(精编)【持续性肾脏替代治疗CRRT英文精品课件】continuous renal replacement therapies.ppt

Physiological ComplicationsPERITONITIS Peritonitis is a serious, but manageable,complication of peritoneal dialysis. Signs of peritonitis include low-grade fever, abdominal pain when fluid is being inserted, and cloudy peritoneal drainage fluid. Early detection and treatment reduces the patient’s discomfort and prevents more serious complications. Treatment begins as soon as a sample of peritoneal fluid is obtained for culture and sensitivity. The patient is started on a broad-spectrum antibiotic, which is usually added to the dialysate solution, although it also can be given intravenously. Depending on the severity of the infection, the patient’s condition should improve dramatically after 8 hours of antibiotic therapy. CATHETER INFECTION During the daily dressing change, the nurse examines the exit site closely for signs of infection, such as tenderness, redness, and drainage around the catheter. In the absence of peritonitis, a catheter infection usually is treated with an oral, broad-spectrum antibiotic. Box 30-8 lists nursing interventions for preventing infections during peritoneal dialysis. HYPOTENSION Hypotension may occur if excessive fluid is removed. Vital signs are monitored frequently, especially if a hypertonic solution is used. Lying and sitting blood pressure readings are especially useful for evaluating fluid status. Progressive drops in blood pressure and weight are signs of fluid deficit. HYPERTENSION AND FLUID OVERLOAD If all the dialysate solution is not removed in each cycle, hypertension and fluid overload may occur. If there is hypertension and a weight increase, the nurse assesses catheter patency and notes the exact amount of fluid in the dialysate bottle. Some manufacturers add 50 mL to a 1,000-mL bottle. Over a period of hours, this can make a considerable difference The nurse also observes the patient for signs of respiratory distress and pulmonary congestion. In the absence of other symptoms of fluid