Page 392 - Critical Care Nursing Demystified

Chapter 8 CARE OF THE PATIENT WITH CRITICAL RENAL NEEDS 377

Once the access site has been inserted and HD has begun, it requires team-
work between the critical care nurse and the HD nurse to care for the patient.
During dialysis the nurse will be observing for possible complications related
to HD. These include
Monitoring the patient for hypotension, which is caused by removal of blood
from the body and can lead to shock and/or clotting of the access site.
Observing/documenting the cardiac rhythm, which can change if electrolyte
disturbances, especially potassium, occur.
Monitoring the site and VS for external or internal bleeding. Signs/symptoms
can include hypotension; tachycardia; tachypnea; cool, clammy skin; and
changes in the level of consciousness. Heparin is used during the procedure,
which could lead to bleeding.
Observing the patient during and after dialysis for disequilibrium syndrome,
which can include headache and twitching, which can lead to seizures,
nausea, and vomiting. This is caused by rapid shifts in fluid and electrolytes.
The physician needs to be notified immediately.

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Teaching the patient and significant others about the equipment, procedure,
access site care, and complications that could occur.

Peritoneal Dialysis (PD)

Peritoneal dialysis (PD) allows the removal of fluid and waste products with the use
of the peritoneal cavity as the filter. The principles of diffusion and osmosis come
into play in this type of dialysis. Diffusion allows substances of high concentration
to move to lower concentration across a semipermeable membrane. In this case the
semipermeable membrane is the gut, which removes urea and electrolytes.
Osmosis is the movement of fluid from areas of lower solute concentration
to areas of higher concentration; the water goes to salt principle. So diffusion
allows excess fluid to be drawn out by an osmotic gradient between the perito-
neum and the dialyzing fluid.
PD can be used temporarily before an AV fistula or graft can be placed. It is easy
to teach, which is why some patients prefer this method of dialysis. It is not as
expensive and does not require the special training that restricts HD. The patient
must have an intact abdominal cavity free from adhesions or surgery; however, it is
slower than HD and therefore is not the treatment of choice in an emergency. Since
it is slower, it poses fewer risks than HD. PD can be performed intermittently or
constantly depending on the amount of fluid and electrolytes to be removed.