A client is diagnosed with chronic kidney disease and needs to begin dialysis. Which condition entered on the client’s medical record should the nurse recognize as a contraindication for peritoneal dialysis?
A.
Type 2 diabetes mellitus.
B.
Nephrotic syndrome history.
C.
Latent hepatitis C
D.
Crohn’s disease with colectomy
The correct answer and Explanation is :
The correct answer is D. Crohn’s disease with colectomy.
Explanation:
Peritoneal dialysis (PD) is a treatment option for patients with chronic kidney disease (CKD) that utilizes the peritoneal cavity to filter waste products from the blood. However, certain contraindications must be considered when evaluating a patient for this treatment.
Crohn’s disease, an inflammatory bowel disease, can affect the gastrointestinal tract, leading to complications that make PD risky. In patients with a history of Crohn’s disease, particularly if they have undergone colectomy, the peritoneum may be compromised. This condition can result in:
- Peritoneal Inflammation: Crohn’s disease can cause chronic inflammation in the abdominal cavity, leading to peritoneal irritation. This inflammation increases the risk of infection and may lead to peritonitis, a severe and often life-threatening infection that can occur when performing PD.
- Adhesions and Scar Tissue: A history of Crohn’s disease and surgical interventions (like colectomy) often result in abdominal adhesions. These adhesions can complicate the PD procedure by obstructing the flow of dialysis fluid or leading to ineffective dialysis.
- Risk of Complications: Patients with prior bowel surgeries may have altered anatomy, which can impact the placement of the PD catheter and increase the risk of complications such as catheter malfunction or leakage.
While other conditions listed—such as type 2 diabetes mellitus, nephrotic syndrome history, and latent hepatitis C—may pose certain risks during dialysis, they are not absolute contraindications for PD. Patients with diabetes can manage their blood sugar levels while on PD, and nephrotic syndrome may even benefit from this dialysis modality due to its ability to manage fluid overload.
In summary, due to the potential for significant complications related to Crohn’s disease and prior surgical interventions, PD is generally contraindicated in patients with this condition, making option D the most appropriate answer.