Management of Peritoneal Dialysis - Essay Example

Management of Peritoneal Dialysis Name Institution Date Management of Peritoneal Dialysis Peritoneal dialysis (PD) is normally regarded as a first-choice of treatment for end-stage renal disease (ESRD) for patients that live in remote regions. The benefits of peritoneal dialysis over haemodialysis are that in peritoneal dialysis, there is longer preservation of residual kidney function, patients get more independence, and patients get a higher opportunity of returning home quickly. In Australia, Indigenous individuals suffer end-phase kidney failure at unreasonably greater rates compared to the general population (Gray et al, 2012). Since many Indigenous people reside in remote communities, peritoneal dialysis units’ task is to make sure that successful establishment and maintenance of programs of peritoneal dialysis in the outback. This paper discusses the management of peritoneal dialysis in the remote communities with respect to the scenario provided. In PD, the abdomen is loaded with sterile solution of dialysis and blood is filtered via the peritoneal membrane that covers the organs of abdominal cavity like the liver, stomach and intestines. The solution of dialysis is entails a kind of sugar (dextrose or glucose) that takes up extra fluid and waste products from the blood, via the peritoneal membrane as well as into the solution. After some hours, the used solution that contains the extra fluid and waste product is removed from the body and substituted with fresh solution (Gray et al, 2013). The procedure is referred to as an exchange, and involves almost 30 to 45 minutes. During the exchanges, the patient is allowed to carry out his or her normal activities. PD can either be done by the patient in the course of the day (continuous ambulatory peritoneal dialysis (CAPD), normally three or four times, or done at night by an automated machine for around eight to ten hours when the patient is asleep (automated peritoneal dialysis (APD). Since the basic equipment is portable, PD can be done almost anywhere, and the procedure can be performed without assistance (Gray et al, 2013). The prevalence of PD in Australia has dropped from 27 percent in 2000 to 21 percent in 2009. On the other hand, PD’s uptake among patients on dialysis living in remote region of Australia and United States of America, and Canadians that live not less than 50km from the nephrologist, has been indicated to be greater than people living in urban regions (Cerasa, 2011). In Australia, peritonitis, mortality and technique failure have been indicated to be greater among rural living Aboriginal PD patients compared to those living in urban areas (Gray et al, 2013). Different peritonitis’ management practices for patients that live far from the treating centre have been reported as well. Treatment of dialysis can only replace a number of kidneys’ functions. Considerable pharmaceutical regimes are needed to some extent carry out the hormone as well as other homeostatic roles of the kidneys (Maripuri et al, 2012). Frequent physical complaints established by dialysis patients involve joint and bone aches, stomach upsets, coughing, headaches, sleep disturbances, poor concentration, dizziness and cramps. This blend of physical complaints and time demands for people on dialysis can result in major changes in economic and social participation, and considerable home life disruption (Tracey et al, 2013). It can be difficult to monitor treatment of PD in remote areas because most patients can fail to comply with regime of treatment. Others can find it difficult to access health care services in case of any arising issue due to location or means of transport. Health outcomes seem to be poorer in regions outside the major cities and there are evident differences in use of health service between areas. On the other hand, it is not presently possible to allot the normally poorer outcomes of health outside leading cities to access as well as treatment, risk factor or environment issues. It is possible that all these three have a part to play (AIHW, 2008). Patients that require CAPD must have sufficient skills and knowledge to allow them to perform home treatment without the CAPD team’s direct supervision. The nephrologist has the responsibility of prescribing dialysis therapy and is also responsible for the general patient’s care (Gray et al, 2013). On the other hand, the CAPD nurse in the community has the responsibility of care of delivering the right prescription of dialysis and educating the patient or family to carry out their dialysis safely (Maripuri et al, 2012). Evidently, in Australia, nephrology nurses have embraced this challenged enthusiastically and willingly. As a CAPD nurse, one of the leading rewards is teaching an individual with ESRD, how to do his or her CAPD effectively and safely. On the contrary, nephrology nurses are frequently disappointed when a patient drops out of the CAPD program as a result of complications (Gray et al, 2013). Strong relationships involving the patient, nephrology nurse and their families are created in the course of education process and phase of home management responsible for the first CAPD education, and ongoing support and management on an outpatient basis (Lim et al, 2011). To realize good outcomes of PD, both training and experience of nephrologists and nurses is very essential. Co-operation from clients is highly recommended, but also facilitates a particular extent of autonomy in prescription adjustment of PD; hence patient education is a major issue (Maripuri et al, 2012). It is imperative that the patient is informed about the prevention of complications as most of the complications may have devastating outcomes on the patient, society and health care system at large. The leading complication of PD is peritonitis. Organisms can either be introduced via the catheter leading to sterile technique’s lapses; through catheter’s colonization; or as a result of bowel disease. PD peritonitis normally manifests with abdominal pain of unpredictable severity, cloudy peritoneal waste matter, and fever (Gray et al, 2013). Hospital investigation is compulsory to facilitate accurate organism identification and initiation of suitable intraperitoneal antibiotics. Another complication is fluid imbalance since the capacity of patients with renal failure to excrete fluid load is decreased or absent. One of the leading complications with a Tenckhoff catheter’s presence within the region of peritoneum is infection around the exit site, where the catheter exists from the patient’s skin (Lim et al, 2011). This is virtually always with organisms of skin where Staph aureus is the most significant. The threat with this kind of infection is that it can spread down the tunnel where the catheter inhabits in to the peritoneum generating severe peritonitis. That is why; all patients that have an exit site infection need to be observed on PD Unit within twenty hour hours. Practices to reduce risk of infection in patients with PD include proper placement of catheter, care of exit-site that entails Staph aureus prophylaxis, cautious training of patients with cyclic retraining, contamination’s treatment, and prevention of fungal and procedure-related peritonitis (Gray et al, 2013). Other method of preventing infection include daily cleaning of the site with antiseptic, and washing hands each moment the catheter is touched (Gray et al, 2013). In renal patients, fluid overload can bring about hypertension. There is normally no response to diuretics, and the right treatment is removal of fluid through dialysis. Depletion of fluid is less common although may be generated by over-vigorous removal of fluid in the course of dialysis or through vomiting or intercurrent diarrhea. It normally manifests with symptomatic postural hypotension and with weakness and nausea (Gray et al, 2013). Treatment is through administration of water and salt, either intravenously or orally depending on its severity, coupled with underlying cause’s attention. Another complication that needs to be prevented is hypertension. In a number of patients, blood pressure is still high regardless of the adequate removal of fluid. Hence, antihypertensive medication should be administered (Lim et al, 2011). PD patients need to be trained for home management of dialysis. During the period of training they are comprehensively prepared in the methods needed to support themselves while at home with PD. Even though the vast mainstream of patients is basically trained to be independent with treatment their families and carers are encouraged to accompany them and see what PD involves (Gray et al, 2013). PD is an effective method of maintaining patients within the community with ESRF who would on the other hand depend on hospital haemodialysis. It provides flexibility and independence to patients. Nephrology nurses are considered to be integral to PD programs’ development and success both within hospital and community setting (Maripuri et al, 2012). The nurse has the role of individual tailoring of education program of PD to suit various learning styles as well as developing methods that make the experience of PD a success. Nursing has a considerable role in allowing for fairness in health care and improved services’ access and outcomes of health care. The wide scope of the responsibility and its application in remote and rural communities past the acute setting has been earlier acknowledged and needs full use of nurses’ role (Gray et al, 2013). While the roles of nursing in rural regions seem to be generalist, a raised number of nurse practitioners (NPs) that work in remote regions is needed (Taylor, 2011). Indigenous individuals and communities get support of medication management, dialysis and education, diet, and support with transport and accommodation needs to make sure that patients get treatments or attend clinics (Gray et al, 2013). Nurses posses unique set of skills which facilitates the provision of variety of services that support every patient across the continuum of care. Effective management is strengthened through strong relationships that involve providers and patients, defined by trust and good communication (Gray et al, 2013). Most patients get nutritional deficit hence some of the nursing interventions that will be beneficial to the patient in the case study include and not limited to monitoring fluid and food ingested hence calculating daily intake of calories. The rationale is to identify nutritional deficits as well as therapy needs that are extremely variable, with respect to client’s renal disease stage, age, other coexisting conditions, and the kind of dialysis (Dirksen, 2011). It is essential to recommend the client to keep a diary of food, including approximation of ingested protein, calories, and electrolytes of individual interest such as chloride, magnesium, potassium, phosphorus, and sodium. The rationale is to help the client realize the opportunity of changing dietary preferences to meet individual wishes within established restriction (Ignatavicus & Workman, 2010). The patient should be encouraged to take part in menu planning because this is likely to increase oral intake as well as promote a sense of control. Small regular means should be encouraged as smaller portions can enhance intake. The kind of dialysis influences patterns of meals; for example, those receiving hemodialysis may not be directly fed during or before the procedure as this can interfere with removal of fluid, and patients with PD may not be able to ingest food while there is distension of the abdomen with dialysate (Ignatavicus & Workman, 2010). Use of spices and herbs like pepper, lemon, garlic, parsley, and onion should be encouraged because there is addition of zest to food to help decrease boredom with diet, at the same time as decreasing possibility of ingesting a lot of sodium and potassium. Since CAPD’s introduction in Australia, nephrology nurses’ contribution within renal management team remains principally invisible. These nurses demonstrate considerable ability, skills, and knowledge to equip patients to carry out their dialysis independently and safely (Gray et al, 2013). Nurses ought to continue being proactive in their nursing practice so that other renal team members, including, nephrologists can largely acknowledge nurses contribution in making the CAPD program a success. The success of PD programs in remote areas depends on several elements, most significantly an incorporated approach to care by every member of the team of PD (Tracey et al, 2013). The team of PD not only includes the health professionals, it also includes patients, families, communities as well as other support individuals. Careful communication, readiness to participate, friendliness and delivering supplies and care are important ingredients of winning a CAPD programs. Without all these ingredients, dialysis in the bush is likely to fail. Reference AIHW (Australian Institute of Health and Welfare) (2008). Rural, regional and remote health: indicators of health system performance. Rural health series no. 10. Cat. no. PHE 103. Canberra: AIHW. Tracey, K., Cossich, T., Bennett, P.N., Wright, S., & Ockerby, C. (2013). A nurse-managed kidney disease program in regional and remote Australia. Renal Society of Australasia Journal, 9(1), 28-34. Cerasa, D. (2011). Australian health care: Closing the service gap. Nursing Management, 18(8), 16–19 Gray, N. A., Dent, H. & McDonald, S. P. (2012). Renal replacement therapy in rural and urban Australia. Nephrol Dial Transplant, 27(5), 2069-2076 Lim, W. H., Boudville, N., McDonald, S. P., Gorham, G., Johnson, D. W. & Jose, M. (2011). Remote indigenous peritoneal dialysis patients have higher risk of peritonitis, technique failure, all-cause and peritonitis-related mortality. Nephrol Dial Transplant, 26:3366-3372. Maripuri, S., Arbogast, P., Ikizler, T. A. & Cavanaugh, K. L. (2012). Rural and micropolitan residence and mortality in patients on dialysis. Clin J Am Soc Nephrol, 7, 1121-1129. Gray, N. A., Grace, B. S. & McDonald, S. P. (2013). Peritoneal dialysis in rural Australia. 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