A patient has returned to the medical surgical unit after receiving peritoneal dialysis. Which of the following nursing interventions should the nurse implement to prevent peritonitis?

A. Prepare the patient for platelet transfusion: In immune thrombocytopenic purpura (ITP), platelet destruction is immune mediated, and transfused platelets are often rapidly destroyed unless there is severe or life-threatening bleeding. Platelet transfusion is not the first intervention for petechiae and ecchymoses without active hemorrhage. Immediate safety measures take priority.

B. Institute bleeding precautions: ITP results in decreased platelet counts due to autoimmune destruction, increasing the risk for spontaneous bleeding. Implementing bleeding precautions—such as avoiding IM injections, using soft toothbrushes, and minimizing invasive procedures—reduces the risk of mucosal or internal hemorrhage. Preventing further bleeding is the priority upon admission.

C. Encourage active range-of-motion exercises: Vigorous activity may increase the risk of bruising or internal bleeding in patients with thrombocytopenia. While mobility is important, activity should be limited or modified until platelet levels are stabilized. Preventing trauma is more urgent than promoting exercise at this stage.

D. Administer aspirin for discomfort: Aspirin inhibits platelet aggregation by irreversibly blocking cyclooxygenase-1 (COX-1), impairing thromboxane A2 production. In a patient with already reduced platelet numbers, aspirin significantly increases bleeding risk and is contraindicated.

A. Administer IV potassium to correct hypokalemia: During the failure stage of acute kidney injury (AKI), hyperkalemia is more common than hypokalemia due to impaired renal excretion. Administering IV potassium without careful monitoring can precipitate life-threatening cardiac arrhythmias. Electrolyte management must be guided by laboratory values.

B. Prepare for hemodialysis to manage fluid and electrolyte imbalances: The failure stage of AKI is characterized by severe reduction in glomerular filtration rate, oliguria or anuria, and accumulation of toxins, electrolytes, and fluid. Hemodialysis provides rapid removal of excess potassium, urea, and fluid, which is critical to preventing complications such as pulmonary edema, hyperkalemia-induced arrhythmias, and severe acidosis.

C. Begin fluid restriction to prevent overload: Fluid restriction may be indicated, especially in oliguric or anuric patients, but it is not sufficient as the primary intervention in the failure stage. Restricting fluid alone does not correct severe electrolyte disturbances or remove accumulated toxins. It is supportive, whereas renal replacement therapy addresses the derangements.

D. Encourage oral intake and high protein to support kidney function: High-protein intake may worsen azotemia in AKI because protein metabolism generates nitrogenous waste that the failing kidneys cannot excrete efficiently. Oral intake is encouraged only if not contraindicated, but promoting protein-heavy intake is not a priority in the failure stage.