Question

Joni Winters, a 64-year-old female client, is admitted with a fractured hip. She has chronic renal failure and has continuous peritoneal dialysis (CAPD) exchanges every 6 hours. The Tenckhoft peritoneal catheter site has redness, which goes across the abdomen. The client states that her abdomen is tender to touch all over, and the nurse notes the abdomen is rigid. The bowel sounds are decreased, and the peritoneal dialysate is in the dwelling phase of the cycle. The vital signs are T, 101°F; BP, 140/90 mm Hg; HR, 110 beats/minute; RR, 28 breaths/minute. Answer each question below:

a. Why does the client have a rigid abdomen?

b. Explain the process of peritoneal dialysis? Why must the client's blood glucose be checked when they are receiving peritoneal dialysis?

c. The following lab values will have a change from normal if the peritoneal dialysis is missed for 3 consecutive days: Potassium, Sodium, magnesium, calcium, and phosphorus. Indicate if they will be lower or higher than normal.

d. For the lab values in letter c, explain why each of these is lower or higher than normal.

e. What will the lab values of specific gravity and urine creatinine clearance be if the client cannot have her dialysis?

f. Explain why her blood pressure and heart rate would be elevated if she did not have her dialysis.

Answer 1

Peritoneal dialysis is a way to remove waste products from your blood when your kidneys can't adequately do the job any longer. This procedure filters the blood in a different way than does the more common blood-filtering procedure called hemodialysis.

B. Peritoneal dialysis is a treatment for kidney failure that uses the lining of your abdomen, or belly, to filter your blood inside your body. Health care providers call this lining the peritoneum.

A few weeks before you start peritoneal dialysis, a surgeon places a soft tube, called a catheter, in your belly.

When you start treatment, dialysis solution—water with salt and other additives—flows from a bag through the catheter into your belly. When the bag is empty, you disconnect it and place a cap on your catheter so you can move around and do your normal activities. While the dialysis solution is inside your belly, it absorbs wastes and extra fluid from your body.

After a few hours, the solution and the wastes are drained out of your belly into the empty bag. You can throw away the used solution in a toilet or tub. Then, you start over with a fresh bag of dialysis solution. When the solution is fresh, it absorbs wastes quickly. As time passes, filtering slows. For this reason, you need to repeat the process of emptying the used solution and refilling your belly with fresh solution four to six times every day. This process is called an exchange.

You can do your exchanges during the day, or at night using a machine that pumps the fluid in and out. For the best results, it is important that you perform all of your exchanges as prescribed. Dialysis can help you feel better and live longer, but it is not a cure for kidney failure.

C. Potassium levels increase

Sodium decreases

Magnesium increasee

Calcium increases

Phosphorus increases

D. When dialysis is missed, the body fluids gets accumulated so are the toxins and the whole body swells.

E. specific gravity of urine increases indicating dehydration.

Creatinine levels increase

F. Due to the fluid accumulation the volume of blood decreases which is why the heart rate and blood pressure increases.