| 👀 Peritoneal Dialysis Care – Preparation before dialysis, monitoring during dialysis, post-dialysis care, and infection prevention. 👀 Hemodialysis Care – Checking vascular conditions before dialysis, monitoring vital signs during dialysis, post-dialysis bleeding prevention, patient lifestyle guidance, and AV fistula care education. 👀 Common Nursing Precautions – Infection prevention, complication management, and the importance of patient education. |
Continuous Ambulatory Peritoneal Dialysis (CAPD) Patient Care
Scenario Title: Holistic Peritoneal Dialysis Education and Practice with a CAPD Patient
Setting: Hospital outpatient dialysis education center
Characters:
- Nurse (RN) – Experienced dialysis nurse
- Mr. Kim (Patient) – Adult male receiving CAPD, practicing self-management at home
Phase 1: Before Peritoneal Dialysis
Mr. Kim: Nurse, I came today to review the peritoneal dialysis process once more. I’m getting more familiar with it, but I want to make sure I’m not missing anything.
Nurse: Mr. Kim, it’s always great to see you! I'm glad you're being proactive. You’re familiar with your dialysis schedule for today, right?
Mr. Kim: Yes, I do it four times a day, and I’ve been keeping the timing consistent.
Nurse: That’s very good. Maintaining a routine helps with better fluid and solute control. Do you remember the steps for exchanging the dialysis solution? Let’s go over everything again—from preparation to completion.
Mr. Kim: Yes, I always check the temperature of the solution in advance, and I follow the steps in order.
Nurse: Excellent! Did you weigh yourself this morning?
Mr. Kim: Yes, and there wasn’t much difference compared to yesterday.
Nurse: Perfect. Daily weight monitoring is essential for detecting fluid retention. How have you been practicing hand hygiene?
Mr. Kim: Before each dialysis, I wash my hands thoroughly with soap for at least 30 seconds. Sometimes I also use alcohol-based hand sanitizer.
Nurse: That’s wonderful. Good hand hygiene is key to infection prevention. Let’s now check your supplies and examine the dialysis solution bag together.
Mr. Kim: Okay.
Nurse: Please examine the expiration date, volume, glucose concentration, and clarity of the solution. Any abnormalities?
Mr. Kim: (Examining) The expiration date is valid, the volume and concentration match my prescription, and the solution is clear.
Nurse: Great. Also, are you disinfecting the insertion site daily?
Mr. Kim: Yes, and there’s been no redness or swelling.
Nurse: Good. Let’s inspect your catheter site. It looks secure—no signs of displacement or twisting. Keep up the great work maintaining the area.
Mr. Kim: Thank you. I try to be extra careful with hygiene.
Phase 2: During Peritoneal Dialysis
Nurse: Are you ready to begin your dialysis session for today?
Mr. Kim: Yes, I’ve prepared sterile gloves, the dialysis solution bag, and the drainage bag. I’ve also broken the inner seal of the dialysis solution bag.
Nurse: Great preparation. First, disinfect your workstation and practice hand hygiene.
Mr. Kim: (Washing and drying hands) Done. I’m putting on my sterile gloves now. (Puts them on)
Nurse: Excellent. Clamp both the infusion and drainage lines, then remove the rubber stopper from the solution bag.
Mr. Kim: (Removes the stopper) Like this?
Nurse: Yes, that’s correct. Next, remove the minicap from your catheter and connect it to the dialysis solution bag.
Mr. Kim: (Makes the connection) All connected.
Nurse: Now, hang the dialysis solution bag higher than the drainage bag to allow gravity to assist the flow.
Mr. Kim: (Adjusts position) Like this?
Nurse: Perfect. Open the drainage clamp and the regulator to start draining.
Mr. Kim: It’s draining. The color looks clear and there’s no odor.
Nurse: Excellent. When the flow stops and air bubbles appear, it means draining is complete. Close the drainage clamp and regulator. Next, flush the system by opening the green seal, and let the solution flow for five seconds into the drainage bag.
Mr. Kim: (Completes flushing) Done. I’ve clamped the drainage line.
Nurse: Good. Now let’s infuse the fresh solution. Open the infusion clamp and patient regulator to allow a slow, controlled flow. This should take 8 to 10 minutes.
Mr. Kim: (During infusion) My abdomen feels slightly bloated.
Nurse: That’s normal. As long as there’s no pain, it’s okay. Once infusion is complete, clamp the lines, disconnect the solution bag, and attach a new sterile minicap.
Mr. Kim: Done.
Nurse: You’re doing very well. Now let’s check the amount of drained fluid and record it.
Mr. Kim: It’s close to what I expected.
Nurse: Excellent. Let’s also check your vitals—your blood pressure, pulse, and temperature are all within normal range. Any discomfort?
Mr. Kim: No, everything went smoothly.
Phase 3: After Peritoneal Dialysis
Nurse: Let’s review the post-dialysis process. Did you document your infusion and drainage amounts?
Mr. Kim: Yes, and I recorded my weight before and after dialysis.
Nurse: Perfect. How was the drained fluid’s condition?
Mr. Kim: Clear and odorless.
Nurse: Good. Cloudiness or odor could indicate peritonitis. Always report such symptoms.
Mr. Kim: I understand.
Nurse: Let’s disinfect the insertion site now.
Mr. Kim: (Disinfecting) Done.
Nurse: Any redness, swelling, or pain at the site?
Mr. Kim: No issues today.
Nurse: Excellent. Let’s check the connectors. Ensure everything is intact and clean.
Mr. Kim: (Inspecting) Everything looks fine.
Nurse: Keep the catheter pointing downward to avoid kinks, and continue wearing your support belt daily. Also, avoid sharp objects near your catheter.
Mr. Kim: Yes, I’m always cautious.
Nurse: Let’s revisit key education points. Are you confident with the procedure?
Mr. Kim: Yes, and I always follow aseptic techniques.
Nurse: That’s great. If the dressing is wet or itchy, change it right away. Do you monitor your daily weight?
Mr. Kim: Yes, I’m consistent with that.
Nurse: Excellent. Also, stick to a low-sodium, low-potassium diet, and manage your fluid intake.
Mr. Kim: I’ve been following dietary guidelines closely.
Nurse: Stress management is also important. Stay emotionally balanced and communicate with your support system.
Mr. Kim: Yes, my family helps me a lot.
Nurse: You’ve done an outstanding job today. Continue this way, and remember to contact us if you notice any abnormal symptoms or catheter issues.
Mr. Kim: I will. Thank you so much for your support.
Nurse: You’re welcome, Mr. Kim. Stay healthy and feel free to reach out anytime!
Learning Objectives for Nurse Trainees:
- Understand and reinforce correct CAPD procedures.
- Practice patient education and motivational interviewing techniques.
- Identify signs of infection and complications such as peritonitis.
- Emphasize documentation, hygiene, and patient empowerment in self-care.
End of Scenario
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