A patient on continuous ambulatory peritoneal dialysis (CAPD) reports that the dialysate fluid is not draining properly. What is the nurse's initial action?

1. A

   Push the catheter further into the abdomen.

2. B

   Administer a diuretic as prescribed.

3. C

   Turn the patient from side to side.

4. D

   Increase the height of the dialysate bag.

Appeared in: HPSSC - 2015

Explanation

• The most common cause of poor dialysate drainage is the catheter tip being obstructed by the omentum or bowel.
• Turning the patient from side to side is a simple, non-invasive maneuver that can reposition the catheter tip and relieve the obstruction.
• This action is considered the first-line intervention because it is safe, effective, and directly addresses the most likely mechanical problem.
• Other positioning changes, like raising the head of the bed or having the patient stand, can also be effective.

Why Other Options Were Wrong

• Option A: Pushing the catheter is an invasive and dangerous procedure that is outside the nursing scope of practice. It carries a high risk of perforating the bowel or other abdominal organs.
• Option B: Diuretics act on the kidneys to increase urine production. They do not influence the mechanical process of draining fluid from the peritoneal cavity.
• Option D: Increasing the height of the dialysate bag facilitates the inflow of dialysate into the abdomen by increasing gravitational pressure. For drainage (outflow), the bag must be placed lower than the patient's abdomen.

Related Visual

Clinical Relevance

• Nursing practice connection: Use the key finding related to Troubleshooting complications in Continuous Ambulatory Peritoneal Dialysis (CAPD) to guide bedside assessment, documentation, and the next nursing action.
• Nurses play a critical role in managing patients on peritoneal dialysis, which includes troubleshooting common problems like poor drainage.
• Patient safety is paramount. Nurses must recognize contraindicated actions, such as manipulating the catheter, which can cause serious harm like peritonitis or organ perforation.
• What if? - If turning the patient from side to side does not resolve the drainage issue, the nurse's next action should be to check the tubing for kinks and ensure all clamps are open. If the problem persists, assessing for constipation and notifying the nephrology provider is necessary.

How to Approach the Question

• First, identify the question type. This is a clinical scenario asking for the best initial nursing action (a priority-based question).
• Analyze the core problem: The dialysate in a CAPD system is not draining. Understand that CAPD drainage relies on gravity.
• Recall the common causes of poor drainage: catheter malposition/obstruction, tubing kinks, fibrin clots, and constipation.
• Evaluate each option based on safety, invasiveness, and physiological principles.
• Eliminate Option A (pushing catheter) as it is dangerous and outside the nursing scope.
• Eliminate Option B (diuretic) as it is physiologically irrelevant to peritoneal drainage.

Concept Tested & Keywords

• Concept Tested: Troubleshooting complications in Continuous Ambulatory Peritoneal Dialysis (CAPD).
• Stem keywords: continuous ambulatory peritoneal dialysis (CAPD), dialysate fluid not draining, nurse's initial action
• Lead-in keywords: initial action

Question ID

QSz_0sZYCmHAAXaya9KN41

Copy ID

Reference Book

E6 Ghai Essential Pediatrics(pp 26-904 of 913) p. 783-785