic drug use. Vitamin intake should be noted down before the commencement of the dialysis.
2. How would the nurse briefly describe the process of dialysis to the patient? Include information about the following questions:
a. In peritoneal dialysis, what is the membrane through which the process occurs?
In severe chronic kidney disease, peritoneal dialysis (PD) is used as a treatment intervention for patients. The membrane used in the process is the patient’s peritoneum. The peritoneum is present in the abdominal region. The peritoneum is used as a membrane to pass fluids and dissolved substrates like urea, glucose and albumin. A permanent tube is used to introduce fluids in the abdomen. (Kimura, Y., Inoue, T., & Suzuki H. 2012).
b. Identify the types of peritoneal dialysis.
There are two types of peritoneal dialysis, automated peritoneal dialysis (APD) and Continuous ambulatory peritoneal dialysis (CAPD). Patients prefer APD since the process involves the exchange of fluids during their sleep. The process consists of a cycler machine that automates the draining and filling process. In CAPD, the entire process is carried out manually. The process is tedious and takes around 30 minutes to complete. The process consists of a dialysate fluid bag that is used for fluid exchange.
c. What is used to prevent fibrin clot formation in peritoneal dialysis?
Clots form in the effluent and are termed as Fibrins. They appear to be white in color and are like stringy fibers. Patients undergoing dialysis face a common problem of fibrin clot formation. Fibrin clot formation would block the flow of dialysate in the catheter. The most common method of preventing fibrin clot formation is by adding Heparin into the dialysate. A nursing professional adds heparin. (Kimura, Y., Inoue, T., & Suzuki H. 2012).
d. How is peritonitis identified and diagnosed in the patient receiving dialysis?
Early signs and symptoms for peritonitis can be identified easily. Patients receiving dialysis may suffer from abdominal pain. Blood-tinged effluent or blood clots are signs of peritonitis. In some cases, weight gain and hernia are also observed. Dehydration, high blood pressure and headaches are common signs that could lead to peritonitis. Microbial infection can cause moderate to severe abdominal pain. The treatment of peritonitis can be done using urokinase along with antibiotic therapy. (Teitelbaum, I., & John Burkart, J)
e. List three advantages of using peritoneal dialysis instead of hemodialysis.
The device used in peritoneal hemodialysis is portable and hence gives the patient freedom to travel without any discomfort. There are few restrictions in diet and fluid intake in peritoneal hemodialysis compared to hemodialysis. Regular visit to a dialysis unit is not necessary in case of peritoneal dialysis. Peritoneal dialysis is a needle-free process. The costs of peritoneal dialysis are lower compared to hemodialysis. (Sinnakirouchenan R & Holley JL. 2011).
3. Identify the source of possible problems with the flow of dialysate in patients with peritoneal dialysis.
Fibrin in the effluent can block the catheter. Fibrin in the effluent would result in blockage, in the flow of dialysate. Fibrin formation can be prevented by using Heparin the dialysate. Trauma in abdomen can cause a bloody effluent. Bloody effluent can cause blockage in the flow of dialysate. Heavy-lifting and menstruation can cause the formation of blood-tingled effluent that can cause problems in the flow of dialysate in peritoneal dialysis.
4. What are the protein needs of the patient receiving peritoneal dialysis?
The protein needs of patients receiving peritoneal dialysis is a crucial factor. The recommended protein intake is around 1.2-1.3g/kg bodyweight/day. Maintaining a daily protein intake (DPI) of 1.2g/kg/day was found to be associated with positive or neutral nitrogen balance. (Riella, MC. 2013).
5. Due to the long distance the patient lives from the medical center, she elects to begin CAPD. What would be included in a plan of hospital care for the patient for this procedure? There are many healthcare considerations to made when a patient opts for Continuous ambulatory peritoneal dialysis (CAPD). The main focus would be on the diet of the patient. She would be encouraged to have food rich in protein. High protein loss is observed in patients receiving CAPD. She should avoid foods that contain phosphorus. Monitoring her fluid consumption on a daily basis is highly essential. The patient has two adopted children. If possible, her children could monitor her blood pressure levels and weight on a weekly basis. Peritoneal dialysis can cause abdominal enlargement. She would need psychological care since her appearance after dialysis might change. Avoidance of physical activity when the peritoneal cavity is full is a must. Apart from this, the patient could live a normal-healthy life. (Teitelbaum, I., & John Burkart, J)
Kimura, Y., Inoue, T., & Suzuki H. 2012. Role of nurses in a continuous ambulatory peritoneal diagnosis outpatient clinic. Contrib Nephrol. 2012; 177: 64-70. Retrieved: http://www.ncbi.nlm.nih.gov/pubmed/22613916
Sinnakirouchenan, R., & Holley, JL. 2011. Peritoneal dialysis versus hemodialysis: risks, benefits, and access issues. Adv Chronic Kidney Dis. 2011 Nov;18(6):428-32. Retrieved: http://www.ncbi.nlm.nih.gov/pubmed/22098661
Riella, MC. 2013. Nutritional evaluation of patients receiving dialysis for the management of protein-energy wasting: what is old and what is new? J Ren Nutr. 2013 May;23(3):195-8. Retrieved: http://www.ncbi.nlm.nih.gov/pubmed/23611546
Teitelbaum, I., & John Burkart, J. Peritoneal Dialysis. CORE CURRICULUM IN NEPHROLOGY. Pdf file. Retrieved: http://www.uphs.upenn.edu/renal/renal%20curr%20pdfs/peritoneal%20dialysis.pdf