A client in the emergency department has suspected stomach perforation due to a peptic ulcer. The nurse is completing the assessment and should expect which of the following findings? (Select all that apply).

Choice A: RBC count The red blood cell (RBC) count is not typically decreased by hemodialysis. Hemodialysis does not remove cells from the blood. However, patients with chronic kidney disease often have anemia, which is a low RBC count, due to a decrease in the production of erythropoietin by the kidneys. Erythropoietin is a hormone that stimulates the bone marrow to produce RBCs. Anemia in these patients is treated with erythropoiesis-stimulating agents, not dialysis.

Choice B: Protein Protein levels are not directly affected by hemodialysis. However, patients on hemodialysis may have lower protein levels due to dietary restrictions or protein loss during the treatment. It is important for patients to manage their protein intake to prevent malnutrition and maintain overall health.

Choice C: Potassium Potassium levels are expected to decrease following hemodialysis. Potassium is an electrolyte that is normally filtered out by the kidneys. In patients with kidney failure, potassium levels can build up in the blood and cause serious heart problems. Hemodialysis removes excess potassium from the blood, which helps to prevent complications such as cardiac arrhythmia. The normal range for serum potassium is 3.5 to 5.0 mmol/L. After a hemodialysis treatment, a nurse should expect to find a decrease in potassium levels in the laboratory data of a client. This is because hemodialysis effectively removes excess potassium, which can accumulate in the blood due to reduced kidney function. Maintaining proper potassium levels is crucial for preventing heart complications in patients with kidney failure.

Choice D: Calcium Calcium levels are not typically decreased by hemodialysis. In fact, calcium levels can be affected by the dialysate used during hemodialysis. Some dialysates contain calcium, and this can actually increase the patient’s blood calcium levels. Patients with kidney failure may also have secondary hyperparathyroidism, which affects calcium levels, and they may be treated with calcium supplements or vitamin D analogs to manage their calcium levels.

Choice A reason: Sodium level is not a direct measure of fluid volume. While sodium balance can influence fluid status, the serum sodium level can be affected by various factors and does not reliably indicate fluid volume increase on its own.

Choice B reason: Intake and output records are important for managing fluid balance, especially in a hospital setting. However, they can be influenced by many factors, such as incomplete recording or insensible losses, and do not provide a direct measure of fluid retention.

Choice C reason: Daily weight is considered the most reliable measure of fluid retention. Weight changes can reflect fluid balance accurately because 1 liter of fluid is roughly equivalent to 1 kilogram of body weight. In clients with chronic kidney disease, daily weight monitoring can help detect fluid volume increases or decreases promptly. For a client with chronic kidney disease, daily weight monitoring is a key assessment tool for detecting fluid volume changes. It provides a quantifiable and objective measure that can guide interventions to manage fluid balance effectively.

Choice D reason: Tissue turgor, which refers to the skin’s elasticity, is not a reliable measure of fluid volume. It can be influenced by age, edema, and other factors, and changes in turgor may not accurately reflect fluid status in the body.