A patient who has had progressive chronic kidney disease (CKD) for several years has just begun regular hemodialysis. Which information about diet will the nurse include in patient teaching?

A. Collect a urine specimen for culture and sensitivity: This intervention is indicated when infection is suspected, in cases of fever, dysuria, or cloudy urine. The lab values here suggest hemoconcentration rather than infection, so a culture would not address the client’s fluid balance problem.

B. Continue routine care because the results are within the expected reference range: The results are not all within the expected range. The BUN of 32 mg/dL is elevated, and the hematocrit of 50% is high, both pointing toward dehydration.

C. Decrease the IV fluid infusion rate and limit oral fluid intake: Reducing fluid intake would be inappropriate in this case, since the client shows signs of fluid volume deficit. Decreasing fluids would worsen dehydration, elevate lab abnormalities further, and compromise perfusion.

D. Evaluate urine for amount and for specific gravity: Monitoring urine volume and specific gravity provides important information about hydration status and renal concentrating ability. Since the elevated BUN and hematocrit suggest dehydration, assessing urine helps guide fluid management and ensures appropriate therapy response.

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.