Practice Question # 564.
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- Question 1 of 1
The nurse prepares a client for peritoneal dialysis. Which of the following actions should the nurse take FIRST?Correct
Answer & Rationale:
The Answer is 2
Warm the dialysate solution—CORRECT: solution should be warmed to body temp in warmer or with heating pad; don’t use microwave oven; cold dialysate increases discomfort.Incorrect
Answer & Rationale:
The Answer is 2
Warm the dialysate solution—CORRECT: solution should be warmed to body temp in warmer or with heating pad; don’t use microwave oven; cold dialysate increases discomfort.
- The peritoneum acts as the dialyzing membrane (semipermeable membrane) to achieve dialysis during kidney failure.
- Peritoneal dialysis (PD) works on the principles of osmosis, diffusion and ultrafiltration; PD occurs via the transfer of fluid and solute from the bloodstream through the peritoneum into the dialysate solution.
- The peritoneal membrane is large and porous, allowing solutes and fluid to move via osmosis from an area of higher concentration in the body to an area of lower concentration in the dialyzing fluid.
- The peritoneal cavity is rich in capillaries; therefore it provides a ready access to the blood supply.
Contraindications to peritoneal dialysis
- Recent abdominal surgery
- Abdominal adhesions
- Other gastrointestinal problems such as diverticulosis
Access for peritoneal dialysis
- A siliconized rubber catheter such as a Tenckhoff catheter is surgically inserted into the client’s peritoneal cavity to allow infusion of dialysis fluid.
- The preferred insertion site is 3 to 5 cm below the umbilicus; this area is relatively avascular and has less fascial resistance.
- The catheter is tunneled under the skin, through the fat and muscle tissue to the peritoneum; it is stabilized with inflatable Dacron cuffs in the muscle and under the skin.
- Over a period of 1 to 2 weeks following insertion, fibroblasts and blood vessels grow around the cuffs, fixing the catheter in place and providing an extra barrier against dialysate leakage and bacterial invasion.
- If the client is scheduled for transplant surgery, the peritoneal dialysis catheter may either be removed or left in place if the need for dialysis is suspected post-transplantation.
Types of peritoneal dialysis
Continuous ambulatory peritoneal dialysis (CAPD)
- Closely resembles renal function because it is a continuous process
- Does not require a machine for the procedure
- Promotes client independence
- The client performs self-dialysis 24 hours a day, 7 days a week.
- Four dialysis cycles are usually administered in a 24-hour period, including an overnight 8-hour dwell time.
- Dialysate, 1½ to 2 L, is instilled into the abdomen four times daily and allowed to dwell as prescribed.
- After dwell, the bag is placed lower than the insertion site so that fluid drains by gravity flow.
- After fluid is drained, the bag is changed, new dialysate is instilled into the abdomen, and the process continues.
- Between exchanges, the catheter is clamped.
Automated peritoneal dialysis
- Automated dialysis requires a peritoneal cycling machine.
- Automated dialysis can be done as intermittent peritoneal dialysis, continuous cycling peritoneal dialysis, or nightly peritoneal dialysis.
- The exchanges are automated instead of manual