Medsurg- Renal
The nurse provides post-procedure teaching for a female client who had a cystoscopy as an outpatient. Which client statement indicates the need for additional instruction? 1. "I can expect pink-tinged urine for at least 24 hours."(3%) 2. "I can take a warm bath and acetaminophen if I have discomfort or bladder spasms."(23%) 3. "I should expect frequency and burning when I urinate."(24%) 4. "I should expect to see blood clots in my urine for up to 24 hours."(48%)
A cystoscopy is a procedure that uses a flexible fiber-optic scope inserted through the urethra into the urinary bladder with the client in the lithotomy position. Complications associated with cystoscopy include urinary retention, hemorrhage, and infection. Therefore, clients are instructed to notify the health care provider (HCP) immediately if they have bright red blood when urinating, blood clots, inability to urinate, fever >100.4 F (38 C) and chills, or abdominal pain unrelieved by analgesia. These conditions necessitate evaluation by the HCP and may require antibiotic therapy or the insertion of a urinary catheter to irrigate the bladder, remove clots, or drain the bladder (Option 4). (Options 1 and 3) Pink-tinged urine, frequency, and dysuria are expected for up to 48 hours following a cystoscopy. Clients are instructed to increase fluids, drink 4-6 glasses of water daily to help dilute the urine, and avoid alcohol and caffeine for 24-48 hours as these can irritate the bladder. (Option 2) Abdominal discomfort and bladder spasms may occur for up to 48 hours following the procedure. Clients are taught to take a mild analgesic (eg, acetaminophen, ibuprofen) and a warm tub/sitz bath (except with recurrent urinary tract infections) for pain relief.
A client who was discharged following a prostatectomy performed 6 days ago calls the clinic and reports passing some small blood clots and experiencing a decreased urinary stream. What is the nurse's best response? 1. "Please come to the clinic to be evaluated by the health care provider."(60%) 2. "Those symptoms are normal in the first week following surgery."(22%) 3. "Try to bear down as if having a bowel movement."(2%) 4. "You should increase your daily fluid intake."(14%)
A prostatectomy uses either minimally invasive or open surgical techniques to remove all or part of the prostate gland for clients with related disorders (eg, cancer, benign prostatic hyperplasia). For up to 36 hours after surgery, small blood clots may occur, although they should not impair the urine stream. Consistent passage of clots after this time could indicate a postoperative complication. Signs of such complications (eg, reduced urine stream, persistent bleeding/blood clots, urinary retention, fever, dysuria) after discharge should be evaluated by the health care provider for further treatment (Option 1). (Option 2) The presence of blood clots 6 days after surgery is not normal and may indicate bleeding from the prostatic fossa. This client requires further evaluation. (Option 3) Clients should avoid the Valsalva maneuver for up to 8 weeks after prostatectomy because the exerted pressure may injure the healing tissue, causing hematuria. (Option 4) Maintaining adequate fluid intake helps prevent blood clot formation. However, this client is reporting blood clots with a decreased urinary stream and needs further evaluation.
A 65-year-old client with end-stage renal disease comes to the emergency department after missing 5 hemodialysis sessions. Serum potassium level is 7.5 mEq/L (7.5 mmol/L) and ECG shows tall, peaked T waves. Which prescription will immediately protect the client from experiencing dysrhythmias associated with hyperkalemia? 1. Intravenous calcium gluconate(28%) 2. Intravenous regular insulin with dextrose(45%) 3. Oral sodium polystyrene sulfonate(15%) 4. Transport to hemodialysis unit(10%)
Hyperkalemia can be asymptomatic but may cause fatigue, generalized weakness, or in severe cases muscle paralysis and/or dysrhythmias. Management includes preventing life-threatening dysrhythmias and correcting serum potassium levels. Intravenous calcium gluconate is administered to hyperkalemic clients with ECG changes (eg, peaked T waves). Calcium gluconate itself does not decrease the serum potassium level but temporarily stabilizes the myocardium by raising the threshold for dysrhythmia occurrence. Once the nurse stabilizes the client by administering calcium gluconate, other prescriptions may then be implemented to decrease serum potassium level (eg, intravenous regular insulin with dextrose, sodium polystyrene sulfonate, hemodialysis) (Option 1). (Option 2) Intravenous regular insulin temporarily corrects hyperkalemia by shifting potassium into the cells. Dextrose is administered concurrently to prevent hypoglycemia. Although intravenous regular insulin will effectively decrease serum potassium levels, calcium gluconate will provide immediate protection from dysrhythmias. (Option 3) Sodium polystyrene sulfonate causes excretion of potassium from the body via the gastrointestinal tract. Although this will effectively decrease serum potassium levels, calcium gluconate will provide immediate protection from dysrhythmias. (Option 4) Although hemodialysis will effectively decrease serum potassium levels, calcium gluconate will provide immediate protection from dysrhythmias.
The nurse is preparing to administer morning medications to a client with type 2 diabetes mellitus and end-stage renal disease who is scheduled for dialysis today. Which medication should the nurse hold for clarification prior to administration? Click the exhibit button for more information. 1. Atenolol(53%) 2. Calcium acetate(17%) 3. Insulin lispro(18%) 4. Vitamin E(10%)
Medication administration may require modification on days that clients are scheduled to receive dialysis. The nurse should consider whether the medication will be dialyzed out of the client's system or may create adverse effects during dialysis. Fluid is removed during dialysis, which may cause hypotension. Typically, antihypertensives are held before dialysis to prevent hypotension. In addition, some medications are dialyzed out of the client's system and should therefore be held until after dialysis. Commonly held medications are water-soluble vitamins (eg, vitamins B and C), antibiotics, and digoxin. (Option 2) Clients with chronic kidney disease have high phosphorus levels as the kidney is unable to filter the phosphate from the body; dialysis also does not filter it. Therefore, the client should still take phosphate binders prior to dialysis. Phosphate binders (eg, calcium containing [calcium carbonate and calcium acetate]) and non-calcium containing [sevelamer and lanthanum]) block absorption of ingested phosphate from the intestine and excrete it through feces. (Option 3) Lispro is a fast-acting insulin that should be given 15-30 minutes before meals. It is appropriate to give scheduled lispro with breakfast prior to dialysis. (Option 4) Vitamin E is a fat-soluble vitamin that is not affected by dialysis. It is given to some clients to prevent leg cramps that can be experienced by dialysis clients.
The emergency department nurse cares for 5 clients. Which of the clients below are at risk for developing metabolic acidosis? Select all that apply. 1. 25-year-old client with claustrophobia who was stuck in an elevator for 2 hours 2. 36-year-old client with food poisoning and severe diarrhea for the past 3 days 3. 40-year-old client with 3-day history of chemotherapy-induced vomiting 4. 75-year-old client with pyelonephritis and hypotension 5. 82-year-old client due for hemodialysis with clotted arteriovenous shunt
Metabolic acidosis is due to an increase in the production or retention of acid or the depletion of bicarbonate via the kidneys or gastrointestinal (GI) tract. In metabolic acidosis there is a decrease in pH (<7.35) and HCO3- (<22 mEq [22 mmol/L]). Common causes of metabolic acidosis include: GI bicarbonate losses (eg, diarrhea) (Option 2) Ketoacidosis (eg, diabetes, alcoholism, starvation) Lactic acidosis (eg, sepsis, hypoperfusion) (Option 4) Renal failure (eg, hemodialysis with inaccessible arteriovenous shunt) (Option 5) Salicylate toxicity (Option 1) A client with claustrophobia who was stuck in an elevator is at risk for an anxiety attack, which leads to hyperventilation and respiratory alkalosis (pH >7.45, PaCO2 <35 mm Hg [4.66 kPa]). (Option 3) A client with excessive vomiting is at risk for metabolic alkalosis due to loss of stomach acid.
The nurse evaluates the results of laboratory tests completed on a client admitted for a non-healing wound. Which of the following values would be a priority for the nurse? 1. Blood urea nitrogen 15 mg/dL (5.4 mmol/L)(5%) 2. Serum albumin 3.7 g/dL (37 g/L)(29%) 3. Serum potassium 4.5 mEq/L (4.5 mmol/L)(1%) 4. Serum sodium 153 mEq/L (153 mmol/L)(63%)
Nutritional deficiencies (eg, zinc, protein, vitamin C) and dehydration can impair wound healing. Dehydration (loss of free water) can increase serum sodium levels. The normal value for serum sodium is 135-145 mEq/L (135-145 mmol/L). The value listed, 153 mEq/L (153 mmol/L), is high. Increased serum sodium level (hypernatremia) has an osmotic action that causes water to be pulled from the interstitial spaces into the vascular system. Remember that "water goes where salt is." This action decreases wound healing at a cellular level, reducing the nutrients cells need for repair. (Option 1) Normal blood urea nitrogen (BUN) values are 6-20 mg/dL (2.1-7.1 mmol/L). Elevated BUN may indicate dehydration and could impair wound healing. (Option 2) Malnutrition can impair wound healing. Serum albumin and prealbumin levels are obtained to assess nutritional status. The normal value for albumin is 3.5-5.0 g/dL (35-50 g/L). (Option 3) The normal value for serum potassium is 3.5-5.0 mEq/L (3.5-5.0 mmol/L).
The nurse is caring for a client with overflow urinary incontinence related to diabetic neuropathy. Which of the following interventions are appropriate? Select all that apply. 1. Decrease fluid intake to 1 glass with each meal and at bedtime 2. Encourage the client to bear down while attempting to void 3. Inspect the perineal area for evidence of skin breakdown 4. Measure postvoid residual volumes as prescribed 5. Tell the client to wait 30 seconds after voiding and then attempt to void again
Overflow urinary incontinence occurs due to compression of the urethra (eg, uterine prolapse, prostate enlargement) or impairment of the bladder muscle (eg, spinal cord injury, diabetic neuropathy, anticholinergic medications). Both types involve incomplete bladder emptying and urinary retention, which lead to overdistension and overfilling of the bladder and frequent involuntary dribbling of urine. When caring for clients with overflow incontinence, the nurse should: Implement a fixed voiding schedule (eg, every 2 hours) to prevent bladder overfilling. Instruct the client to use the Valsalva maneuver (ie, "bearing down") and Credé maneuver (ie, gently applying pressure to the lower abdomen) to help facilitate bladder emptying (Option 2). Assess the perineal area for skin breakdown related to incontinence (Option 3). Measure postvoid residual volumes as prescribed to ensure that the client is not retaining large amounts of urine (Option 4). Instruct the client to wait 20-30 seconds after voiding and then attempt to void a second time (ie, double voiding) to help empty residual urine (Option 5). (Option 1) Fluid restriction can lead to dehydration with concentrated urine, which irritates the bladder and increases the risk for urinary tract infection. Dehydration also contributes to constipation, which worsens incontinence by compressing the bladder.
The nurse is caring for a client whose peritoneal dialysis is beginning to exhibit insufficient outflow. What actions should the nurse perform initially? Select all that apply. 1. Assess for abdominal distention and constipation 2. Contact the client's health care provider 3. Examine the catheter for kinks and obstructions 4. Flush the tubing with 100 mL of dialysate 5. Place the client in a side-lying position
Peritoneal dialysis uses the abdominal lining (ie, peritoneum) as a semipermeable membrane to dialyze a client with insufficient renal function. A catheter is placed into the peritoneal cavity, and dialysate (ie, dialysis fluid) is infused. The tubing is clamped to allow the fluid to remain in the cavity, usually for 20-30 minutes (dwell phase). The catheter is then unclamped to allow dialysate to drain via gravity. Insufficient outflow results most often from constipation when distended intestines block the catheter's holes. If outflow becomes sluggish, the nurse should assess the client's bowel patterns and administer appropriate prescribed medications (eg, stool softeners) (Option 1). The nurse should also check the tubing for kinks and reposition the client to a side-lying position or assist with ambulation (Options 3 and 5). The drainage bag should be maintained below the abdomen to promote gravity flow. The nurse should assess for fibrin clots and milk the tubing to dislodge or administer fibrinolytics (eg, alteplase) as prescribed. If these measures are ineffective, an x-ray may be needed to check the catheter location. (Options 2 and 4) The nurse should identify the problem before instilling additional fluids and perform routine assistive measures before contacting the health care provider
A client diagnosed with end-stage renal disease comes to the dialysis clinic for treatment. Which actions should the nurse take to prepare the client for hemodialysis? Select all that apply. 1. Administer subcutaneous heparin to decrease clotting during dialysis 2. Administer the client's morning doses of carvedilol and lisinopril 3. Check the client's medical records to determine the last post-dialysis weight 4. Obtain a set of client vital signs and the client's current weight 5. Palpate the fistula in the client's arm for a thrill and auscultate for a bruit
Prior to dialysis treatment, the nurse should assess the client's fluid status (weight, blood pressure, peripheral edema, lung and heart sounds), vascular access (arteriovenous fistula, arteriovenous grafts), and vital signs (Option 4). The amount of fluid removed (ultrafiltration) is determined by calculating the difference between the last post-dialysis weight and the client's current pre-dialysis weight (Option 3). After the client is connected to the dialysis machine, IV heparin is added to the blood from the client to prevent clotting that can occur when blood contacts a foreign substance. Giving subcutaneous heparin prior to initiation is not necessary (Option 1). (Option 2) During dialysis, excess fluid is removed, making the client prone to hypotension. In addition, medications are removed from the blood during hemodialysis, making them ineffective. Many medications that are taken once daily can be held until after the dialysis treatment to prevent their removal. If blood pressure medications are given prior to dialysis, the client can develop hypotension during the dialysis and then uncontrolled hypertension (decreased drug concentrations). (Option 5) Arteriovenous fistulas are created by anastomosing an artery to a vein; a thrill can be felt when palpating the fistula, and a bruit can be heard during auscultation when the fistula is functioning properly.
Which nursing instruction is the highest priority when teaching a 38-year-old female client newly diagnosed with stress incontinence? 1. Coaching related to Kegel exercises(45%) 2. Importance of voiding every 2 hours(30%) 3. Minimizing caffeine and alcohol(19%) 4. Use of incontinence pads and pessary(4%)
The nursing care plan for a client experiencing stress incontinence includes pelvic floor exercises, bladder training, incontinence products, and lifestyle modifications. The highest priority for a client newly diagnosed with stress incontinence is preventing skin breakdown and urinary tract infections through bladder training. Teaching the client to empty the bladder every 2 hours when awake and every 4 hours at night reduces these risks (Option 2). Pelvic floor exercises (eg, Kegel exercises), which strengthen the sphincter and structural supports of the bladder, are an essential part of the teaching plan but are not the priority for this client (Option 1). It will take approximately 6 weeks for pelvic floor muscle strength to improve. Natural bladder irritants (eg, smoking, caffeine, alcohol) increase incontinence and should be eliminated but are not the priority in this client (Option 3). Pessaries relieve minor pelvic organ prolapse and may be used in some clients when initial conservative measures fail. This client should receive initial instruction on the importance of emptying the bladder often (Option 4).
Which health history information would be most important for the nurse to obtain when assessing a client with suspected bladder cancer who reports painless hematuria? 1. Family risk factors(31%) 2. Industrial chemical exposure(16%) 3. Tobacco use(45%) 4. Usual diet(6%)
The tell-tale symptom of bladder cancer, seen in >75% of cases, is painless hematuria; the client will report seeing blood in the urine with no associated pain. As with many other types of cancer, the primary cause of bladder cancer is cigarette smoking or other tobacco use (Option 3). Poorer outcomes are seen with increased length of time as a smoker and higher number of packs per day. (Option 1) Clients who have family members with bladder cancer have an increased risk of developing bladder cancer themselves; however, the primary risk factor is tobacco use. (Option 2) Occupational carcinogen exposure is the second most common risk factor. Occupational exposures include printing, iron and aluminum processing, industrial painting, metal work, machining, and mining. Clients are exposed to carcinogens through direct skin contact and inhalation (aerosols and vapors). (Option 4) Consuming a high-fat diet and using artificial sweeteners are risk factors for developing bladder cancer, but they are not the primary cause.
The nurse reinforces teaching about self-management strategies for a client with urge incontinence. Which of the following statements indicate that teaching has been effective? Select all that apply. 1. "I am going to join a walking program to lose excess weight." 2. "I may have dry mouth as a side effect from the oxybutynin." 3. "I really need caffeine to get myself going in the morning." 4. "I should perform Kegel exercises several times daily." 5. "I will void every 2 hours until I am having fewer accidents."
Urge incontinence (UI), also known as overactive bladder, occurs when the bladder contracts randomly, causing a strong, sudden urge to urinate that is followed by urine leakage. UI may occur without cause or may result from spinal cord injury and impairment of the bladder (eg, interstitial cystitis) or neurological system (eg, Parkinson disease, stroke). Interventions for clients with UI include: Loss of excess weight to reduce pressure on the pelvic floor (Option 1). Anticholinergic medications (eg, oxybutynin, tolterodine) to decrease bladder spasms. Dry mouth (xerostomia) is a frequent adverse effect (Option 2). Avoidance of bladder irritants (eg, artificial sweeteners, caffeine, citrus juices, alcohol, carbonated drinks, nicotine) (Option 3). Pelvic floor exercises (eg, Kegel) to strengthen the muscles and help prevent urinary leakage (Option 4). Bladder training (eg, voiding every 2 hours while awake) and gradually lengthening intervals between voiding (Option 5).
The nurse is caring for a 68-year-old male client following a laparoscopic cholecystectomy 8 hours ago. The client has not urinated since surgery. Which would be the most appropriate initial intervention? 1. Conduct a bladder scan(64%) 2. Help the client out of bed(29%) 3. Insert an indwelling catheter using sterile technique(2%) 4. Obtain a prescription for intermittent catheterization(3%)
Urinary retention occurs frequently after surgery due to administration of opioids (eg, morphine) and anesthesia, and in older men, who often have an enlarged prostate gland or benign prostatic hyperplasia (BPH). Up to 50% of men over age 60 have an enlarged prostate. Body position can also contribute to urinary retention. Most men are used to urinating when standing up; therefore, the nurse or assistive personnel should help the client out of bed rather than offer a urinal for use in bed (Option 2). Providing privacy may also aid in relaxation and urination. (Option 1) The second intervention should be a bladder scan. If the client is unable to urinate, an ultrasound scan can be used to noninvasively assess the volume of urine in the bladder. It can also be used to determine the residual bladder volume after the client has urinated to assess the amount of retention. (Option 3) An indwelling catheter is not currently indicated for this client. Catheter-associated urinary tract infection (CAUTI) is a significant hospital-acquired infection. The risk of CAUTI can be reduced by using an indwelling catheter only when other interventions have failed to produce desired outcomes. (Option 4) Intermittent catheterization would be the third intervention if the client has been unable to urinate or has significant urinary retention (>300-400 mL).
The nurse gathers a health history from a 58-year-old male client with acute urinary retention. Which of the following questions should the nurse ask to aid in assessing for benign prostatic hyperplasia? Select all that apply. 1. "Do you feel the need to urinate again immediately after urinating?" 2. "Do you have to strain to begin your stream of urine?" 3. "How often do you engage in sexual intercourse?" 4. "How often do you wake at night with the urge to urinate?" 5. "Is your stream of urine weak or intermittent?"
With increasing age (typically age >50), male clients experience hormone changes that can lead to prostate enlargement, known as benign prostatic hyperplasia (BPH). BPH is often not diagnosed until it begins to compress the surrounding bladder and urethra, causing voiding difficulties and abnormalities. Clients with BPH exhibit the following signs and symptoms: -Urinary retention -Sensation of incomplete emptying and/or increased urgency to void (Option 1) -Straining or difficulty initiating voiding (hesitancy) (Option 2) -Weak and/or intermittent stream of urine during voiding (Option 5) -Frequent voiding patterns throughout the day (eg, urinating more than once in 2 hours) and night (nocturia) (Option 4) (Option 3) Frequency of sexual intercourse is unrelated to urinary retention and BPH in the male client.
When a client diagnosed with acute urinary retention is emergently catheterized, the nurse should initially assess for which priority manifestation that may occur as a result of the catheterization? 1. Dysuria(10%) 2. Hypotension(34%) 3. Infection(47%) 4. Tachycardia(6%)
Acute urinary retention is best treated with rapid, complete bladder decompression rather than the intermittent urine drainage that is limited to 500 to 1000 mL at a time. Rapid decompression can be associated with hematuria, hypotension, and postobstructive diuresis (Option 2). However, these are rarely clinically significant if appropriate supportive care is administered, whereas inability to relieve the obstruction can be associated with infection and kidney injury (Option 3). (Option 1) Dysuria from catheterization can be treated with analgesics or antispasmodic medications. Maintaining perfusion and adequate blood pressure is the priority concern. (Option 4) With sudden release of bladder obstruction, cardiovascular autonomic activity occurs and the blood pressure and heart rate are reduced due to the excitation of the parasympathetic system.
A client with chronic kidney disease has blood laboratory results as shown in the exhibit. What is the best afternoon snack to provide to this client? Click on the exhibit button for additional information. 1. Apple slices with caramel dip(28%) 2. Chips and avocado dip(4%) 3. Nonfat yogurt with orange slices(46%) 4. Vanilla pudding with strawberries(20%)
Clients with chronic kidney disease (CKD) have decreased glomerular filtration, resulting in retention of fluid, potassium, and phosphorus. Fluid retention is initially treated with sodium restriction and diuretic therapy. Dietary adjustments should also be made to reduce serum potassium and phosphorus. Laboratory values are key to determining allowable foods. Dairy products (eg, milk, yogurt) and certain fruits (eg, bananas, oranges, coconuts, watermelons, and avocados) contain high potassium levels. Dairy products also contain high phosphorus levels. Examples of allowable foods for CKD clients include apples, pears, grapes, pineapple, blackberries, blueberries, and plums. (Option 2) Avocados are high in potassium; the chips may be high in sodium. (Options 3 and 4) Pudding and yogurt contain dairy products and are high in phosphorous and potassium. Oranges are high in potassium.
A client returns to the unit after receiving hemodialysis for the first time. The client vomits once, reports headache, and appears restless and disoriented. What is the priority intervention? 1. Administer antihypertensives that were held prior to dialysis(12%) 2. Administer PRN ondansetron to relieve nausea(12%) 3. Contact the health care provider(49%) 4. Place client in Trendelenburg position(26%)
Dialysis disequilibrium syndrome (DDS) is a rare but potentially life-threatening complication that can occur in clients during the initial stages of hemodialysis (HD); it can be prevented by slowing the rate of dialysis. During HD, solutes (ie, urea) are removed more quickly from the blood than from the brain cells and cerebrospinal fluid, creating a concentration gradient that can lead to excess fluid in the brain cells and increased intracranial pressure. Characteristic neurologic manifestations include nausea and vomiting, headache, restlessness, change in mentation, and seizure activity. If DDS is suspected, the health care provider should be contacted immediately (Option 3). If severe, DDS can progress to coma and death. If DDS is identified during treatment, the rate of dialysis should be slowed or stopped. Treatment focuses on interventions to decrease cerebral edema and manage symptoms. (Option 1) Antihypertensives are withheld prior to HD to minimize the risk for hypotension. If the client is not hypotensive after HD, prescribed antihypertensives should be administered but are not the priority intervention for a client with DDS. (Option 2) Antiemetics should be administered to treat nausea associated with DDS, but they are not the priority intervention. (Option 4) Trendelenburg position may increase cerebral edema and would be inappropriate for a client with DDS.
The nurse assesses a client receiving peritoneal dialysis. Which assessment findings are most important for the nurse to report to the health care provider? Select all that apply. 1. Cloudy outflow 2. Low-grade fever 3. Oliguria 4. Pruritus 5. Tachycardia
During peritoneal dialysis (PD), a catheter is placed into the peritoneal cavity to infuse dialysate (dialysis fluid); the tubing is then clamped to allow the fluid to dwell for a specified period. After the dwell time, the catheter is unclamped and the fluid (effluent) drains out via gravity. Cloudy outflow (effluent), tachycardia, and low-grade fever are signs of peritonitis, an infection of the peritoneal cavity and a major concern with PD. Bloody fluid can indicate intestinal perforation or that the client may be menstruating. Brown effluent can indicate fecal contamination from perforation. All these findings need to be reported to the health care provider. (Option 3) Oliguria (very low urine output) is associated with acute or chronic kidney failure and is the reason the client is receiving peritoneal dialysis. It does not indicate a complication of PD. (Option 4) Pruritus (itching) is a common finding in clients with kidney failure, and may occur due to dry skin, neuropathy, or skin deposits of waste products (eg, urea, calcium-phosphate) that are normally removed via the kidney. PD can help relieve this symptom of kidney failure by filtering waste products.
The nurse assesses a client during the dwell time of a peritoneal dialysis cycle. Which assessment would require immediate intervention? 1. Blood pressure of 168/88 mm Hg and pulse of 72/min(11%) 2. Client experiencing intermittent nausea(8%) 3. Crackles present in the left and right lung bases(76%) 4. Presence of 1+ pitting edema in ankles and feet bilaterally(3%)
During peritoneal dialysis, dialysate is infused into the abdominal cavity and the tubing is then clamped to allow the fluid to dwell for a specified period. After the dwell time, the catheter is unclamped and the fluid drains out via gravity. During the instillation and dwell portions of the cycle, clients are monitored closely for indications of respiratory distress (eg, difficulty breathing, rapid respirations, crackles) that can result from instilling the dialysate too rapidly, overfilling of the abdomen, or fluid entering the thoracic cavity (Option 3). Crackles can also occur if over time there is more dialysate infused than is removed (fluid gain). (Option 1) Clients receive peritoneal dialysis due to chronic kidney failure. The client's blood pressure is likely elevated secondary to the renal failure. This assessment is important to monitor, but crackles in the lungs are the priority. (Option 2) Clients with renal failure typically have electrolyte abnormalities (eg, acidosis) that lead to nausea. This is not a priority. (Option 4) Edema in the extremities can also indicate volume overload. However, this could be due to many other factors (eg, blood pressure medications such as amlodipine) or fluid overload from kidney disease. It is not a priority over crackles, which indicate direct seeping of excess peritoneal cavity fluid into the thorax through diaphragmatic channels.
