A nurse is caring for a client receiving peritoneal dialysis who reports severe abdominal pain and has a cloudy dialysate return. The client's temperature is 101.2°F (38.4°C). What is the nurse's priority action?
1Increase the dwell time to improve clearance
2Obtain dialysate sample for culture and sensitivity✓ 정답
3Administer prescribed analgesic for pain relief
4Flush the catheter with normal saline solution
해설
The combination of cloudy dialysate return, severe abdominal pain, and fever indicates peritonitis, a serious complication of peritoneal dialysis. Obtaining a dialysate sample for culture and sensitivity is the priority to identify the causative organism and guide appropriate antibiotic therapy.
Core Nursing ExplanationKey Concept Analysis: This question assesses the recognition and immediate nursing response to peritonitis, a serious and common infection in patients undergoing Peritoneal Dialysis (PD). The classic triad of symptoms—cloudy dialysate, abdominal pain, and fever—is diagnostic for peritonitis. The priority action is to obtain a sample for Culture and Sensitivity (C&S) to identify the infecting organism and determine the most effective antibiotic, which is the cornerstone of treatment.
Answer Rationale: Key Point! In suspected peritonitis, diagnostic confirmation precedes definitive treatment. While all actions listed may be part of the care plan, obtaining the dialysate sample for C&S is the priority because it directly guides the specific, life-saving antibiotic therapy. Delaying this to manage symptoms first could allow the infection to worsen.
Distractor Analysis:
- Watch out for confusion! Option 1: Increasing dwell time is contraindicated. Dwell time might be shortened in peritonitis to increase fluid exchange and remove inflammatory cells and bacteria, not increased.
- Option 3: While pain management is important, administering an analgesic addresses a symptom but does not treat the underlying, urgent infectious process. This is a supportive, not a priority, action.
- Option 4: Flushing the catheter with normal saline is not a standard intervention for suspected peritonitis and could potentially introduce more contaminants or disrupt the system. The catheter lumen should not be routinely flushed.
Related Concepts: Peritonitis in PD is often caused by touch contamination during an exchange. Strict aseptic technique is paramount. Treatment typically involves intraperitoneal (IP) antibiotics. The nurse must also monitor for signs of sepsis (e.g., tachycardia, hypotension).
Nursing Clinical Practice GuideClinical Scenario: You are the nurse on a medical-surgical unit. Mr. Chen, a 65-year-old with End-Stage Renal Disease (ESRD) on continuous ambulatory peritoneal dialysis (CAPD), calls you to his room. He states his last dialysate drain was very cloudy and his abdomen hurts "terribly." You assess his vital signs: Temp 101.5°F, HR 110, BP 138/88.
Nursing Intervention Strategy:
1Immediate Assessment & ActionDon gloves. Inspect the drained dialysate bag for cloudiness. Using sterile technique, obtain a 10-20 mL sample of the cloudy dialysate from the drainage bag port, label it, and send it STAT for cell count, Gram stain, and culture & sensitivity. This is your first action.
2Notify the ProviderReport your findings and the action taken. Anticipate orders for IP antibiotics (often added to the next dialysate bag) and possibly systemic antibiotics.
3Supportive CareAfter securing the sample, administer prescribed analgesics for pain. Monitor vital signs closely for signs of worsening infection or sepsis. Document the characteristics of the effluent (cloudy, possibly with fibrin strands).
4Patient Education ReinforcementOnce the acute situation is managed, review aseptic exchange technique with the patient to prevent future episodes.
Patient Safety and Precautions: Never use the same catheter for sampling that is used for infusion if avoidable; use the drainage bag port. Maintain sterility of the PD catheter connection site at all times. Monitor for Key Point!hypotension and altered mental status, which could indicate progression to septic shock.
Nursing Procedure & Medication FlowProcedure: Obtaining a Dialysate Sample for C&S
1. Gather supplies: Sterile gloves, antiseptic swabs, sterile syringe (10-20 mL), sterile specimen container.
2. Clamp the PD transfer set.
3. Clean the sampling port on the drainage bag with antiseptic for 60 seconds and let it dry.
4. Using sterile technique, attach the syringe to the port, aspirate the sample, and transfer it to the sterile container.
5. Label and send to lab immediately.
Medication: Intraperitoneal (IP) Antibiotics
- Common drugs: Cefazolin or Ceftazidime are often used as first-line.
- Administration: The antibiotic is injected into the dialysate bag using aseptic technique. The bag is then warmed and infused as a usual exchange, with a recommended dwell time (often 4-6 hours).- Precaution: Ensure the antibiotic is compatible with the dialysate solution. Monitor for allergic reactions.
Peritonitis — Inflammation of the peritoneum, often due to bacterial infection. In PD, it presents with cloudy dialysate, abdominal pain, and fever.
Culture and Sensitivity (C&S) — A laboratory test to identify the microorganism causing an infection and determine which antibiotics will be effective against it.
Peritoneal Dialysis — A renal replacement therapy where the peritoneal membrane acts as a filter. Dialysate is infused into the abdominal cavity, wastes diffuse into it, and then it is drained out.
Aseptic Technique — A set of specific practices and procedures to prevent contamination by pathogens during clinical procedures, critical for PD exchanges.
Intraperitoneal — Administration of a substance (e.g., medication, dialysate) directly into the peritoneal cavity.