1. The client/caregiver can define peritoneal dialysis.
    1. It is a process that mimics the function of the kidney.
    2. A dialysis solution is put into the membrane of the abdomen to remove wastes and other impurities and excess fluid from the body.
  2. The client/caregiver can list various types of peritoneal dialysis.
    1. Intermittent peritoneal dialysis
      1. The process is performed by a machine, usually in the hospital at night while sleeping.
      2. It is done three to five times a week in 8-to 10-hour sessions.
      3. The abdomen is empty between dialysis.
    2. Continuous ambulatory peritoneal dialysis
      1. A bag of dialysate solution is instilled into the abdomen, which takes about 10 minutes.
      2. This solution is left in place for 4 to 8 hours and then drained.
      3. This procedure is repeated four to five times daily.
    3. Continuous cycling peritoneal dialysis
      1. This procedure is done at night by connecting tubing from a machine to the abdomen.
      2. The machine performs approximately three to seven exchanges during the night.
      3. The peritoneal fluid is left in the abdomen during the day.
  3. The client/caregiver can describe the basic procedure.
    1. Peritoneal dialysis is done by inserting a catheter through the abdominal wall.
    2. The dialysis solution is allowed to flow into the abdomen between the abdominal wall and the visceral wall, which covers the abdominal organs.
    3. The solution is allowed to stay in the abdomen for a set amount of time.
    4. The peritoneum acts as a membrane, allowing diffusion and osmosis to occur to remove toxic wastes and excess fluid from the body.
      1. Diffusion is the movement of a solution of higher concentration to a solution of lower concentration.
      2. Osmosis is the passage of fluid through a membrane from a solution of lower concentration to a solution of higher concentration.
    5. The fluid is then drained from the abdomen.
  4. The client/caregiver can list precautions to follow when doing the procedure.
    1. Wash your hands every time you need to handle your catheter.
    2. Store supplies in a cool, clean, dry place.
    3. Warm the fluid before beginning the procedure.
    4. Maintain sterile technique when opening and closing catheter connections.
    5. Notify physician if pain occurs.
    6. Inspect each bag of solution for signs of contamination before use.
  5. The client/caregiver can list measures to follow between dialysis treatments.
    1. Follow the diet as instructed by the physician, usually low in protein, sodium, and potassium.
    2. Restrict fluids as instructed.
    3. Obtain adequate rest and exercise.
    4. Take temperature for early detection of infection.
    5. Weigh daily at the same time each day.
    6. Wear a Medic Alert bracelet.
    7. Keep a follow-up appointment with a physician.
    8. Avoid using over-the-counter medication without approval from the physician.
    9. Report any increased abdominal girth, distention, pain, absence of bowel movements, and fever.
  6. The client/caregiver can list measures for care of the exit site of the dialysis catheter.
    1. Assess for signs and symptoms of infection.
    2. Apply antiseptic and dry sterile dressing as instructed.
    3. Keep sterile cap in place.
    4. Report any signs of infection at the site (i.e., redness, swelling, tenderness, and drainage).
  7. The client/caregiver is aware of possible complications of peritoneal dialysis.
    1. Infection, the most common problem (peritonitis)
    2. Dehydration
    3. Hernias
    4. Constipation
    5. Respiratory difficulty
    6. Catheter-related complications
    7. Dialysis complications
  8. The client/caregiver can list specific symptoms of infection, which need to be reported promptly.
    1. Signs and symptoms of infection to report are
      • Fever
      • Nausea or vomiting
      • Redness or pain around the catheter
      • Unusual color or cloudiness in used dialysis solution
      • A catheter cuff that has been pushed out

Resources

American Association of Kidney Patientswww.aakp.org
American Kidney Fundwww.kidneyfund.org
National Kidney Foundationwww.kidney.org
Dietitian
Support groups
Counseling

References

Ackley, B. J., & Ladwig, G. B. (2006). Nursing diagnosis handbook: A guide to planning care. St. Louis: Mosby Inc.Canobbio, M. M. (2006). Mosby’s handbook of patient teaching. St. Louis: Mosby Inc.Perry, A., & Potter, P. (2006). Clinical nursing skills & technique. St. Louis: Mosby Inc.Timby, B. K., & Smith, N. C. (2003). Introductory medical-surgical nursing (8th ed.). Philadelphia: J. B. Lippincott

Credits

Client Teaching Guides for Home Health Care, 2nd ed.© 2008 Jones and Bartlett Publishers, Inc.www.jbpub.com

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