Question about peritoneal dialysis and what the nurse should do

[buterflycf]

Hello can anyone help with this question. I did the math but now what? What does the fluid status mean? Thanks, I am new with dialysis, maybe one of you experts can answer?

The nurse is caring for a patient undergoing acute peritoneal dialysis. Below is the flow sheet listing the first five exchanges. What is the patient's fluid status at the end of the five exchanges? What does the nurse do next?

In OUt

2000 1825 8 am

2000 1970 8:45 am

2000 2240 9:30 am

2000 2180 10:15 am

2000 2250 11:00 am

[Hellllllo Nurse, BSN, RN]

The pt's fluid status is determined by the pt's assessment- s/s, not the numbers. But, by the numbers you have written, are you saying the pt absorbed fluid the first two exchanges?

[buterflycf]

yes, my teacher gave this to us and said for us to think about what it means. She wants to know what the nurse would be thinking about when she saw this. Isnt it normal that the patient retain some fluid in the beginning? Thanks for being so quick

[Hellllllo Nurse, BSN, RN]

In my experience, pts do not normally retain fluid in the beginning. If a pt's blood glucose is very high and a glucose dianeal solution is being used, sometimes the pt's blood osmolarity is greater than that of the dianeal, causing fluid to be absorbed into the pt's vasculatur, rather than removed.

So, it's important to know your pt's blood glucose levels and keep them under control. Also, the pt may need a stronger dianeal to pull more fluid. How do you think this would be determined?

[buterflycf]

would it be based on weight? Thanks!

[Hellllllo Nurse, BSN, RN]

Weight is part of it- also V/S. symptoms and assessment.

If a pt is heavy, hypertensive, has any edema, the nurse would use a stronger dianeal to pull more fluid off.

Is the pt is light, has poor turgor, skin is dry, low bp, nausea, dizzy when standing up- the nurse would use a weaker dianeal and encourage the pt to take in a little more po fluids or have IV fluids increased.