Using the semi-permeable membrane property of the peritoneum, a certain amount of physiological peritoneal dialysis fluid is instilled into the peritoneal cavity to remove metabolic waste and excess water from the body and correct electrolyte and acid-base imbalance through the principles of diffusion, convection and osmosis in order to maintain the stability of the body’s internal environment.
【Nursing problems
1. Pain: associated with improper temperature or pH of peritoneal dialysis fluid and peritoneal inflammation.
2. Potential complications: peritonitis, hypotension, abdominal bleeding.
3, lack of knowledge: lack of knowledge related to the disease.
4, anxiety: related to the threat to the individual’s health.
Observation points]
1. Observe whether there is blood and fluid oozing at the mouth of the tubing after placement, and whether the abdominal dialysis tubing is unobstructed.
2. Closely observe the color, ultrafiltration volume and properties of the dialysis fluid.
3.Observe the patient for complications such as peritonitis, hypotension and abdominal bleeding.
4.Observe whether there is abdominal pain and discomfort.
【Nursing measures
1.Pre-operative preparation
Understand the patient’s medical history and clinical characteristics, understand the patient’s renal function, water-electrolyte and acid-base balance disorders, understand the indications and complications, explain the purpose of peritoneal dialysis, operating procedures, intraoperative and postoperative complications to the patient and family members, relieve ideological concerns and fears, and obtain cooperation. Take temperature, pulse, respiration and blood pressure, do procaine skin test, clean and prepare the abdomen and pubic area before the operation, and prepare for dialysis.
2.Strictly implement aseptic operation
During the dialysis process, we must pay attention to the aseptic operation, which can effectively prevent complications such as bacterial peritonitis and infection at the exit of the catheter.
3.Care of dialysis process
Before using dialysis fluid, check carefully for turbidity, flocculence, leakage and factory date, add drugs to dialysis fluid according to medical prescription and heat it to 37.0℃, master the separation and connection methods of various connecting tubes, fix the catheter properly, prevent pulling and twisting the catheter, keep the patient’s bowels open and avoid coughing, prevent infection caused by trauma at the exit of the catheter, use disposable sterile breathable dressing, and if you need to use gauze, it should be used after each use. If gauze is used, disinfect the gauze before each use, do not touch the dialysis tubing orifice directly with your hands, strengthen the observation and evaluation of the dialysis tubing orifice: whether the skin has blood oozing, fluid leakage, redness and swelling, etc., and pay attention to the cleaning and disinfection of the catheter outlet. The speed of fluid intake during dialysis should not be too fast, controlled in about 3 min, the abdominal cavity stays for 4h, and then the dialysis fluid is drained out, and the fluid should not be discharged too fast to prevent the large omentum from flowing into the dialysis tubing with the fluid. Accurately record the time, volume and color of fluid in and out of the abdominal cavity each time, measure blood potassium, sodium, chloride, urea nitrogen, creatinine and blood gas analysis every 2 to 3 days, and do bacterial culture of dialysis fluid every 3 days.
4.Strengthen basic care
Keep the bedclothes tidy, do morning and evening care, oral and skin care, and turn and pat the back of patients who cannot take care of themselves and have difficulty moving regularly to prevent bed sores and unnecessary infections. Encourage patients to move appropriately after their condition improves to prevent complications.
1, pay attention to whether there is ooze, oozing blood and edema at the incision, change the medication once every 1 to 3 days and remove the sutures in 10 days, or you can seal the tube until the sutures are removed after the operation and then do abdominal dialysis.
2, postoperative semi-recumbent or sitting position, avoid coughing and vomiting to prevent drifting of the tube.
3, the room before dialysis with ultraviolet radiation for 30 minutes, twice a day; wipe the patient’s bed, table and other objects, and walls and floors with 2% Lysol solution; change the patient’s sheets and clothes, once a day; also pay attention to room ventilation, and place Lysol foot mats in front of the door.
4. closely observe the color and clarity of the dialysis fluid during dialysis, and send it for bacterial culture and drug sensitivity test regularly.
5, keep the drainage tube unobstructed, do not block the drainage tube with protein blocks or blood clots, if there is an obstruction, use 10 ml of saline for rapid injection, do not use a syringe to avoid aspiration of the large omentum into the microporous dialysis tube.
6, observe the ultrafiltration of the abdominal dialysis fluid, record in detail the amount of positive and negative ultrafiltration, and adjust the dialysis concentration in a timely manner.
7.Good care of dialysis tubing to prevent pulling or twisting.
8, do a good job of protective isolation, live in a single room, strict accompanying and visiting system to prevent cross-infection. Wash hands before entering the room and wear a good mask and hat.
9, do a good job of monitoring: daily weight, pulse, central venous pressure should be measured, accurate records of 24-hour in and out, critical patients do a good job of nursing records, should also record in detail the time of dialysis fluid each time in and out of the abdominal cavity, the volume of fluid, residence time, regular delivery of drainage fluid to do a variety of electrolyte and sugar checks, dialysis process to observe whether there is dehydration or water retention, high sodium, high sugar, low potassium, high potassium and other complication symptoms, timely inform the physician of timely adjustments.
10. Care of dialysis tubing: Before daily dialysis, the catheter and its skin outlet should be disinfected with complex iodine solution and covered with a dressing. Keep it clean and dry, and replace it immediately if it is wet. Carefully observe the dialysis tubing outlet for blood leakage, fluid leakage, redness and swelling, etc. If there is any of these conditions, treat accordingly. If the patient needs to take a shower, the dialysis tubing can be wrapped with plastic before showering, and the skin around it can be gently wiped dry after showering, then disinfected with complex iodine and rewrapped, but it is not advisable to take a tub bath to avoid peritonitis.
[Care of diet].
Give an easily digestible, high-calorie, high-vitamin diet. For those with poor appetite, appropriately increase the intake of tonic foods and supplement high-calorie diet with high bioeffective proteins such as milk, fresh eggs, beef, etc. The daily calorie intake should be more than 35kcal/kg body weight. High phosphorus diet should be avoided. For those with rapid weight gain, swelling or hypertension, water and sodium intake should be restricted. Increase exercise in moderation to promote appetite. For those who do not prefer animal protein and have weak digestive ability, it is advocated to eat soy-based foods.