The nurse is caring for a client with advanced cirrhosis. Which of the following clinical manifestations should the nurse recognize as a serious complication of this condition?

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.

Title: Choice A reason: Liver enzymes Liver enzymes are proteins that speed up chemical reactions in your body. They include alanine transaminase (ALT), aspartate transaminase (AST), and alkaline phosphatase (ALP). High levels of liver enzymes in the blood can indicate liver disease. However, rheumatic endocarditis is a heart condition, not a liver condition. Therefore, while liver enzymes are important for diagnosing liver conditions, they would not assist in confirming a diagnosis of rheumatic endocarditis.

Title: Choice B reason: Serum albumin Serum albumin is a type of protein that your liver and kidneys produce to help your body maintain fluid balance and function. Low or high albumin levels can indicate liver disease, kidney disease, or nutritional deficiency. However, rheumatic endocarditis is a heart condition, not a liver or kidney condition. Therefore, while serum albumin is important for diagnosing liver and kidney conditions, it would not assist in confirming a diagnosis of rheumatic endocarditis.

Title: Choice C reason: Throat culture A throat culture is a lab test used to find and identify germs in the back of your mouth that are making you sick. It can diagnose infections like strep throat, gonorrhea, thrush, diphtheria, and pertussis. Rheumatic endocarditis is often caused by a streptococcal infection, which can be identified through a throat culture. Therefore, a throat culture would assist in confirming a diagnosis of rheumatic endocarditis.

Title: Choice D reason: Arterial blood gases An arterial blood gas (ABG) test measures the levels of oxygen and carbon dioxide in your blood as well as the pH balance in your blood. It helps diagnose and monitor conditions that affect your respiratory, circulatory, and metabolic systems. However, rheumatic endocarditis is a heart condition that is often caused by a bacterial infection. Therefore, while an ABG test is important for diagnosing conditions that affect your respiratory, circulatory, and metabolic systems, it would not assist in confirming a diagnosis of rheumatic endocarditis.