A55-yr-old woman admitted for shoulder surgery asks the nurse for a perineal pad, stating that laughing or coughing causes leakage of urine. Which intervention is appropriate to include in the care plan?

• Monitoring vital signs is important to detect changes such as fever or hemodynamic instability, but it is not a primary infection control measure. Vital signs reflect the presence of infection rather than actively preventing contamination during peritoneal dialysis.

• Checking blood glucose levels is essential for diabetic clients, since hyperglycemia can worsen infection risk and healing capacity. However, glucose monitoring is not a direct infection control practice related to preventing peritoneal dialysis–associated peritonitis.

• Performing hand hygiene is a critical infection control step because it minimizes the transmission of microorganisms from healthcare providers or caregivers to the peritoneal catheter site. Consistent hand hygiene reduces the risk of peritoneal contamination during exchanges.

• Applying antibiotic ointment at the catheter exit site reduces the chance of bacterial colonization and local infection. Preventing exit-site infections is crucial, since they can progress to tunnel infections or peritonitis if not controlled early.

• Assessing fluid intake helps evaluate fluid balance and kidney function, but it does not contribute to infection prevention. While important for overall care in dialysis clients, it is not an essential infection control practice.

• Using sterile techniques during catheter handling and dialysate exchanges prevents the introduction of microorganisms into the peritoneal cavity. Maintaining strict sterility is the cornerstone of preventing peritonitis in peritoneal dialysis patients.

A. BUN 100 mg/dL: In chronic glomerulonephritis, progressive kidney damage leads to impaired excretion of nitrogenous wastes, causing elevated blood urea nitrogen (BUN) levels. A BUN of 100 mg/dL reflects significant renal dysfunction, which occurs in advanced disease.

B. RBC 4.9 mm3: A normal red blood cell count would typically range from 4.2 to 5.4 million/mm³ in adults. Clients with chronic kidney disease often develop anemia due to decreased erythropoietin production, so a normal RBC is not an expected finding.

C. Serum potassium 4.0 mEq/L: Clients with chronic glomerulonephritis are at risk for hyperkalemia due to impaired potassium excretion. Therefore, a normal potassium level does not reflect the typical laboratory pattern in advanced disease.

D. Serum creatinine 0.8 mg/dL: Normal serum creatinine is approximately 0.6–1.2 mg/dL. In chronic glomerulonephritis, creatinine usually increases as renal function declines. A value of 0.8 mg/dL does not indicate impaired kidney function and is not an expected finding.