Nursing Care for Patients with End Stage Renal Disease Having Peritonitis from Continuous Ambulatory Peritoneal Dialysis: A Study of Two Cases

Abstract

Background : Currently, the number of patients with chronic kidney disease (CKD) is increasing. Patients with continuous ambulatory peritoneal dialysis are high risk of peritoneal infection. This effect can lead to a lower quality of life.

Objective : To study of nursing care of continuous ambulatory peritoneal dialysis patient with bacterial infection.

Methods : This comparative study was conducted by using the data of two patients with end-stage renal failure having infected peritoneum from CAPD admitted at Male Department of Medicine 2, Samutprakarn Hospital from February to March 2020. The data of this study were collected from patient medical records, and interviewing patients and their relatives. The nursing diagnosis was indicated based on an assessment of 11 patterns of Gordon. Consequently, the nursing care plan, implementation, and evaluation were followed for caring. 

          Results : The results showed that two patients with end-stage chronic kidney disease undergoing peritoneal dialysis, who had peritoneal infection, had the same nursing problem: bacterial infection and spread rapidly in the abdomen. The patients have signs and symptoms; fever, abdominal pain, turbid dialysis solution, hypokalemia and pale etc.     There was adjusted the treatment plan by using the antibiotic for both injectable and mixed with last dialysis solution set of each day. However, in both these case studies, it was found that there were different degrees of severity of infectious complications and the difficulty of nursing practice depending on factors; The first patient had nutrition problems. The patient had nausea, vomit, and eat little food. The second patient was dyspnea from cardiovascular disease and poor blood sugar control from diabetes, including blurred vision. Thus, peritoneal dialysis was inefficiency.

Conclusion : This study revealed that patients with continuous ambulatory peritoneal dialysis were at high risk of peritoneal infection. The infection might affect the peritoneal fluid level and lead to fluid overload resulting in other complications. The nurse needs to have knowledge and skills to assess patients' symptoms and signs comprehensively and observe abnormal symptoms to provide nursing care to patients out of the crisis, reduce complications, and return to everyday life.