Patient has chronic kidney disease. He has been advised continuous ambulatory peritoneal dialysis (CAPD). Where it should be done?

Appeared in: NCL (MP) Nursing Officer - 2020

Explanation

Continuous Ambulatory Peritoneal Dialysis (CAPD) is a type of renal replacement therapy specifically designed to be performed by the patient or a caregiver in a home setting.
The term 'ambulatory' signifies that the patient can walk around and perform normal daily activities while the dialysis solution (dialysate) is dwelling in their abdomen.
Patients undergo a short training period in a hospital or dialysis center to learn the sterile technique for exchanges before transitioning to independent home care.
This method provides greater flexibility and autonomy compared to facility-based hemodialysis.

Option A: This is incorrect because CAPD's primary advantage is that it is a home-based therapy. Requiring it to be done in a hospital would negate its purpose of providing patient autonomy and flexibility.
Option B: While a hospital is involved initially for catheter placement and training, the ongoing, routine dialysis exchanges are not performed in a hospital. This would be inefficient and defeats the purpose of CAPD.
Option D: This option is incorrect because the primary and intended location for routine CAPD is the home. Options A and B describe settings for initiation, training, or complication management, not the standard procedure.

Clinical Relevance

Nursing practice connection: Use the key finding related to The appropriate setting for performing Continuous Ambulatory Peritoneal Dialysis (CAPD) to guide bedside assessment, documentation, and the next nursing action.
Nurses are central to patient and family education for CAPD, focusing on strict aseptic technique to prevent the most common and serious complication: peritonitis.
Key nursing assessments include monitoring the patient's weight, blood pressure, and fluid balance, as well as inspecting the catheter exit site for signs of infection.
Recognizing the early signs of peritonitis (cloudy effluent, abdominal pain, fever) and instructing the patient to seek immediate medical attention is a critical patient safety role for nurses.

How to Approach the Question

First, identify the key terms in the question: 'Continuous Ambulatory Peritoneal Dialysis (CAPD)' and 'Where it should be done?'.
Analyze the meaning of 'Ambulatory'. This word implies the ability to walk or move around, which strongly suggests the therapy is not confined to a fixed, institutional setting like a hospital.
Recall the fundamental differences between major dialysis modalities. Hemodialysis is typically facility-based, whereas peritoneal dialysis is designed for home administration.
Evaluate the options based on this understanding. 'Only in well equipped hospital' and 'In any hospital' contradict the 'ambulatory' and home-based nature of CAPD.
Conclude that 'At home' is the only option that aligns with the design, purpose, and primary advantage of CAPD.

Concept Tested & Keywords

Concept Tested: The appropriate setting for performing Continuous Ambulatory Peritoneal Dialysis (CAPD).
Stem keywords: chronic kidney disease, continuous ambulatory peritoneal dialysis, CAPD
Lead-in keywords: Where it should be done
Negative lead-in flag: false

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E6 Medicine Davidson Principles Practice 24e p. 444-446

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