Acute Pain | Nursing Diagnosis Peritoneal Dialysis

Nursing diagnosis: acute Pain related to insertion of catheter through abdominal wall, catheter irritation, improper catheter placement, irritation, infection within the peritoneal cavity, infusion of cold or acidic dialysate, abdominal distention, rapid infusion of dialysate

Possibly evidenced by
Reports of pain
Self-focusing
Guarding, distraction behaviors, restlessness

Desired Outcomes/Evaluation Criteria—Client Will
Pain Control
Verbalize decrease of pain and discomfort.
Demonstrate relaxed posture and facial expression; be able to sleep and rest appropriately.

Nursing intervention with rationale:
1. Investigate client’s reports of pain; note intensity (0 to 10), location, and precipitating factors.
Rationale: Assists in identification of source of pain and appropriate interventions.

2. Explain that initial discomfort usually subsides after the first few exchanges.
Rationale: Information may reduce anxiety and promote relaxation during procedure.

3. Monitor for pain that begins during inflow and continues during equilibration phase. Slow infusion rate, as indicated.
Rationale: Pain will occur if acidic dialysate causes chemical irritation of peritoneal membrane.

4. Note reports of discomfort that are most pronounced near the end of inflow, and instill no more than 2,000 mL of solution at a single time.
Rationale: Likely the result of abdominal distention from dialysate. Amount of infusion may have to be decreased initially.

5. Prevent air from entering peritoneal cavity during infusion. Note report of pain in area of shoulder blade.
Rationale: Inadvertent introduction of air into the abdomen irritates the diaphragm and results in referred pain to shoulder blade. This type of discomfort may also be reported during initiation of therapy or during infusions and usually is related to stretching or irritation of the diaphragm with abdominal distention. Smaller exchange volumes may be required until client adjusts.

6. Elevate head of bed at intervals. Turn client from side to side. Provide back care and tissue massage.
Rationale: Position changes and gentle massage may relieve abdominal and general muscle discomfort.

7. Warm dialysate to body temperature before infusing.
Rationale: Warming the solution increases the rate of urea removal by dilating peritoneal vessels. Cold dialysate causes vasoconstriction, which can cause discomfort and excessively lower the core body temperature, precipitating cardiac arrest.

8. Monitor for severe or continuous abdominal pain and temperature elevation, especially after dialysis has been discontinued.
Rationale: May indicate developing peritonitis.

9. Encourage use of relaxation techniques, such as deepbreathing exercises, guided imagery, and visualization. Provide diversional activities.
Rationale: Redirects attention and promotes sense of control.

10. Add sodium hydroxide to dialysate, if indicated.
Rationale: Occasionally used to alter pH if client is not tolerating acidic dialysate.