A client is receiving continuous enteral nutrition through a nasogastric small-bore silicone feeding tube. What should the nurse plan for when this client has a computed tomography (CT) scan ordered?

Choice A reason: Bradycardia, which is a slower than normal heart rate, is not a common finding associated with renal calculi. Renal calculi, or kidney stones, typically cause symptoms related to the urinary system rather than directly affecting the heart rate.

Choice B reason: Bradypnea, or abnormally slow breathing, is also not a typical symptom of renal calculi. Patients with kidney stones may experience changes in urination patterns, such as frequency or urgency, but not typically changes in respiratory rate.

Choice C reason: Severe pain is indeed the most common symptom associated with renal calculi. This pain, known as renal colic, is often sudden in onset, very severe, and may radiate from the back down to the lower abdomen or groin. The pain is caused by the stone moving into the ureter and causing a blockage, which leads to increased pressure and stretching of the kidney or ureter. Renal calculi can cause a range of symptoms, with severe pain being the most prominent and often the first symptom that leads individuals to seek medical care. The pain is typically very intense and can be accompanied by other symptoms such as nausea, vomiting, and hematuria (blood in the urine).

Choice D reason: Nocturia, or frequent urination at night, can be a symptom of renal calculi, especially if the stones affect the bladder or cause urinary tract infections. However, the most characteristic symptom of renal calculi is severe pain, not necessarily nocturia.

Choice A: Hyperglycemia The reason hyperglycemia is a risk when the prescribed dwell time is not maintained is due to the glucose present in the dialysate. The dialysate used in PD often contains glucose, which acts as an osmotic agent to facilitate fluid removal from the blood. If the dwell time is too short, there may not be enough time for the glucose to be absorbed, leading to higher levels of glucose in the blood. Conversely, if the dwell time is too long, excessive glucose absorption can occur, also leading to hyperglycemia. For patients with diabetes mellitus, maintaining the prescribed dwell time is essential to manage their blood glucose levels effectively. The normal range for fasting blood glucose is typically between 70 to 99 mg/dL, and for diabetes patients, maintaining blood glucose levels as close to the normal range as possible is crucial to prevent complications.

Choice B: Disequilibrium Syndrome Disequilibrium syndrome is characterized by neurological symptoms resulting from rapid changes in the composition of extracellular fluids during dialysis. This condition is more commonly associated with hemodialysis due to the rapid shifts that can occur with this modality. In PD, the risk of disequilibrium syndrome is significantly lower because the exchange of solutes and fluids is more gradual. Therefore, while important to consider, it is not the primary complication associated with the maintenance of dwell time in PD.

Choice C: Peritonitis Peritonitis, an infection of the peritoneal cavity, is a serious complication of PD but is not directly related to the duration of dwell time. It is typically caused by contamination during the exchange process or catheter-related infections. While proper technique and hygiene are critical in preventing peritonitis, the dwell time itself does not influence the risk of developing this infection.

Choice D: Hyperphosphatemia Hyperphosphatemia refers to elevated levels of phosphate in the blood and is a concern in patients with renal failure due to the kidneys’ inability to excrete phosphate effectively. The dwell time in PD may affect the removal of phosphate to some extent; however, it is not the primary concern related to the maintenance of dwell time. Phosphate binders and dietary restrictions are commonly used to manage phosphate levels in PD patients.