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RENAL DIALYSIS: PERITONEAL 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 DIAGNOSIS: Fluid Volume, risk for excess Risk factors may include Inadequate osmotic gradient of dialysate Fluid retention (malpositioned or kinked/clotted catheter, bowel distension; peritonitis, scarring of peritoneum) Excessive PO/IV intake Possibly evidenced by [Not applicable; presence of signs and symptoms establishes an actual diagnosis.] DESIRED OUTCOMES/EVALUATION CRITERIA—PATIENT WILL: Fluid Balance (NOC) Demonstrate dialysate outflow exceeding/approximating infusion. Experience no rapid weight gain, edema, or pulmonary congestion. ACTIONS/INTERVENTIONS Peritoneal Dialysis Therapy (NIC) Independent Maintain a record of inflow/outflow volumes and cumulative fluid balance. Record serial weights, compare with I&O balance. Weigh patient when abdomen is empty of dialysate (consistent reference point). Assess patency of catheter, noting difficulty in draining. Note presence of fibrin strings/plugs. Check tubing for kinks; note placement of bottles/bags. Anchor catheter so that adequate inflow/outflow is achieved. RATIONALE In most cases, the amount drained should equal or exceed the amount instilled. A positive balance indicates need of further evaluation. Serial body weights are an accurate indicator of fluid volume status. A positive fluid balance with an increase in weight indicates fluid retention. Slowing of flow rate/presence of fibrin suggests partial catheter occlusion requiring further evaluation/intervention. Improper functioning of equipment may result in retained fluid in abdomen and insufficient clearance of toxins.
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ACTIONS/INTERVENTIONS Peritoneal Dialysis Therapy (NIC) Independent Turn from side to side, elevate the head of the bed, apply gentle pressure to the abdomen. Note abdominal distension associated with decreased
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