TRIGGER 4: How do we assess Peggys ability to self-

care and carry out the requirements of peritoneal

dialysis? What are these/ and how do these impact on
an individuals life
I. Nutrition
a. What do you need to focus on in your
daily nutrition?
b. Can you make a list of your daily diet?
c. How much salt do you use in your
meals?
III. Exchange room
a. How and how often do you clean the
area where you perform your
exchanges?
b. Is there anyone else who comes into
the room during the exchanges?
c. Is it necessary to keep the dialysis
room clean and tidy?
d. What is most difficult for you during
the exchange?
II. Constipation
a. Do you have constipation?
b. What kinds of problems are due to
constipation?
c. What do you do when you get
constipated?
d. What should you do in order not to get
constipated?
IV. Peritonitis
a. What is peritonitis?
b. What are the signs of peritonitis?
c. What should you do if you get
peritonitis?
d. What should you do in order not to get
peritonitis?
V. Infections
a. When did your transfer set get
replaced?
b. What should be done if the transfer
set or the tips of the bags come in
contact with the floor?
c. How often should the transfer set be
replaced?
d. What should you use for catheter
dressing?
e. What are the signs of catheter exit site
infection?
f. How do you understand whether there
is a hernia or leakage from dialysate?
VII. Personal hygiene
a. How often do you take a bath?
b. How often do you wash your hands?
VI. Medications
a. Who measures your blood pressure?
b. Do you use i.v. injections? If so, who
gives them to you?
c. How do you calculate the amount of
fluid you will drink in a day?
d. What may be the reason if your fluid is
not completely discharged? What
should be done in this situation?
e. How do you understand if too much
fluid is accumulated in your body?
What should be done in this situation?
f. How many times and at what time do
you make exchanges?
VIII. Dialysis materials
a. How do you warm the solution bags if
you do not have a heater?
b. What are the favourable and
unfavourable aspects of the peritoneal
dialysis?
 The well-being
The repetition and frequency of dialysis procedure constantly reminds one of the
disease, favouring self-analysis that exaggerates physiological phenomena. Dietary
restrictions are perceived as the deprivation of the last pleasure" that patients keep.
Body Image
Issues like skin colour, body odour, loss of urinary function, internal arteriovenous
fistula or peritoneal catheter presence, scars, or abdominal distension help patients to
perceive their bodies negatively and with inferiority feeling. And these feelings will
limit the social and family relationships, encouraging introversion.
Autonomy
The frequency of dialysis (either HD or exchange sessions in PD) interferes and
limits the lifestyle of patients. On the other hand, inferiority feelings facilitate physical
deterioration, passivity, neglect, and dependency, often enhanced by the good-
intentioned help from patients family and social environment.
Mental Attitude
Anxiety is always in the background due to daily contact with the disease and the
risk of death. And that anxiety leads to distress, somatisation, obsessive attitudes,
depression, aggression, and so forth.
TRIGGER 5: What is the role of the community nurse
in this situation?
The community nurses role in this situation is to firstly build rapport and a
therapeutic relationship within the community and with individuals, especially Peggy in
this situation, to be able to gain trust. The nurse must be aware of any and all
disadvantages the community and Peggy face that may increase the risk of illness or
decrease their ability to access services and healthcare; in this case the nurse should
be aware and take into consideration that the nature of their remote community and
that they are isolated from multiple healthcare services and education that would
otherwise be available to those not living in a remote area. Also, Peggy is of Aboriginal
descent and has significant increases in the risk of multiple illnesses, including chronic
kidney disease and diabetes. (Treas & Wilkinson, 2014)

The community nurses role is to educate the community in regards to health

promotion and preventative strategies and to provide nursing and first aid care given
the need arises. In this situation, the community nurse should educate Peggy on
strategies to monitor and manage her DMT2 and her dialysis. This could include
common symptoms for her Tenckhoff catheter, how to properly care for and use the
catheter and foods to eat and avoid in her diet to make sure her glucose levels remain
stable. (Rosdahl & Kowalski, 2012)
REFERENCES

Moreiras-Plaz, M., Blanco-Garca, R., Cossio-Aranibar, C.R., & Rodriguez-Goyanes, G.

(2011). Assessment of health related quality of life: The cinderella of peritoneal
dialysis? International Journal of Nephrology, 2011(2011), 8. doi:
10.4061/2011/528685
Muntean, A., Tomita, M., & Ungureanu, R. (2013). The role of the community nurse in
promoting health and human dignity. Iran Journal Public Health, 42(10), 1077-
1084. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4436534/

Ozturk, S., Yucel, L., Guvenc, S., Ekiz, S., & Kazancioglu, R. (2009). Assessing and training
patients on peritoneal dialysis in their own homes can influence better
practice. Journal of Renal Care, 35(3), 141-146. doi: 10.1111/j.1755-
6686.2009.00089.x