The practical nurse (PN) is evaluating a client who is admitted to the hospital with a diagnosis of cholelithiasis. Which finding should the practical nurse (PN) report to the charge nurse?

Choice A reason: Nausea is a common side effect of chemotherapy and can significantly affect the client's quality of life. Managing nausea is important for ensuring the client can maintain adequate nutrition and hydration. However, it is not the most critical problem when planning care for a client with leukemia, as it does not pose an immediate threat to life compared to the risk of infection.
Choice B reason: Fatigue is another common issue experienced by clients undergoing chemotherapy. It can result from the treatment itself, the underlying disease, or anemia. While addressing fatigue is essential for improving the client's daily functioning and well-being, it is not the most urgent concern in this scenario. The client's significantly low WBC count poses a more immediate risk to their health.
Choice C reason: Infection is the most significant problem to consider when planning care for this client. The client's WBC count of 2,500/mm³ (2.5 x 10⁹/L) is well below the normal range, indicating leukopenia, which increases their susceptibility to infections. Clients with leukemia receiving chemotherapy are at a higher risk for infections due to both the disease and the treatment's impact on the immune system. Monitoring for signs of infection, implementing infection control measures, and providing prompt treatment if an infection is detected are critical to prevent severe complications.
Choice D reason: Bleeding is a potential concern for clients with leukemia, especially if platelet counts are low. However, in this case, the client's platelet count is within the normal range (250,000/mm³ or 250 x 10⁹/L). While it is important to monitor for bleeding, the immediate risk of infection due to the low WBC count is more pressing and requires prioritized attention.

Choice A reason: Coughing over the catheter site while cleansing the skin is a behavior that indicates the client needs additional teaching. This action can introduce bacteria and other pathogens to the catheter site, increasing the risk of infection. Proper technique should include covering the mouth when coughing and ensuring the area remains as sterile as possible during the cleansing process. Educating the client on the importance of maintaining sterility and preventing contamination is crucial in peritoneal dialysis catheter care.
Choice B reason: Wearing only one sterile glove when cleansing the insertion site may not be ideal, but it does not necessarily indicate a lack of understanding or need for additional teaching. The main concern is ensuring the insertion site is cleaned properly. However, best practice would be to wear two sterile gloves to maintain sterility and reduce the risk of infection.
Choice C reason: Washing hands before opening the 4 by 4 dressing packet is a proper and essential technique in peritoneal dialysis catheter care. This action helps minimize the risk of infection by ensuring that the hands are clean before handling sterile supplies. This behavior does not indicate a need for additional teaching.
Choice D reason: Pouring antiseptic solution and sterile water on sterile dressings is an acceptable practice in peritoneal dialysis catheter care. This step helps disinfect the catheter site and maintain sterility. This behavior does not indicate a need for additional teaching.