Risk for Deficient Fluid Volume | Nursing Care Plan for Peritoneal Dialysis

Nursing diagnosis: risk for deficient Fluid Volume

Risk factors may include
Use of hypertonic dialysate with excessive removal of fluid from circulating volume

Possibly evidenced by
(Not applicable; presence of signs and symptoms establishes an actual diagnosis)

Desired Outcomes/Evaluation Criteria—Client Will
Systemic Toxin Clearance: Dialysis
Achieve desired alteration in fluid volume and weight with BP and electrolyte levels within acceptable range.
Experience no symptoms of dehydration.

Nursing intervention with rationale:
1. Maintain record of inflow and outflow volumes and individual and cumulative fluid balance.
Rationale: Provides information about the status of client’s loss or gain at the end of each exchange.

2. Adhere to schedule for draining dialysate from abdomen.
Rationale: Prolonged dwell times, especially when 4.5% glucose solution is used, may cause excessive fluid loss.

3. Weigh when abdomen is empty, following initial 6 to 10 runs, then as indicated.
Rationale: Detects rate of fluid removal by comparison with baseline body weight.

4. Monitor BP lying and sitting and pulse. Note level of jugular pulsation.
Rationale: Decreased BP, postural hypotension, and tachycardia are early signs of hypovolemia.

5. Note reports of dizziness, nausea, and increasing thirst.
Rationale: May indicate hypovolemia or hyperosmolar syndrome.

6. Inspect mucous membranes, evaluate skin turgor, peripheral pulses, and capillary refill.
Rationale: Dry mucous membranes, poor skin turgor, and diminished pulses and capillary refill are indicators of dehydration and need for increased intake or changes in strength of dialysate.

7. Monitor laboratory studies, as indicated, such as: Serum sodium and glucose levels
Rationale: Hypertonic solutions may cause hypernatremia by removing more water than sodium. In addition, dextrose may be absorbed from the dialysate, thereby elevating serum glucose.

8. Monitor laboratory studies, as indicated, such as: Serum potassium levels
Rationale: Hypokalemia may occur and can cause cardiac dysrhythmias.