Which finding is common in a client who has chronic kidney disease (CKD)?

Choice A reason: While cardiac and respiratory assessments are important in the oliguric phase of AKI to monitor for fluid overload, this patient is in the diuretic phase. The primary risk here is not fluid excess (leading to heart failure or pulmonary edema) but rather the systemic consequences of rapid volume depletion.

Choice B reason: Mental health status is a component of holistic care and may be affected by uremia (causing encephalopathy). However, during the diuretic phase of AKI, physiological instability due to massive fluid loss takes clinical precedence over psychosocial assessments to ensure the patient's immediate physical safety and survival.

Choice C reason: Edema is a hallmark of the oliguric phase where the kidneys fail to excrete water. In the diuretic phase, edema typically resolves as the patient voids large volumes. Assessing pain is standard, but neither edema nor pain represents the most acute physiological threat during this specific phase of renal recovery.

Choice D reason: A urine output of 2300 mL indicates the diuretic phase of AKI, where the kidneys have regained the ability to excrete waste but cannot yet concentrate urine. This puts the patient at severe risk for hypovolemia, hypotension, and critical depletion of electrolytes like potassium and sodium, requiring intensive monitoring.

Choice A reason: Fistula drainage from the bowel contains caustic enzymes and gastric acids that cause rapid, severe excoriation and breakdown of the surrounding skin. Maintaining skin integrity is the priority nursing intervention to prevent secondary infections, pain, and complex wound management issues associated with enzymatic skin digestion.

Choice B reason: A low-fiber (low-residue) diet is often indicated during exacerbations of Crohn's disease to reduce bowel frequency and irritation. However, it is not the most immediate or critical priority when a patient has an active, heavily draining fistula that poses a direct threat to integumentary health.

Choice C reason: Antibiotics are frequently used to treat infections associated with fistulas, such as abscesses. While important for managing the underlying infectious process, the immediate physical threat of skin maceration and tissue destruction from the drainage itself requires more urgent nursing attention and protective barriers.

Choice D reason: Intravenous glucocorticoids are used to manage systemic inflammation in Crohn's disease. While they help treat the underlying disease activity, they can also delay wound healing. They do not address the immediate, localized problem of corrosive drainage damaging the patient's external abdominal or perianal tissue.