Dialysis refers to a way of blood cleansing when a person’s kidneys can no longer do that job. Dialysis helps in getting rid of the body’s wastes, extra water and salt and aids in controlling the blood pressure. Based on Mehrotra et al., (2016), peritoneal dialysis is one of the types of dialysis in the treatment of end- stage kidney failure whereby the inside lining of a person’s belly (peritoneum) acts as a natural filter. The body’s wastes are removed by a dialysate which is a cleansing fluid, which is washed in and out of the belly in cycles. A health care provider inserts a catheter in the belly through surgery a few weeks prior to peritoneal dialysis. When the treatment starts, dialysate is put in the belly through it from a bag. The fluid then leaves the body through the catheter after the completion of the filtering process. The dialysis solution absorbs extra fluid and salt from the body. There are two types of peritoneal dialysis which includes continuous ambulatory peritoneal dialysis and automated peritoneal dialysis (Mehrotra et al., 2016). This paper will focus on the roles of a nurse in facilitating the patient to cope and enhance self-management while also discussing the peritoneal dialysis self-care, depression and body image.
Research indicates that promotion of self- management improves the health status of patients on peritoneal dialysis, as they manage 90% or upwards of their personal care (Manera et al., 2019). Self- management refers to the actions the patients take in order to manage their disease and its treatment. It is essential for the patient to take care of the access area and catheter to prevent infection. According to Manera et al., (2019),the patients should ensure they follow up on their care which is a fundamental part of their safety and treatment. Patients should be sure to make and attend to all the appointments and call their doctor/ nurse in case of any problems. They should also know their test results and keep a list of the medicines they take.
Manera et al., (2019) stated that the nurse has a role in providing health education to the patient on how to take care of themselves. The information given should promote self care and knowledge regarding peritoneal disease. The patients should take care of the access and catheter even at home. They should keep the bandage area dry and clean and change it when it is dirty or bloody. The access area should be dry and clean and checked daily for signs of infection. The patient should wash their hands prior to touching the catheter. The patient should not use unapproved clamps on the catheter and never use sharp objects or scissors around the catheter. The nurse should advise the patient not to lift heavy objects and not swimming or taking a bath unless stated if it is okay by the doctor/ nurse. The nurse should inform the patient on when to call for help or seek immediate medical attention. For instance, if the patient notices sign of infection like increased swelling, pain and warmth or redness. Other signs include. Red streaks, draining of pus on the access area and fever. The nurse should empower the patients to provide self-care whereby the patients will feel that they have regained control of their bodies which will aid in the management of their disease.
Depression has been recognized as an independent risk factor for mortality in patients on peritoneal dialysis (Manera et al., 2017). Depression has been a frequent occurrence of psychiatric problem in peritoneal dialysis patients which reduces their social and physical functioning. Their adherence with the treatment regime also reduces significantly. The nurse should select the most suitable renal replacement therapy for the lifestyle and personality of the patient to reduce the onset of depression. the patient’s coping and adaptation can be influenced by the nurses’ attitudes and actions. The patients tend to worry about the cause of their hospitalization and the treatment and consequences hence require the most psychological care. So it is essential for the nurses to provide both technical care as well as emotional care to the patients. The nurses should form information groups where the patients attend the sessions. The groups will facilitate assurance, teaching and support, encouraging active treatment participation and the patient can ask questions.
According to Manera et al., (2017), body image is another effect that is brought by the dialysis access surgery. This can affect patient’s self-esteem and feelings of sexual attractiveness and desirability hence impinging on the existing or creating new relationships. The peritoneal dialysis catheter can cause problems on the body image. The abdomen acquires a round appearance and weight gain occurs from the high sugar contents of the dialysate which some patients may not like. The renal nurses have a fundamental role to play in preparing and educating the patients concerning the changes in the body image after a diagnosis of end stage renal disease (Manera et al., 2017). The nurses should recruit and consent patients on renal replacement therapy to participate in workshops employed as educational forums. The renal nurses can assist the clients to come in terms with their body image by permitting them space and the opportunity to express why them may feel dissimilar or need to separate themselves specifically to those that care about them the most.
Manera, K. E., Johnson, D. W., Craig, J. C., Shen, J. I., Ruiz, L., Wang, A. Y. M., … & Tong, A. (2019). Patient and caregiver priorities for outcomes in peritoneal dialysis: multinational nominal group technique study. Clinical Journal of the American Society of Nephrology, 14(1), 74-83. https://doi.org/10.2215/CJN.05380518
Manera, K. E., Tong, A., Craig, J. C., Brown, E. A., Brunier, G., Dong, J., … & Johnson, D. W. (2017). Standardized outcomes in Nephrology—Peritoneal dialysis (SONG-PD): study protocol for establishing a core outcome set in PD. Peritoneal Dialysis International, 37(6), 639-647. Retrieved from https://journals.sagepub.com/doi/abs/10.3747/pdi.2017.00022
Mehrotra, R., Devuyst, O., Davies, S. J., & Johnson, D. W. (2016). The current state of peritoneal dialysis. Journal of the American Society of Nephrology, 27(11), 3238-3252. https://doi.org/10.1681/ASN.2016010112
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