Which medication taken by a patient with decreased renal function will be of most concern to the nurse?

A. Decreased pH: A lower urine pH can result from diet, such as high-protein intake, or metabolic conditions like acidosis. While it is important to note, a mildly acidic urine pH is not usually urgent and does not require immediate notification of the healthcare provider.

B. Increased protein: Proteinuria is a significant finding because it indicates possible glomerular damage or kidney disease. Persistent protein loss in the urine can contribute to nephrotic syndrome, fluid imbalance, and long-term renal impairment, making it a priority to report promptly.

C. Increased WBC: An elevated white blood cell count in urine suggests infection, such as a urinary tract infection. While important, this requires follow-up with a urine culture and treatment but is not as urgent as proteinuria, which may indicate progressive renal damage.

D. Increased specific gravity: A higher specific gravity usually reflects concentrated urine from dehydration or reduced fluid intake. This finding is generally reversible with hydration and does not necessarily indicate a pathologic renal condition requiring immediate provider notification.

• Providing antibiotic ointment to the dialysis exit site is a medical order–driven intervention used for infection prevention, not a component of emotional support. While important in care, it does not directly address the psychosocial or supportive needs of the client during dialysis.

• Encouraging questions and discussions about fears allows the nurse to validate the client’s feelings, provide accurate education, and reduce anxiety. Open communication supports coping, enhances trust, and directly fulfills the provider’s order for emotional support and counseling.

• Monitoring for signs of peritonitis is primarily a clinical safety measure rather than emotional support, but it remains an anticipated nursing action during peritoneal dialysis. By ensuring early detection of infection, the nurse indirectly provides reassurance, which helps reduce patient anxiety about complications.

• Restricting fluid intake without considering urinary output is inappropriate because fluid management must be individualized. Overly strict restriction without assessing renal function and residual urine output may worsen the client’s sense of isolation and discomfort.