A nurse is caring for a client who has chronic kidney failure. The client received hemodialysis 1 hr ago. The nurse should identify that which of the following findings is a manifestation of a complication related to the procedure?

​​​​​​​Condition Choices

• Dysrhythmias: Dysrhythmias are often linked to electrolyte imbalances, particularly potassium abnormalities, rather than WBC count changes. The client’s potassium level remains within normal limits, making dysrhythmias unlikely.
• Infection: A decreasing WBC count below the normal range weakens the immune response, increasing susceptibility to infections. The client’s WBC count has declined from 4,500/mm³ to 4,100/mm³, placing them at higher risk for opportunistic infections, a major concern in HIV.
• Renal failure: Renal failure is typically assessed through elevated BUN and creatinine levels, along with signs of fluid imbalance. The client’s BUN is slightly elevated but not significantly high, and there are no other indicators of renal failure.
• Bleeding: Bleeding risk is associated with low platelet levels, which impair clotting ability. The client’s platelet count remains within normal limits, reducing the likelihood of bleeding complications.
• Seizures: Seizures can result from severe electrolyte imbalances, neurological conditions, or uncontrolled infections. The client does not exhibit signs of neurological dysfunction, and electrolyte levels are stable, making seizures unlikely.

Finding Choices

• WBC count: A declining WBC count below the normal range weakens the immune response, making the client more susceptible to infections. This is particularly concerning for individuals with HIV, as they are already at an increased risk for opportunistic infections.
• Potassium level: Potassium levels are crucial for cardiac function and neuromuscular stability. The client’s potassium level remains within normal limits, making it an unlikely contributor to any immediate risk.
• Platelets: Platelets play a key role in clot formation. The client’s platelet count is within the normal range, so they are not currently at increased risk for bleeding.
• Sodium level: Sodium is essential for fluid balance and neurological function. The client’s sodium level remains within the normal range, meaning it is not contributing to any immediate concerns.
• BUN level: Elevated BUN levels can indicate impaired kidney function, dehydration, or increased protein metabolism. The client’s BUN level has increased slightly but is still within the normal range, making renal failure unlikely at this time.

A. Obtain bottles of warm, sterile 0.9% sodium chloride solution: Evisceration requires immediate coverage of the exposed organs with sterile, saline-moistened dressings to prevent drying and infection. Using warm saline helps maintain tissue viability and minimizes damage.

B. Apply a firm pressure dressing across the client's abdomen: A firm pressure dressing is inappropriate, as it could cause further damage to the eviscerated organs and increase intra-abdominal pressure, leading to ischemia or perforation.

C. Attempt to reinsert the protruding viscera: Reinserting the eviscerated organs is contraindicated due to the high risk of contamination, trauma, and further complications. The nurse should instead protect the organs with moist dressings and prepare the client for emergency surgery.

D. Place the client in left lateral recumbent position: The client should be placed in a low Fowler’s position with knees slightly flexed to reduce tension on the abdominal wound and prevent further protrusion of organs. A left lateral recumbent position does not provide the same benefit.