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Peritoneal dialysis

- Peritoneal dialysis is a type of dialysis that uses the peritoneum (the lining of the abdominal cavity) as a natural filter to remove waste and fluid from the blood. 
- The peritoneum is rich in blood vessels and has a large surface area that allows diffusion of waste and fluid across its membrane. 
- A catheter is inserted into the peritoneal cavity through a small incision in the abdomen and connected to a bag of dialysate. The dialysate is infused into the peritoneal cavity and left there for a certain period of time (dwell time) during which waste and fluid move from the blood to the dialysate. The dialysate is then drained out of the peritoneal cavity and replaced with fresh dialysate.
- Peritoneal dialysis can be performed at home or at work by the patient or a caregiver. 
- There are two main types of peritoneal dialysis: continuous ambulatory peritoneal dialysis (CAPD) and automated peritoneal dialysis (APD). 
- CAPD involves four to five exchanges of dialysate per day, each lasting about 30 to 40 minutes. APD involves using a machine (cycler) that performs several exchanges of dialysate overnight while the patient sleeps. 
- Peritoneal dialysis requires regular assessment of weight, fluid balance, electrolytes, glucose, infection, catheter function, and complications such as peritonitis, leakage, hernia, malnutrition, and encapsulating peritoneal sclerosis.

Questions on Peritoneal dialysis

Correct Answer is C

Explanation

This statement is incorrect. Peritoneal dialysis uses the peritoneal membrane as a filter. It involves the instillation and drainage of dialysate fluid into the abdominal cavity through a catheter.

Correct Answer is A

Explanation

This statement is incorrect. Elevating the client's legs may help improve blood flow, but it does not address the underlying cause of the reported symptoms. The nurse should first check the client's blood pressure and pulse rate to assess for hypotension before implementing further interventions.

Correct Answer is C

Explanation

This statement is incorrect. Cleaning the catheter site with hydrogen peroxide is not recommended, as it can be too harsh and irritating to the skin. Instead, the site should be cleaned with mild soap and water or as instructed by the healthcare provider.

Correct Answer is A

Explanation

No explanation

Correct Answer is B

Explanation

No explanation

Correct Answer is D

Explanation

This statement is correct. Cloudy dialysate drainage may indicate infection or peritonitis. The nurse should check the client's vital signs and assess for signs of abdominal pain or tenderness, as this requires immediate evaluation.

Correct Answer is A

Explanation

This statement is incorrect. Iron intake may need to be managed for clients with anemia, which is common in end-stage renal disease (ESRD) and dialysis. However, protein restriction remains a more significant dietary consideration for clients on hemodialysis.QUESTIONS

Correct Answer is C

Explanation

This statement is incorrect. Hypokalemia (low potassium levels) is not an indication for initiating dialysis. In fact, dialysis may lead to a reduction in potassium levels, and clients on dialysis are more likely to experience hyperkalemia.

Correct Answer is D

Explanation

This statement is accurate. Dialysis is the process of removing waste products, excess fluids, and toxins from the blood when the kidneys are no longer able to perform these functions adequately.

Correct Answer is D

Explanation

Uremia, which is characterized by elevated levels of urea and other waste products in the blood, is a critical indication for initiating dialysis in clients with acute kidney injury. Dialysis helps remove these toxic substances from the bloodstream.

Correct Answer is D

Explanation

Hypervolemia (severe fluid overload) is a critical indication for initiating dialysis in clients with end-stage renal disease. Dialysis helps remove excess fluid from the body and can relieve symptoms such as pulmonary edema and hypertension.

Correct Answer is D

Explanation

Severe metabolic acidosis, which results from the kidneys' inability to adequately excrete acids and regulate pH balance, is a critical indication for initiating dialysis in clients with CKD.

Correct Answer is D

Explanation

Uremia, which is the accumulation of urea and other waste products in the blood, can lead to various complications, including pruritus. Dialysis helps remove these waste products from the bloodstream and may alleviate the itching associated with uremia.

Correct Answer is D

Explanation

A significantly decreased glomerular filtration rate (GFR) indicates that the kidneys' ability to filter waste products and excess fluids from the blood is severely impaired. Dialysis can help support kidney function and remove waste products when the GFR is critically low.

Correct Answer is C

Explanation

This statement is incorrect. Hyponatremia (low sodium levels) is not the primary indication for initiating dialysis in this scenario. Uremia and the accumulation of waste products are the primary concerns that require dialysis to address.QUESTIONS

Correct Answer is B

Explanation

This statement is incorrect. Hemodialysis does not use a pump to circulate dialysate through the intestines; that description is characteristic of peritoneal dialysis.

Correct Answer is C

Explanation

This statement is incorrect. Elevating the client's legs may promote blood flow, but it does not address the immediate issue of lightheadedness and dizziness. Assessing the client's blood pressure and pulse rate is the priority to determine the appropriate intervention.

Correct Answer is A

Explanation

This statement is incorrect. Iron intake may need to be managed for clients with anemia, which is common in end-stage renal disease (ESRD) and dialysis. However, protein restriction remains a more significant dietary consideration for clients on hemodialysis.

Correct Answer is B

Explanation

This statement is incorrect. Administering an anticoagulant medication is not indicated for muscle cramps during hemodialysis. Anticoagulants are used to prevent blood clots during the procedure but would not alleviate muscle cramps.

Correct Answer is C

Explanation

This statement is incorrect. Increasing the dialysate solution flow rate may not be appropriate without further assessment of the client's fluid status. It could worsen the fluid overload and further increase blood pressure.

Correct Answer is C

Explanation

This statement is incorrect. Serum potassium levels may be monitored for a client on hemodialysis due to the potential for electrolyte imbalances, but they are not the primary concern during ESA therapy for anemia management.

Correct Answer is A

Explanation

This statement is incorrect. Assessing for swelling and tenderness in the neck is not related to the AV fistula assessment. Swelling and tenderness may be related to other issues but are not specific to AV fistula functioning.

Correct Answer is B

Explanation

This statement is incorrect. Monitoring blood urea nitrogen (BUN) levels is crucial for clients with ESRD, but it is not directly related to the administration of heparin during hemodialysis.QUESTIONS

This statement is incorrect. Peritoneal dialysis does not require a catheter to be inserted into the bladder. Instead, it uses a catheter to infuse and drain dialysate into and out of the peritoneal cavity.

This statement is accurate. Cloudy drainage from the catheter site may indicate peritonitis, which is an infection of the peritoneal cavity. Obtaining a sample of the drainage for culture and sensitivity testing can help identify the presence of infection and guide appropriate treatment.

This statement is incorrect. Serum potassium levels may be monitored for a client on peritoneal dialysis due to the potential for electrolyte imbalances, but they are not the primary concern during ESA therapy for anemia management.

This statement is accurate. Infection is a significant risk for clients on peritoneal dialysis due to the direct access to the peritoneal cavity through the catheter. Strict aseptic technique is crucial to prevent infections.

This statement is incorrect. Notifying the healthcare provider about the symptoms is important, but the nurse should first assess the catheter for possible issues to determine if immediate intervention is needed.

No explanation

This statement is incorrect. Hypertonic dialysate would not cause hypotension. In fact, it may lead to a decrease in blood pressure due to fluid removal, but it would not be considered a primary cause of hypotension.

This statement is incorrect. Encouraging the client to consume dairy products is not directly related to managing constipation. While calcium intake may be important for bone health in clients with ESRD, it is not a primary intervention for constipation.QUESTIONS

Incorrect. Clients on dialysis typically need to restrict their phosphorus intake to prevent complications related to high phosphorus levels, such as bone disease and cardiovascular issues.

Incorrect. Administering prescribed intravenous medications may be necessary during dialysis, but it is not the priority action stated in this question.

Incorrect. The catheter should not be immersed in water during bathing or showering, as this can introduce pathogens and increase the risk of infection.

Incorrect. Limiting fluid intake only on the day of dialysis treatment is not sufficient to maintain overall hydration and may lead to imbalances and complications between dialysis sessions.

Correct. Notifying the healthcare provider about any redness or drainage at the catheter site is essential, as these can be signs of infection or other complications that require prompt evaluation and treatment.

Incorrect. While daily dressing changes are important, using sterile technique for catheter dressing changes may not be necessary, as the dressing does not directly contact the peritoneal cavity during CAPD exchanges.

Incorrect. If an AV fistula starts bleeding, the client should not apply pressure to the site. Instead, they should immediately elevate the arm and apply pressure to the bleeding site with a clean cloth or bandage while seeking medical attention.QUESTIONS

Incorrect. Administering intravenous hypertonic saline during dialysis is not a routine intervention to prevent hypotension. It may be used in specific cases, but fluid management is the primary approach.

Incorrect. Encouraging the client to perform another exchange without further assessment can potentially exacerbate any underlying issue causing the cloudy effluent.

Incorrect. Checking the client's pre-dialysis weight is not the priority when the client is experiencing severe neurological symptoms. Immediate assessment and intervention are needed.

Incorrect. Applying a heating pad to the affected muscles is not recommended during dialysis, as it may cause burns or worsen the cramps.

Incorrect. Placing the client in a semi-Fowler's position may be appropriate for respiratory distress, but the nurse should first assess the client's vital signs and overall condition before implementing positioning changes.

Correct. Abdominal pain and fever in a client on peritoneal dialysis may indicate peritonitis, an infection of the peritoneal cavity. Obtaining a peritoneal fluid sample for testing is essential to confirm the diagnosis and initiate appropriate treatment promptly.

Incorrect. Administering an antiemetic medication is not indicated for a metallic taste in the mouth, as it is not associated with nausea or vomiting.

Incorrect. While checking the client's platelet count is important, it is not the first action to address active bleeding. Applying pressure to the bleeding site takes priority to control the bleeding.QUESTIONS
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