The nurse is visiting a patient who performs peritoneal dialysis at home. The nurse is evaluating the patient's technique. Which finding requires additional teaching?

The patient uses clean technique when instilling the dialysate

The patient performs exchanges on a table with a sterile drape

The patient verbally expresses symptoms to report to the HCP

The patient washes their hands before beginning

Answer and Explanation

The Correct Answer is A

Choice a reason: The patient uses clean technique when instilling the dialysate is incorrect and requires additional teaching. Peritoneal dialysis requires sterile technique to prevent infection. Using a clean technique, which is less rigorous than sterile technique, increases the risk of introducing pathogens into the peritoneal cavity. Proper sterile technique involves meticulous hand hygiene, using sterile gloves, and ensuring all equipment and supplies are sterile.
Choice b reason: The patient performs exchanges on a table with a sterile drape is appropriate. Using a sterile drape helps maintain a sterile field and reduces the risk of contamination during the dialysis procedure. This practice is an important part of sterile technique and helps ensure the patient's safety.
Choice c reason: The patient verbally expresses symptoms to report to the HCP is a positive behavior. Being aware of and communicating symptoms that may indicate complications, such as signs of infection or peritonitis, is crucial for timely intervention and management. This practice shows the patient is knowledgeable about monitoring their health and knowing when to seek professional help.
Choice d reason: The patient washes their hands before beginning is an essential step in both clean and sterile techniques. Proper hand hygiene is critical in preventing the spread of infection and is a fundamental practice in peritoneal dialysis. Washing hands thoroughly before starting the procedure helps minimize the risk of contamination.

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Correct Answer is C

Explanation

Choice a reason: Starting the flow of urine before passing the container under the stream to collect the specimen is an appropriate instruction. This technique is recommended to ensure that the initial part of the urine, which may contain contaminants from the urethral opening, is not collected. By allowing the first part of the urine to flow into the toilet, the midstream portion is considered cleaner and more representative for diagnostic testing.
Choice b reason: Removing the specimen container before stopping the stream of urine is also an appropriate instruction. This helps to ensure that only the midstream portion of the urine is collected, minimizing the risk of contamination from the skin or other surfaces. It also prevents the urine from splashing or overflowing, which could potentially contaminate the sample or the surrounding area.
Choice c reason: Using the provided towelette to cleanse the area by moving in a back-and-forth motion is incorrect and requires intervention. The proper technique for cleansing the area involves using the towelette to wipe from front to back in a single, continuous motion. This helps to reduce the risk of introducing bacteria from the perineal area into the urinary tract, which can lead to inaccurate test results or urinary tract infections.
Choice d reason: Instructing the client to use their non-dominant hand to spread the labia is an appropriate instruction. This technique helps to ensure that the urinary meatus is exposed and that the urine flows directly into the specimen container. Using the non-dominant hand allows the dominant hand to be used for holding and positioning the specimen container, making the process more manageable and reducing the risk of contamination.

A. Dehydration B. Protein in the urine C. Obesity D. Iron deficiency

Correct Answer is A

Explanation

Choice a reason: Dehydration is a significant risk factor for the formation of renal calculi (kidney stones). When the body is dehydrated, urine becomes concentrated with minerals and salts, which can crystallize and form stones. Ensuring adequate hydration is crucial in preventing kidney stone formation, as it helps to dilute the urine and flush out potential stone-forming substances.
Choice b reason: Protein in the urine, or proteinuria, is not a direct cause of kidney stones. Proteinuria can indicate underlying kidney disease or damage but is not typically linked to the formation of kidney stones. Monitoring protein levels in the urine is important for overall kidney health, but it is not a primary factor in stone formation.
Choice c reason: Obesity is associated with an increased risk of kidney stones. Obesity can lead to changes in the body's metabolism and increase the excretion of certain substances, such as calcium and oxalate, which can contribute to stone formation. Maintaining a healthy weight through diet and exercise can help reduce the risk of developing kidney stones.
Choice d reason: Iron deficiency is not a known risk factor for the formation of kidney stones. While maintaining adequate iron levels is important for overall health, it does not have a direct impact on the formation of renal calculi. Other dietary and metabolic factors play a more significant role in stone development.

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The nurse is visiting a patient who performs peritoneal dialysis at home. The nurse is evaluating the patient's technique. Which finding requires additional teaching?

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