Urinary Disorders Q 75

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The nurse is instructing a client with diabetes mellitus about peritoneal dialysis. The nurse tells the client that it is important to maintain the dwell time for the dialysis at the prescribed time because of the risk of:

  

    A. Infection

    B. Hyperglycemia

    C. Fluid overload

    D. Disequilibrium syndrome

    

    

Correct Answer: B. Hyperglycemia

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An extended dwell time increases the risk of hyperglycemia in the client with diabetes mellitus as a result of absorption of glucose from the dialysate and electrolyte changes. Diabetic clients may require extra insulin when receiving peritoneal dialysis. Hypertonicity in these hyperglycemic episodes is almost always due exclusively to glucose gain. A rare manifestation of severe hyperglycemia in subjects on dialysis is the development of pulmonary edema, which is corrected after correction of hyperglycemia with insulin.

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Option A: All dialysis treatments include a certain risk of infection because of the decreased immune defenses of patients in established renal failure (ERF) and because dialysis techniques increase the potential of microbial contamination. Peritoneal dialysis (PD), and in particular continuous ambulatory PD (CAPD), is associated with a high risk of infection of the peritoneum, subcutaneous tunnel, and catheter exit site.

Option C: Patients in PD with rapid peritoneal transport have reduced ultrafiltration, increased glucose absorption, and albumin loss in the dialysate. This phenomenon induces fluid overload, hypertension, dyslipidemia, and malnutrition, along with increased mortality.

Option D: The exact incidence of dialysis disequilibrium is not known, but seems to be decreasing since the early days of hemodialysis, most likely due to the fact that current patients are initiated on dialysis at much lower urea concentrations than previously. Measurement of urea in the blood and cerebrospinal fluid (CSF) showed that after hemodialysis treatment, there was a substantial gradient, with the urea concentration in the CSF being higher than that in the blood.

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