Question

Joni Winters, a 64-year-old female client, is admitted with a fractured hip. She has chronic renal failure and has continuous peritoneal dialysis (CAPD) exchanges every 6 hours. The Tenckhoft peritoneal catheter site has redness and swelling which goes across the abdomen. The client states that her abdomen is tender to touch all over, and the nurse notes the abdomen is rigid. The bowel sounds are decreased, and the peritoneal dialysate is in the dwelling phase of the cycle. The vital signs are T, 101°F; BP, 140/90 mm Hg; HR, 110 beats/minute; RR, 28 breaths/minute. Answer each question below:

a. Why does the client have a rigid abdomen?

b. Why must the client's blood glucose be checked when they are receiving peritoneal dialysis?

c. The following lab values will have a change from normal if the peritoneal dialysis is missed for 3 consecutive days:

Potassium

Sodium

Magnesium,

Calcium,

Phosphorus.

For each of these electrolytes indicate if they will be increased or decrease.

Answer 1

Patient is a case of chronic renal failure on peritoneal dialysis

Now peritoneal catheter shows redness at catheter site and swelling across abdomen - this is suggestive of inflammation most probably secondary to some infection.

On examination patient has Abdominal tenderness with rigid abdomen- this is suggestive of peritonitis

Other signs like decrease bowel sounds, increase temprature, tachycardia, elevated BP , tachypnoea are all in favour of peritonitis

DIAGNOSIS - PERITONITIS

Coming to your specific Q

A Patient has rigid abdomen due to PERITONITIS

B. Patient tend to go under HYPOVOLEMIC events so blood glucose has to be checked during dialysis

C. All electrolyte will be derranged

Hyperkalemia

Hyponatremia

hypercalcemia

Magnesium and phosphorus are also.increaswd