A nurse is assessing a client following hemodialysis. Which of the following findings indicates dialysis disequilibrium?

A. Metabolic alkalosis: In metabolic alkalosis, the pH is elevated (above 7.45), and the bicarbonate (HCO3) is increased (above 28 mEq/L). In this scenario, the pH is low (7.12), and HCO3 is low (20 mEq/L), which is not consistent with alkalosis.

B. Metabolic acidosis: In metabolic acidosis, the pH is low (below 7.35), and the bicarbonate (HCO3) is low (below 21 mEq/L), which is consistent with the client's ABG values (pH 7.12, HCO3 20 mEq/L). This suggests the client has metabolic acidosis, which is common in chronic kidney failure due to impaired excretion of acid and decreased bicarbonate.

C. Respiratory acidosis: In respiratory acidosis, the pH is low, and the PaCO2 is elevated (above 45 mm Hg). The PaCO2 in this client is within the normal range (40 mm Hg), making respiratory acidosis unlikely.

D. Respiratory alkalosis: In respiratory alkalosis, the pH would be high, and the PaCO2 would be low (below 35 mm Hg). The client's pH is low (7.12), and the PaCO2 is normal, so respiratory alkalosis is not present.

A. Speech-language pathologist: Speech-language pathologist specializes in assessing and treating swallowing difficulties, such as dysphagia, which is common after a stroke. The SLP will provide strategies for safe swallowing, conduct swallow studies, and recommend modifications to diet or feeding techniques to prevent aspiration.

B. Respiratory therapist: While a respiratory therapist may be needed if the client has respiratory issues or difficulty breathing, they are not typically the primary specialist for managing dysphagia.

C. Occupational therapist: An occupational therapist focuses on helping clients with activities of daily living (ADLs), such as dressing, grooming, and fine motor skills. While important for stroke recovery, they are not the primary specialist for dysphagia management.

D. Physical therapist: A physical therapist works with clients on improving mobility, strength, and balance. Though essential for stroke rehabilitation, physical therapy does not focus on the management of dysphagia.