Magtabog, Anna Christina A. NCM 102 Mr.

Ricardo October 4, 2010

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Assignment # 3
PERITONEAL DIALYSIS
Peritonea dia!sis is a "a! to remo#e "aste
$rod%cts &rom bood "hen the 'idne!s can
no onger do the (ob. )%ring $eritonea
dia!sis, bood #esses in the $eritone%m &i
in &or the 'idne!s, "ith the he$ o& a &%id
*dia!sate+ "ashed in and o%t o& the
$eritonea s$ace.
Peritonea dia!sis di&&ers &rom hemodia!sis,
a more common bood-&itering $roced%re.
,ith $eritonea dia!sis, treatments can be
gi#en in the com&ort o& the $atient-s home, at
"or' or "hie tra#eing. .t can be %sed "ith &e"er medications and ess
restricti#e diet than "ith hemodia!sis.
Peritonea dia!sis is o&ten done to manage 'idne! &ai%re %nti a 'idne!
trans$ant is $ossibe. /idne! &ai%re itse& %s%a! res%ts &rom a ong-term
*chronic+ disease that ca%ses 'idne! damage o#er a n%mber o& !ears. Common
ca%ses o& 'idne! &ai%re inc%de0
)iabetes
1igh bood $ress%re *h!$ertension+
/idne! in&ammation *gomer%one$hritis+
2ood #esse in&ammation *#asc%itis+
Po!c!stic 'idne! disease *c!sts in the 'idne!+
Most $eo$e "ho re3%ire dia!sis &ace a #ariet! o& serio%s heath
$robems, inc%ding diseases that ca%se 'idne! &ai%re as "e as 'idne! &ai%re
itse&. )ia!sis $roongs i&e &or man! $eo$e, b%t i&e e4$ectanc! &or those "ho
need the $roced%re is sti m%ch o"er than that o& the genera $o$%ation. 5he
main com$ications o& $eritonea dia!sis are0
Infections. 5he most common $robem &or $eo$e recei#ing $eritonea
dia!sis is $eritonitis, an in&ection o& the $eritone%m. An in&ection can aso
de#eo$ at the site "here catheter is inserted to carr! the ceansing &%id into
and o%t o& abdomen.
Weight gain. 5he &%id %sed to cean bood in $eritonea dia!sis
contains s%gar *de4trose+. Patient ma! ta'e in se#era h%ndred caories each
da! b! absorbing some o& this &%id, 'no"n as dia!sate. 5he e4tra caories can
aso ead to high bood s%gar i& the $atient has diabetes.
Weakening of the abdominal mscles. !oding &%id in the
abdomen &or ong $eriods ma! strain be! m%sces.
Other complications that can stem from dialysis or the underlying kidney
disease include:
Anemia. Anemia 6 not ha#ing eno%gh red bood ces in the
boodstream 6 is a common com$ication o& 'idne! &ai%re. 7aiing 'idne!s
red%ce their $rod%ction o& a hormone caed er!thro$oietin, "hich stim%ates
&ormation o& red bood ces.
"one diseases. .& the damaged 'idne!s are no onger abe to %se
#itamin ) to absorb caci%m, !o%r bones ma! "ea'en. O#er$rod%ction o&
$arath!roid hormone 6 a common com$ication o& 'idne! &ai%re 6 can stri$
caci%m &rom !o%r bones.
!igh blood #$ess$e %h&#e$tension'. 1igh bood $ress%re is a
eading ca%se o& 'idne! &ai%re. 8ating too m%ch sat or drin'ing too m%ch
&%id "hie being treated &or 'idne! &ai%re, high bood $ress%re ma! get "orse
6 "hich ta'es a to in remaining 'idne! &%nction. 9e&t %ntreated, high bood
$ress%re can ead to a heart attac' or stro'e.
(lid o)e$load. ,hie hoding the dia!sis &%id in !o%r abdomen &or
ong $eriods, !o%r bod! ma! absorb too m%ch &%id. 5his can ca%se i&e-
threatening com$ications, s%ch as heart &ai%re or &%id acc%m%ation and
s"eing in !o%r the *$%monar! edema+.
Am&loidosis. )ia!sis-reated am!oidosis de#eo$s "hen $roteins in
bood are de$osited on (oints and tendons, ca%sing $ain, sti&&ness and &%id in
the (oints. 5he condition is common in $eo$e "ho ha#e been on dia!sis &or
more than &i#e !ears.
Man! &actors a&&ect ho" "e $eritonea dia!sis "or's in remo#ing "astes
and e4tra &%id &rom !o%r bood. 5hese &actors inc%de0
:i;e o& $atient
1o" 3%ic'! $eritone%m &iters "aste *$eritonea trans$ort rate+
1o" m%ch dia!sis so%tion %sed *&i #o%me+
5he n%mber o& dai! e4changes
)"e times
5he concentration o& s%gar *de4trose+ in the dia!sis so%tion
1eath care team "i $er&orm se#era tests to chec' i& dia!sis is
remo#ing eno%gh "aste $rod%cts. 5hese tests are es$ecia! im$ortant d%ring
the &irst "ee's o& dia!sis to determine "hether the $atient recei#ing an
ade3%ate amo%nt, or dose.
Peritonea e3%iibration test *P85+. 5his test meas%res ho" m%ch s%gar
has been absorbed &rom a bag o& %sed dia!sis so%tion and ho" m%ch o&
t"o "aste $rod%cts< %rea and creatinine, ha#e entered into the so%tion
d%ring a &o%r-ho%r e4change.
Cearance test. :am$es o& %sed dia!sis so%tion and a bood sam$e are
coected to com$are the amo%nt o& %rea in the %sed so%tion "ith the
amo%nt in the bood. .& the $atient-s 'idne!s sti $rod%ces %rine, a %rine
sam$e ma! be ta'en at the same time to meas%re its %rea
concentration.
If the test results show that the dialysis schedule is not removing enough wastes, the doctor
may change the prescription. This might involve changing the number of exchanges, increasing the
amount of solution you use for each exchange or using a dialysis solution with a higher
concentration of dextrose, a type of sugar.
!E*ODIALYSIS
1emodia!sis is the most common method
o& dia!sis. 1emodia!sis is %sed &or $atients
"ho are ac%te! i and re3%ire short-term
dia!sis *da!s to "ee's+ and &or $atients "ith
8:R) "ho re3%ire ong-term or $ermanent
thera$!. A dia!;er *aso re&erred to as an
arti&icia 'idne!+ ser#es as a s!nthetic
semi$ermebe membrane, re$acing the
rena gomer%i and t%b%es as the &iter &or
the im$aired 'idne!s.
7or $atients "ith chronic rena
&ai%re, hemodia!sis $re#ents death, atho%gh it does not c%re rena disease
and does not com$ensate &or the oss o& endocrine or metaboic acti#ities o& the
'idne!s. 5reatments %s%a! occ%r three times a "ee' &or 3 to 4 ho%rs $er
treatment. Patients recei#e chronic or maintenance dia!sis "hen the! re3%ire
dia!sis thera$! &or s%r#i#a and contro o& %remic s!m$toms. 5he trend in
managing 8:R) is to initiate treatment be&ore the signs and s!m$toms
associated "ith %remia become se#ere.
5he ob(ecti#es o& hemodia!sis are to e4tract to4ic nitrogeno%s
s%bstances &rom the bood and to remo#e e4cess "ater. .n hemodia!sis, the
bood, aden "ith to4ins and nitrogeno%s "astes, is di#erted &rom the $atient to
a machine, a dia!;er, "here to4ins are remo#ed and the bood is ret%rned to
the $atient.
)i&&%sion, osmosis, and %tra &itration are the $rinci$es on "hich
hemodia!sis is based. 5he to4ins and "astes in the bood are remo#ed b!
di&&%sion6that is, the! mo#e &rom an area o& higher concentration in the bood
to an area o& o"er concentration in the dia!sate. 5he dia!sate is a so%tion
made %$ o& a the im$ortant eectro!tes in their idea e4tra ce%ar
concentrations. 5he semi $ermeabe membrane im$edes the di&&%sion o& arge
moec%es, s%ch as R2C-s and $roteins.
84cess "ater is remo#ed &rom the bood b! osmosis, in "hich
"ater mo#es &rom an area o& higher so%te concentration *the bood+ to an area
o& o"er so%te concentrations *the dia!sate bath+. .n %tra &itration, "ater
mo#es %nder high $ress%re to an area o& o"er $ress%re.
5he bod!-s b%&&er s!stem is maintained %sing a dia!sate bath
made %$ o& bicarbonate *most common+ o& acetate, "hich is metaboi;ed to
&orm bicarbonate. 5he anticoag%ant he$arin is administered to 'ee$ bood
&rom cotting in the dia!sis circ%it. Ceansed bood is ret%rned to the bod!. 2!
the end o& the dia!sis treatment, man! "aste $rod%cts ha#e been remo#ed,
the eectro!te baance has been restored to norma, and the b%&&er s!stem has
been re$enished.
5here are three t!$es o& hemodia!sis0 con#entiona hemodia!sis, dai!
hemodia!sis, and noct%rna hemodia!sis.
+. ,on)entional hemodial&sis
5he $roced%re o& con#entiona hemodia!sis are0 $atients attached to a
dia!sis machine< the &%nction o& a dia!sis machine is to $%sh bood to circ%ate
thro%gh the $atient-s bod! and machine, at the same time, monitor
tem$erat%re, bood $ress%re and time o& the $roced%re< i& $atient is %sing
&ist%a or gra&t, t"o h%ge-gate needes on $atients- side0 one brings "astes- &%
bood &rom $atients- bod! to the dia!;er, "hie another neede carries cean
bood bac' to the bod!< it is o&&ered three times a "ee' and 3 or 4 ho%rs $er
session. Patients are re3%ired to &oo" their rigid sched%e.
-. Dail& hemodial&sis
5he $roced%re o& dai! hemodia!sis is simiar to the con#entiona
hemodia!sis e4ce$t it is $er&ormed si4 da!s a "ee' and abo%t 2 ho%rs $er
session.
.. Noct$nal hemodial&sis
5he $roced%re o& noct%rna hemodia!sis is simiar to con#entiona
hemodia!sis e4ce$t it is $er&ormed si4 nights a "ee' and si4-ten ho%rs $er
session "hie the $atient see$s.
A ne#h$olog& n$se shold #e$fo$m/
Hemodialysis Vascular Access: Assess the &ist%a=gra&t and arm
be&ore, a&ter each dia!sis or e#er! shi&t0 the access &o", com$ications Assess
the com$ication o& centra #eno%s catheter0 the ti$ $acement, e4it site,
com$ications doc%ment and noti&! a$$ro$riate heath care $ro#ider regarding
an! concerns. 8d%cates the $atient "ith a$$ro$riate ceaning o& &ist%a=gra&t
and e4it site< "ith recogni;ing and re$orting signs and s!m$toms o& in&ection
and com$ication.
Hemodialysis adequacy: Assesses $atient constant! &or signs and
s!m$toms o& inade3%ate dia!sis. Assesses $ossibe ca%ses o& inade3%ate
dia!sis. 8d%cating $atients the im$ortance o& recei#ing ade3%ate dia!sis.
Hemodialysis treatment and complications: Per&orms head to toe
$h!sica assessment be&ore, d%ring and a&ter hemodia!sis regarding
com$ications and access-s sec%rit!. Con&irm and dei#er dia!sis $rescri$tion
a&ter re#ie" most %$date ab res%ts. Address an! concerns o& the $atient and
ed%cate $atient "hen recogni;ing the earning ga$.
Medication management and infection control
practice: Coaborate "ith the $atient to de#eo$ a medication regimen. 7oo"
in&ection contro g%ideines as $er %nit $rotoco.