A nurse is caring for a client receiving hemodialysis

Exhibits

A nurse is caring for a client who has received hemodialysis. Which of the following assessment findings require follow-up?

A. "You should warm the dialysate in a microwave oven before instillation": Dialysate should be warmed to body temperature before infusion, but a microwave is unsafe because it can heat unevenly and cause burns or discomfort.

B. "You should anticipate pain the first week during the inflow of dialysate": Mild abdominal pain or discomfort during dialysate inflow is common during the initial week as the peritoneum adjusts. This usually improves with time, and reassuring the client about this expected symptom helps with adherence to treatment.

C. "You should expect redness at the catheter exit site": Redness at the catheter exit site suggests infection and is not an expected finding. The site should remain clean and free from signs of inflammation, and any redness, drainage, or swelling must be reported promptly.

D. "You should avoid foods high in fiber": Fiber is not contraindicated in peritoneal dialysis. In fact, constipation should be prevented because it can interfere with dialysate flow, so a diet that includes adequate fiber is encouraged unless restricted for another reason.

• Elevating the affected arm may help reduce swelling in some conditions, but it does not treat the underlying cause of infection. While elevation can provide temporary comfort, it does not address systemic signs such as fever, elevated WBC, or CRP.
• Increasing fluid intake can support general hydration but does not treat an infection at the hemodialysis access site. In some clients with renal impairment, fluid intake must be carefully monitored, making this intervention secondary to infection management.
• Consulting with nephrology is essential because the client’s hemodialysis access site infection requires specialized assessment and possible modification of dialysis protocols. Nephrology input ensures appropriate antibiotic selection and access management.
• Administering antibiotics directly addresses the infection, which is indicated by redness, warmth, swelling, pain at the access site, fever, and elevated WBC and CRP. Timely antibiotic therapy reduces the risk of sepsis and further complications.
• Applying a cold compress may temporarily relieve discomfort but can impair circulation and does not treat the infection. Comfort measures alone are insufficient without definitive treatment such as antibiotics and specialist consultation.
• Neuropathy generally presents with numbness, tingling, or burning sensations rather than localized swelling, warmth, and systemic signs of infection. The client’s presentation does not align with neuropathic changes.
• Thrombosis of a dialysis access site may cause swelling or decreased blood flow but usually does not cause redness, warmth, fever, or elevated inflammatory markers. The systemic signs point more toward infection than clot formation.
• Aneurysm can present as swelling or a palpable mass at the access site, but it typically lacks signs of inflammation such as redness, warmth, pain, fever, and elevated WBC or CRP. The clinical picture is more consistent with infection.
• Infection is indicated by local signs of inflammation (redness, warmth, swelling, tenderness), systemic symptoms (fever, fatigue), and laboratory findings (elevated WBC and CRP). These findings confirm that the client is most likely experiencing an access site infection.
• Monitoring temperature is crucial to track the client’s response to infection and antibiotic therapy. Persistent or rising temperatures can indicate worsening infection or sepsis.
• Monitoring pain level helps assess the severity of the infection locally and the effectiveness of interventions such as antibiotics or analgesics. Changes in pain may also indicate progression or improvement of the infection.
• Monitoring blood glucose is not directly relevant in this client because there is no history of diabetes or concern for hyperglycemia affecting the infection. Tracking glucose would not provide useful information about the progress of the access site infection.
• Monitoring fluid balance is not a priority parameter in this scenario. While fluid monitoring is important for dialysis clients in general, the client’s current issue is localized infection, so changes in intake or output are not the best indicators of treatment effectiveness.
• Monitoring respiratory rate is not directly relevant because the client does not show respiratory symptoms or complications. Although systemic infection can occasionally affect breathing, it is not a primary parameter for assessing the progress of a localized vascular access infection.