A nurse is providing teaching to a client and his partner about performing peritoneal dialysis at home. When discussing peritonitis, which of the following manifestations should the nurse identify as the earliest indication of this complication?

D. This sequence is important because regular insulin should not be contaminated with NPH insulin, and drawing up regular insulin first helps ensure accurate dosing and prevents mixing of the two insulins prematurely.

A Insulin injections are typically administered subcutaneously, which usually requires a 90-degree angle (perpendicular) for needle insertion, especially if the person has adequate subcutaneous tissue.

B. Prefilled insulin syringes should be stored with the needle pointing upward to prevent insulin leakage or air bubbles from affecting the accuracy of the dose.

C NPH (Neutral Protamine Hagedorn) insulin is a suspension and should not be vigorously shaken. Shaking could cause frothing or denaturation of the insulin, affecting its efficacy and consistency.

C. An increase in uric acid levels (hyperuricemia) is a hallmark finding in acute gout. Elevated uric acid levels predispose to the formation and deposition of urate crystals in joints, leading to the inflammatory response seen in gout attacks.

A While CK levels can increase in conditions affecting muscles (like rhabdomyolysis), it is not specifically associated with acute gout.

C Uric acid levels are typically elevated during acute gout attacks. This is because gout results from the deposition of urate crystals in the joints due to elevated serum uric acid levels. Therefore, during an acute gout attack, uric acid levels in the blood are often higher than normal.

D. Chloride is an electrolyte and its levels can vary based on hydration status, acid-base balance, and kidney function. It is not directly associated with acute gout, so its levels would not necessarily increase in this condition.