Peritoneal Dialysis Overview

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Questions and Answers

What is the primary purpose of peritoneal dialysis?

  • To enhance mental clarity
  • To maintain a positive nitrogen balance (correct)
  • To improve digestive function
  • To increase muscle mass

Which of the following is a necessary preparation step before starting peritoneal dialysis?

  • Administering medication to sedate the patient
  • Assessing the patient's blood pressure
  • Instructing the patient to empty the bladder and bowel (correct)
  • Providing information about protein-rich diets

What role does heparin play in the preparation for peritoneal dialysis?

  • To reduce inflammation
  • To prevent clotting (correct)
  • To provide energy boost
  • To enhance nutrient absorption

How long is the typical dwell time for peritoneal dialysis to allow diffusion and osmosis?

<p>20 to 30 minutes (C)</p> Signup and view all the answers

What should be done to the dialysate solution before using it for peritoneal dialysis?

<p>Warm it to body temperature (A)</p> Signup and view all the answers

Which of the following phases is NOT part of the peritoneal dialysis exchange cycle?

<p>Infusion (C)</p> Signup and view all the answers

When draining the solution from the peritoneal cavity, what is the usual duration for completion?

<p>20 to 30 minutes (A)</p> Signup and view all the answers

Which type of catheter is commonly used for peritoneal dialysis?

<p>Tenckhoff (B)</p> Signup and view all the answers

What is the primary reason for the removal of excess water during peritoneal dialysis?

<p>The dialysate has a high dextrose concentration. (B)</p> Signup and view all the answers

Which complication is characterized by inflammation of the peritoneum?

<p>Peritonitis (A)</p> Signup and view all the answers

What should be checked daily before peritoneal dialysis?

<p>Weight (D)</p> Signup and view all the answers

Which of the following statements about drainage fluid is true?

<p>Drainage fluid is normally colorless or straw-colored. (B)</p> Signup and view all the answers

What technique should be used during the intra-dialysis procedure?

<p>Aseptic technique (B)</p> Signup and view all the answers

What is the maximum expected protein loss in peritoneal dialysis drainage?

<p>10 to 20 g/day (C)</p> Signup and view all the answers

What is one of the possible pulmonary complications from peritoneal dialysis?

<p>Atelectasis (D)</p> Signup and view all the answers

During the exchange, how long should the dialysate remain in the abdomen after instillation?

<p>Approximately 10 minutes (C)</p> Signup and view all the answers

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Study Notes

Peritoneal Dialysis (PD)

  • Treatment for patients with severe chronic kidney disease
  • Uses the patient's own peritoneal membrane as a filter
  • Goals: remove waste, rebalance fluids, maintain nitrogen balance, quality of life

PD Catheter Types

  • Straight Tenckhoff
  • Curled Tenckhoff
  • Swan-neck
  • T-fluted

Preparing the Patient

  • Surgeon, interventional radiologist, or nephrologist explain the procedure
  • Nurse obtains signed consent for catheter insertion
  • Patient empties bladder and bowel

Preparing the Equipment

  • Assemble equipment
  • Check physician's orders for dialysate concentration and medications
    • Heparin: prevents clotting
    • KCI: prevents hypokalemia
    • Antibiotics: for peritonitis
    • Insulin: for diabetic patients
  • Warm dialysate solution to body temperature (too cold causes pain and cramping)

PD Cycle

  • Three phases: inflow, dwell, drain
  • Each cycle is called an exchange

Performing the Exchange

  • Dialysate is infused by gravity into the peritoneal cavity
  • Dwell time allows diffusion and osmosis
  • Drainage is typically completed in 20-30 minutes
  • Drainage fluid should be clear
  • Bloody or pink drainage is normal after catheter insertion

Types of PD

  • Continuous ambulatory peritoneal dialysis (CAPD)
  • Automated peritoneal dialysis (APD)
    • Continuous cycling peritoneal dialysis (CCPD)
    • Intermittent peritoneal dialysis
    • Nocturnal (nightly) intermittent peritoneal dialysis

Complications

  • Peritonitis
  • Leakage
  • Bleeding
  • Exit site infection
  • Hernias
  • Lower back problems (increased intraabdominal pressure)
  • Pulmonary complications (atelectasis, pneumonia, bronchitis)
  • Protein loss

Nursing Management - Predialysis Care

  • Document vital signs (temperature, pulse, blood pressure)
  • Check daily weight before dialysis
  • Monitor lab values (BUN, electrolytes, creatinine, pH, hematocrit)
  • Measure and record abdominal girth
  • Maintain fluid and dietary restrictions
  • Have the client empty their bladder before catheter insertion
  • Warm the dialysate solution to body temperature
  • Explain procedures and expected sensations

Nursing Management - Intra-Dialysis Care

  • Use strict aseptic technique
  • Add prescribed medications to the dialysate solution
  • Prime tubing with solution and connect to peritoneal catheter
  • Instil dialysate over 10 minutes
  • Clamp tubing and allow dwell time
  • Keep drainage tubing clear of kinks and secure connections

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