Textbook of Medical Surgical Nursing

Question: Discuss about the Textbook of Medical Surgical Nursing. Answer: Introduction: Sharon will undergo automated peritoneal diagnosis at home. It involves removing waste and excess fluid by using peritoneal membrane as a filter for the exchange of fluid and dissolved substances like urea, glucose, electrolytes, etc. Continuous cycling peritoneal dialysis (CCPD) takes shorter dwell time at night with one eight hour dwell time during and it promotes patient independence. Two priorities of care for Sharon includes. Reducing risk for infection: Sharon is at risk of contamination of catheter during insertion of bags and peritonitis. To minimize infection, nurses should be alert for signs of infection like cloudy drainage or elevated temperature. Cloudy drainage is an indication of peritoneal disease. It is necessary to maintain aseptic techniques such as wearing a mask during insertion of catheter and dressing changes. It will prevent entry of organism and avoid airborne contamination (Ma, 2016). Reduce pain in a patient: Peritoneal dialysis is associated with insertion of a catheter through the abdominal wall. It may cause pain and restlessness in the patient. The nurse should investigate the intensity and location of pain to determine appropriate intervention. Sharon should be made aware that her initial pain will subside after little exchange (Farrell DEMPSEY, 2010).Focus should be on preventing air from entering peritoneal cavity during infusion because it air entry irritates the diaphragm and leads to acute pain. The dialysate should be warmed to body temperature because cold dialysate causes vasoconstriction which causes discomfort and lowers the body temperature of the patient. To relieve pain and discomfort, an appropriate analgesic will be given to the patient (Hedayati, 2013). To ensure optimal health of Sharon, three types of nursing intervention in the community include Predialysis care: Community nurse will check the vital signs of Sharon such as body temperature, orthostatic blood pressure while lying, standing and sitting., respiration rate, and lung sounds. It will help in estimating fluid volume status and Sharon's level of tolerance for the procedure. It is important because the poor respiratory function will affect Sharon's ability to tolerate peritoneal dialysis and temperature check will prevent infection (O'Shaughnessy, 2014). Intradialysis care: Peritonitis is a common complication associated with peritoneal dialysis. The nurse should strictly follow aseptic technique to reduce the risk of peritonitis. They should add prescribed medication to the dialysate so that it flows freely into the abdominal cavity. Dialysate should remain in the abdomen for prescribed dwell time to maintain the exchange of solute and water between blood and dialysate. Signs of respiratory distress in a patient should be observed carefully. After dwell time, dialysate should be checked for clarity, color and odor to determine signs of infection or organ perforation (Yu et al., 2016). Post-dialysis care: All the vital signs of Sharon should be monitored again to determine the beneficial or adverse effects of the dialysis procedure. The timing of meal should be adjusted according to dialysis outflow. Sharon should be given meal when the abdomen is free from the dialysate. It enhances food intake and reduces nausea. The patient and their family should be informed about the procedure so that they can handle it themselves at home (Nadeau-Fredette et al., 2015). Three psychosocial issues in patient are: Depression: Dialysis has the serious impact on quality of life, social and economic well-being of the patient. Such patients suffer from depression, fear, anxiety, and irritation. Nurses should support such patients and get them involved in the process from the beginning. Once they are aware of ways to manage the procedure, their emotion distress will also reduce (Farrell DEMPSEY, 2010). Trouble in adjusting to dialysis procedure: Dialysis is a mentally disturbing procedure for individual undergoing it for the first time. First, they have to deal with the creation of arterio-venous fistula in the arm which is painful. Then going for multiple rounds of dialysis in a week has to affect their work life. It leads to a prolonged period of frustration. It leads to an outburst of anger sometimes on family members and sometimes on nurses. Nurses should give them knowledge about the disease and procedure to remove any confusion. They should be encouraged to express their feeling verbally so that they problem can be addressed and they can adjust to managing the procedure (Farrell DEMPSEY, 2010). Affect on patients self-esteem- Patient undergoing peritoneal dialysis cannot actively participate in sport and other social activities. This has a significant impact on their autonomy and self-esteem. It also has an impact on adherence to treatment options. The nurse should strengthen their belief system and make them believe that their illness is under control. Family support is also necessary to manage their medication and diet and motivate them to respond to treatment (Wang et al., 2014). People who have diabetes are at major risk of developing kidney failure. Diabetes mellitus is characterized by an increase in blood sugar level due to the inability of the body to make enough insulin. Insulin hormone regulates the amount of sugar in the blood, and insufficient production of insulin leads to high blood sugar level. The high amount of glucose in the blood damages the millions of tiny filtering units within the kidney. The kidney cannot purify blood properly. It leads to more water and salt retention in the body causing ankle swelling and weight gain. Protein is also found in the urine. Thus diabetes may lead to renal failure. Around 30% of people with diabetes develop kidney disease or diabetic nephropathy. A diabetic person is more susceptible to nephropathy if they cannot control their sugar levels (Reidy et al., 2014). Three medicines that Sharon is taking are Ramipril, Actrapid pen 100 units/ml, Captopril. The purpose of Ramipril- It is an ACE (Angiotensin Converting Enzyme) inhibitor used to treat high blood pressure or congestive heart failure. Sharon is taking this drug because she has a history of high blood pressure. High blood pressure is mostly seen in people with diabetes. The combination of hypertension and diabetes can be lethal for Sharon and may increase risk of heart attack (SHARMA, 2016). So Ramipril is essential for Sharon. The purpose of Captopril- It is also an ACE inhibitor drug used to treat high blood pressure, congestive heart failure and kidney problem caused by diabetes. Since Sharon suffers from renal failure, this drug is relevant for her to protect her kidneys. Captopril relaxes the blood vessels and allows the blood to flow smoothly (Prado et al., 2015). The purpose of Erythropoietin 60 units per week- It is given to Sharon because hse has renal failure and she has to undergo dialysis every week. She also had a right arm Arterio-Venous Fistula created for hemodialysis purpose. Erythropoietin is a growth factor that stimulates the production of red cells. It is necessary for Sharon because she has a chance of developing anemia due to renal failure. It is a better alternative for her than blood transfusions (Hrbrand et al., 2014). Reference Farrell, M. Dempsey, J. (2010).The Textbook of Medical-Surgical Nursing (3rd ed.). Hedayati, S. S. (2013). Improving symptoms of pain, erectile dysfunction, and depression in patients on dialysis.Clinical Journal of the American Society of Nephrology,8(1), 5-7. Hrbrand, F., Rottenkolber, D., Fischaleck, J., Hasford, J. (2014). Erythropoietin-induced treatment costs in patients suffering from renal anemiaa comparison between biosimilar and originator drugs.Das Gesundheitswesen,76(11), e79-e84. Ma, T. K. W., Chow, K. M., Kwan, B. C. H., Pang, W. F., Leung, C. B., Li, P. K. T., Szeto, C. C. (2016). Peritonitis before Peritoneal Dialysis Training: Analysis of Causative Organisms, Clinical Outcomes, Risk Factors, and Long-Term Consequences.Clinical Journal of the American Society of Nephrology, CJN-00830116. Nadeau-Fredette, A. C., Chan, C. T., Cho, Y., Hawley, C. M., Pascoe, E. M., Clayton, P. A., ... Johnson, D. W. (2015). Outcomes of integrated home dialysis care: a multi-centre, multi-national registry study.Nephrology Dialysis Transplantation,30(11), 1897-1904. O'Shaughnessy, M. (2014). Application of Dorothea Orem's theory of self-care to the elderly patient on peritoneal dialysis.Nephrology Nursing Journal,41(5), 495. Prado, M. A., Francisco, P., El Beck, M., Barros, M. (2015). Pharmacological Profile of Elderly Diabetics in Campinas, So Paulo, Brazil.International Journal of Epidemiology,44(suppl 1), i93-i94. Reidy, K., Kang, H. M., Hostetter, T., Susztak, K. (2014). Molecular mechanisms of diabetic kidney disease.The Journal of clinical investigation,124(6), 2333-2340. SHARMA, D. S. (2016). Drugs Used for the Cure of High Blood Pressure(Review).International Journal of Scientific Research,4(8). Wang, T. J., Lin, M. Y., Liang, S. Y., Wu, S. F. V., Tung, H. H., Tsay, S. L. (2014). Factors influencing peritoneal dialysis patients' psychosocial adjustment.Journal of clinical nursing,23(1-2), 82-90. Yu, Z. L., Seow, Y. Y., Seow, P. S., Tan, B. L. K. (2016). Effectiveness of a day care program in supporting patients on peritoneal dialysis and their caregivers.International urology and nephrology,48(5), 799-805.