Caring for the orthopaedic patient receiving continuous ambulatory peritoneal dialysis

Providing nursing care for patients with End stage renal disease (ESRD) receiving continuous ambulatory peritoneal dialysis (CAPD) provides a variety of challenges for the orthopaedic nurse. In ESRD the kidneys not only lose the ability to remove waste products and excess fluids, but also are unable to assist the body to use active vitamin D3 for calcium absorption. ESRD patients are at a high risk for developing fractures due to the kidneys' inability to excrete phosphate, resulting in elevated plasma phosphate and low plasma calcium levels resulting in osteodystrophy. Patients conduct peritoneal dialysis treatments independently after receiving an in-depth education program. It is important for the nurse to continue to foster patients' independence by encouraging self-administration of CAPD even during hospitalization. CAPD is carried out manually by instilling dialysis solution into the peritoneal cavity usually four times daily to remove excess fluids and metabolic waste products. Orthopaedic nurses face the challenge of not only caring for the patient's orthopaedic injury but also ensuring CAPD is implemented correctly. This article outlines common problems experienced by ESRD patients, principles of CAPD, and expected nursing care.