A nurse is assessing a client's response to receiving morphine for postoperative pain management. Which of the following findings is the nurse's priority?

Rationale for Correct Choices

• Blood glucose: The client’s blood glucose decreased from 250 mg/dL to 140 mg/dL, indicating a positive response to diabetes management through medication and dietary adherence. This is a key marker of metabolic control in diabetes.
• Urinary frequency: Two weeks ago, the client reported "frequent urination" (polyuria), which is a classic symptom of uncontrolled hyperglycemia. Today, this symptom is not reported, and given the improvement in blood glucose, it's highly probable that the polyuria has resolved or significantly decreased.

Rationale for Incorrect Choices

• Temperature: The client’s temperature increased from 38.3°C to 39.0°C, suggesting a worsening or persistent infection. An increasing fever is a negative trend and does not indicate improvement.
• WBC: The WBC count rose from 9,500/mm³ to 11,200/mm³, exceeding the normal upper limit. This may reflect an active or worsening infection, especially in the context of a draining foot wound and elevated temperature.
• Heart rate: The heart rate remains elevated at 106/min (tachycardia) compared to the previous 104/min. Persistent tachycardia can be a sign of systemic infection or dehydration and is not a sign of clinical improvement.
• Blood pressure: The blood pressure decreased from 98/74 mm Hg to 90/68 mm Hg, which may suggest worsening hemodynamic status and possible sepsis. Hypotension is not an indicator of improvement.

A. Nosebleed: A nosebleed is not typically associated with dialysis disequilibrium. It may be related to other factors like dry air or blood pressure changes, but it is not a classic symptom of dialysis disequilibrium.

B. Malaise: Malaise can occur after hemodialysis due to various reasons, such as fluid shifts, but it is not a specific indicator of dialysis disequilibrium.

C. Headache: Headache is a common symptom of dialysis disequilibrium, which occurs due to rapid changes in fluid and electrolyte balance during hemodialysis. This can lead to cerebral edema, which manifests as a headache.

D. Elevated temperature: An elevated temperature is not a typical sign of dialysis disequilibrium. It could indicate an infection or other issues related to dialysis, but it is not directly related to disequilibrium.