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 and swelling 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:

1. The following lab values will have a change from normal if the peritoneal dialysis is missed for 3 consecutive days:

Potassium

Sodium

Magnesium,

Calcium,

Phosphorus.

For each of these electrolytes indicate if they will be increased or decrease.

2. For the 5 electrolytes explain why each of these is lower or higher than normal. (Not just because she missed her dialysis).

Answer 1

Qn.No1.

The following lab values will have a change from normal if the peritoneal dialysis is missed for 3 consecutive days:

electrolytes	pattern of changes due to missing of dialysis	Reason for lower or higher Not just because she missed her dialysis).
Potassium	increase	reduced renal excreation and increased release of potassium from the cells , hypoaldosteronism and tissue breakdown. increased intake of potassium containing food.
Sodium	decrease / increase	decrease when large amount of fluid is retained. it is called dilutional hyponatremia or sodium become low due to increased loss. When renal failure progresses kidney tubules lost its ability to reabsorb sodium, it leads to sodium loss. Also can increase if the person took large amount of sodium containing food when there is no urine output, ESRD stage.
Magnesium,	increase	kidney unable to excrete excess amount.
Calcium,	decrease	due to increased serum phosphorous and and decreased renal production of 1,25 ergocalciferol(1,25 OH, viatiminD) and decrease absorption from the intestine. serum calciterol is less in CRF because of hyperphosphatemia. High level of phosphorous suppresses conversion of inactive hydroxyvitamin into calciterol(vitamin D3) .It is essential for absorption of calcium from the stomach.
Phosphorus.	increase	due to failure of kidney to excreat excess amount from the body.