A nurse is caring for a client receiving peritoneal dialysis. Which assessment finding would indicate the most…

Question

A nurse is caring for a client receiving peritoneal dialysis. Which assessment finding would indicate the most serious complication requiring immediate intervention?

Accepted Answer

보기 4: Dialysate leakage around the catheter exit site with erythema and purulent drainage

Dialysate leakage with erythema and purulent drainage indicates an exit site infection that can rapidly progress to peritonitis, requiring immediate intervention. Cloudy dialysate with fever suggests peritonitis, while decreased urine output and mild edema are less urgent concerns.

Answer

보기 1: Cloudy dialysate outflow with abdominal pain and fever

Answer

보기 2: Decreased urine output over the past week

Answer

보기 3: Mild edema in the lower extremities

Concept	Description & Implication
Peritoneal Dialysis (PD)	A renal replacement therapy using the peritoneal membrane as a filter. Dialysate is infused into the peritoneal cavity, dwells, and is then drained, removing waste and excess fluid.
Exit-Site Infection (ESI)	Infection at the skin where the PD catheter exits. Signs: Redness (erythema), swelling, tenderness, warmth, and purulent drainage. A serious complication that threatens catheter survival.
Peritonitis	Infection/inflammation of the peritoneal lining. A major PD complication. Signs: Cloudy dialysate effluent, abdominal pain, fever. Requires antibiotic therapy (often intraperitoneal).
Tunnel Infection	Infection along the subcutaneous pathway of the PD catheter. Often accompanies severe ESI. Diagnosed by redness, tenderness, and swelling along the catheter track.

Complication	Key Assessment Findings	Priority & Action
Exit-Site Infection (ESI) with Purulent Drainage & Leakage	Erythema, swelling, pain, warmth at exit site; purulent drainage; dialysate leakage.	HIGHEST PRIORITY. Immediate intervention to prevent peritonitis/sepsis. Notify provider, obtain culture, administer antibiotics.
Peritonitis	Cloudy dialysate effluent, generalized abdominal pain, rebound tenderness, fever, nausea.	HIGH PRIORITY (Urgent). Requires prompt treatment but source (like ESI) may be more immediate. Notify provider, send effluent for cell count/culture, initiate antibiotics.
Catheter Dysfunction (Inflow/Outflow Failure)	Poor dialysate inflow or drainage; abdominal pain with infusion; constipation may be a cause.	Moderate Priority. Assess for kinks, fibrin clots, constipation. May require catheter manipulation or thrombolytics.
Fluid Overload	Edema, weight gain, hypertension, shortness of breath, decreased urine output.	Moderate Priority. Adjust dialysis prescription (increase dextrose concentration for more ultrafiltration), reinforce fluid/dietary restrictions.

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A nurse is caring for a client receiving peritoneal dialysis. Which assessment finding would indicate the most serious complication requiring immediate intervention?

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