A nurse is caring for a client who is undergoing initial peritoneal dialysis. Which of the following should the nurse
report immediately to the provider?
Blood-tinged dialysate outflow
Dialysate leakage during inflow
Report of discomfort during dialysate inflow
Purulent dialysate outflow
The Correct Answer is D
Choice A reason: Blood-tinged dialysate outflow can occur initially due to the surgical procedure and is not typically a cause for immediate concern unless it persists or is accompanied by other symptoms.
Choice B reason: Dialysate leakage during inflow might indicate a problem with the catheter placement or integrity but is not usually an emergency. It should be monitored and reported if it continues.
Choice C reason: Discomfort during dialysate inflow is common, especially in new patients, as they adjust to the sensation of fluid being infused. It should be reported if the discomfort is severe or persistent.
Choice D reason: Purulent dialysate outflow indicates an infection, such as peritonitis, which is a serious complication
of peritoneal dialysis. This requires immediate atention and intervention by the healthcare provider.
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Related Questions
Correct Answer is D
Explanation
Choice A reason: While a heart atack is a serious condition, it is not directly related to peritonitis. Peritonitis can lead to systemic infection, which may indirectly affect the heart, but it is not the primary concern in the immediate care of peritonitis.
Choice B reason: Diabetes is a chronic condition that requires ongoing management. However, it is not the most immediate threat when a client is diagnosed with peritonitis. The nurse should continue to monitor blood glucose levels as part of routine care.
Choice C reason: Respiratory failure can be a complication of peritonitis if the infection spreads and affects other systems. However, the primary concern with peritonitis is the potential for the infection to lead to sepsis.
Choice D reason: Sepsis is a life-threatening condition that can occur as a complication of peritonitis. It happens when the body's response to infection causes injury to its own tissues and organs. Monitoring for signs of sepsis is crucial because early intervention can be lifesaving.
Correct Answer is ["A","E","F"]
Explanation
Choice A reason: Postvoid urine residual measurement is a direct method to assess for urinary retention.
Choice B reason: Blood urea nitrogen (BUN) levels may indicate kidney function but not specifically urinary retention.
Choice C reason: A cystourethrogram is used to visualize the bladder and urethra, which may not be the first choice for assessing urinary retention.
Choice D reason: Creatinine levels indicate kidney function but not urinary retention.
Choice E reason: A kidney, ureter, bladder (KUB) x-ray can show the size of the bladder and may indicate retention.
Choice F reason: A bladder scan is a non-invasive way to measure the amount of urine in the bladder and assess for
retention.
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