A nurse is preparing to discharge a client who has a new diagnosis of chronic kidney disease (CKD). Which of the following referrals should the nurse plan to initiate?

Choice A Reason:

The dressing for a PICC line should be changed every 7 days or sooner if it becomes wet, soiled, or loose. Therefore, a dressing change 7 days ago is within the recommended guidelines and does not necessarily require immediate notification of the provider.

Choice B Reason:

An increase in the circumference of the client’s upper arm by 10% can indicate swelling, which may be a sign of complications such as infection, thrombosis, or infiltration. This finding should be promptly reported to the provider for further evaluation and intervention.

Choice C Reason:

The catheter not being used for 8 hours is not typically a cause for concern as long as it is properly flushed and maintained. PICC lines can remain in place for extended periods without use, provided they are flushed regularly to prevent occlusion.

Choice D Reason:

Flushing the catheter with 10 mL of sterile saline after medication use is a standard practice to maintain patency and prevent blockage This action does not require notification of the provider unless there are other associated complications.

Choice A Reason

Determine the time the last dose of pain medication was administered. While it is important to know when the last dose of pain medication was given, assessing the client’s current pain level is a priority. This helps in understanding the severity and nature of the pain, which guides further interventions.

Choice B Reason

Reposition the client to assist with reduction of pain. Repositioning can help alleviate pain, but it should be done after assessing the pain. Without understanding the pain’s characteristics, repositioning might not address the underlying issue effectively.

Choice C Reason

Ask the client to describe the pain and rate it on a scale of 0 to 10. This is the correct first action. Pain assessment is crucial in determining the appropriate intervention. By asking the client to describe and rate their pain, the nurse can tailor the pain management plan to the client’s specific needs.

Choice D Reason

Check the client’s medical record for type of PRN pain medication. Reviewing the medical record for PRN pain medication is important, but it should follow the initial pain assessment. Knowing the pain’s intensity and characteristics will help in deciding whether PRN medication is needed.