A nurse is caring for a client who has skeletal traction for a fracture of the lower extremity. Which of the following actions should the nurse take?

Choice A reason: Raising the drainage bag above the abdomen reverses gravity flow, stopping dialysate outflow and worsening the issue in peritoneal dialysis. Fluid drains downward naturally, so elevating the bag traps it, potentially causing discomfort or infection risk from stagnation. This action opposes dialysis mechanics, where the bag must stay low, making it contraindicated and detrimental to treatment efficacy.

Choice B reason: High-Fowler’s position (upright) may shift abdominal contents, but it doesn’t directly resolve catheter blockages or flow issues in peritoneal dialysis. It’s used during infusion to aid breathing, not drainage. Without evidence of respiratory distress, this adjustment lacks priority over actions addressing flow directly, like repositioning, rendering it less effective here.

Choice C reason: Measuring dialysate outflow quantifies the flow reduction, identifying if less fluid returns than infused, signaling obstruction or leakage. This data guides interventions, like catheter checks or flushes, ensuring dialysis removes toxins effectively. It’s a critical step in troubleshooting, providing objective evidence of the problem’s scope, essential for maintaining treatment goals.

Choice D reason: Monitoring the access site for drainage detects leaks or infection—common flow rate culprits—as fluid escaping reduces outflow. Peritonitis risk rises with poor site integrity, necessitating early intervention. This action ensures catheter function and patient safety, directly addressing potential causes of the observed decrease, making it vital.

Choice E reason: Repositioning to the other side relieves catheter kinks or omental wrapping, frequent causes of slow flow in peritoneal dialysis. Shifting position adjusts intra-abdominal pressure, freeing the catheter tip to drain properly. This non-invasive fix restores dialysis efficacy, a standard first-line response, directly tackling mechanical flow issues effectively.

Choice A reason: Limiting reconciliation to admission and discharge misses medication changes during hospitalization, risking errors or omissions. Effective reconciliation occurs at all care transitions—admission, transfers, discharge—ensuring a current, accurate list. This approach prevents discrepancies, like duplicative therapies or missed doses, that could harm the client. Skipping interim updates undermines safety, as hospital regimens evolve, making this action incomplete and inadequate for proper care.

Choice B reason: Comparing only home medications to new prescriptions excludes drugs given during hospitalization, creating an incomplete profile. Reconciliation requires reviewing all medications—home, inpatient, and discharge—to identify conflicts or redundancies. Focusing solely on prescribed home meds overlooks real-time additions, like painkillers or antibiotics, risking interactions or therapeutic gaps. This narrow scope fails to meet reconciliation’s comprehensive safety goal.

Choice C reason: Deleting new prescriptions with potential home medication interactions exceeds nursing scope and risks altering treatment without provider input. Reconciliation identifies conflicts for collaborative resolution, not unilateral changes. For example, removing a necessary anticoagulant due to an interaction could harm the client. This action bypasses clinical judgment, undermining the process’s intent to flag, not fix, issues independently.

Choice D reason: Considering medication interaction risks is the essence of reconciliation, ensuring safety by identifying conflicts between home and hospital drugs—like warfarin and antibiotics increasing bleeding risk. The nurse compiles a full list, assesses potential adverse effects, and reports to the provider for adjustments. This proactive step prevents harm, aligns with standards, and supports individualized care, making it the correct action.