This is an extra credit question: A nurse is caring for a client receiving hemodialysis.

Exhibits

A nurse is for a client who has received hemodialysis. Which of the following assessment findings require follow-up?

Choice A reason: Discomfort during dialysate inflow is common in peritoneal dialysis due to the rapid introduction of fluid into the peritoneal cavity, stretching the peritoneum. It is usually transient and not a sign of serious complications like infection. Immediate reporting is unnecessary unless severe or persistent, as it does not indicate an acute emergency.

Choice B reason: Slight abdominal pressure during peritoneal dialysis is normal due to the presence of dialysate in the peritoneal cavity. It does not indicate a serious complication like infection or peritonitis. This sensation typically resolves and does not require immediate reporting unless accompanied by severe pain or other alarming symptoms.

Choice C reason: Yellow dialysate outflow is typically normal, as dialysate may appear slightly yellow due to the presence of fibrin or minor hemolysis. It does not indicate infection or a life-threatening issue. Clear or slightly yellow outflow is expected, unlike purulent outflow, which signals infection and requires urgent attention.

Choice D reason: Purulent dialysate outflow indicates peritonitis, a serious complication of peritoneal dialysis caused by bacterial infection in the peritoneal cavity. This presents with cloudy, pus-filled effluent, often with fever or abdominal pain. Immediate reporting is critical to initiate antibiotics and prevent sepsis, making this the most urgent finding to address.

Choice A reason: Deep partial- and full-thickness burns to the neck and chest risk airway edema due to thermal injury, leading to obstruction. The resuscitation phase prioritizes the ABCDE approach, with airway as the first concern. Ensuring a patent airway via assessment or intubation prevents respiratory arrest, making this the most critical intervention.

Choice B reason: Pain medication is essential for burn patients due to severe pain from nerve exposure, but it is not the priority in the resuscitation phase. The ABCDE approach places airway and breathing above pain management. Airway compromise from neck burns can be fatal, making pain control secondary to airway patency.

Choice C reason: Inserting an indwelling urinary catheter monitors urine output, critical for assessing fluid resuscitation in burns. However, in the ABCDE approach, airway takes precedence over circulation monitoring. Neck and chest burns risk rapid airway obstruction, making catheter insertion a secondary intervention after ensuring airway and breathing are stable.

Choice D reason: Fluid resuscitation is vital in burns to correct hypovolemia from plasma leakage, but it follows airway and breathing in the ABCDE approach. Neck and chest burns pose an immediate airway threat due to edema, requiring prioritization of airway patency to prevent respiratory failure before addressing circulatory needs.