# A nurse is caring for a client with chronic kidney disease stage 5 who is on peritoneal dialysis. Which assessment finding would require the nurse to take immediate action? > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=541404 > language: ko > subject: Adult Health ## 문제 A nurse is caring for a client with chronic kidney disease stage 5 who is on peritoneal dialysis. Which assessment finding would require the nurse to take immediate action? ## 보기 1. Blood pressure of 90/60 mmHg with mild dizziness 2. Muscle cramping in the lower extremities 3. Air bubbles visible in the arterial line of the dialysis circuit **✔ 정답** 4. Nausea and headache during the final hour of treatment **정답: 3** ## 해설 Air bubbles in the arterial line indicate a potential air embolism, a life-threatening emergency requiring immediate action. Other findings are common complications but do not pose an immediate life risk. ## 심화 해설 Analysis of the Correct Answer The finding that requires immediate action is air bubbles visible in the arterial line of the dialysis circuit. In the context of hemodialysis, the presence of air in the extracorporeal circuit represents a critical and potentially life-threatening emergency due to the risk of air embolism. Modern dialysis machines are equipped with air detectors and safety clamps specifically designed to prevent this complication; however, if air is visualized, it indicates a breach in the system's integrity or a failure of a safety mechanism [1]. The immediate nursing action is to stop the blood pump and clamp the venous line to prevent air from entering the patient's systemic circulation. The provided evidence underscores that most hemodialysis emergencies are attributable to human error, and meticulous adherence to safety protocols—including the management of the extracorporeal circuit—is paramount to preventing life-threatening events [1]. Analysis of Incorrect Options Option 1: Blood pressure of 90/60 mmHg with mild dizziness A blood pressure of 90/60 mmHg accompanied by mild dizziness is a common finding during dialysis, often indicative of intradialytic hypotension. While this requires prompt nursing assessment and intervention—such as placing the patient in the Trendelenburg position, reducing the ultrafiltration rate, or administering a fluid bolus—it is generally a manageable complication, not an immediate life-threatening emergency like an air embolism. The complexity of dialysis treatment and high patient comorbidity make such fluctuations expected, and staff are extensively trained to handle them [1]. Option 2: Muscle cramping in the lower extremities Muscle cramping is a frequent and uncomfortable complication of dialysis, often related to rapid fluid and electrolyte shifts, particularly a reduction in plasma osmolality. While distressing for the patient, it does not pose an immediate threat to life. Management typically involves reducing the ultrafiltration rate or administering hypertonic saline. It does not represent a system failure or a risk of catastrophic injury, unlike a breach in the closed dialysis circuit [1]. Option 4: Nausea and headache during the final hour of treatment Nausea and headache are classic symptoms of dialysis disequilibrium syndrome, which is thought to result from a rapid shift in plasma osmolality causing cerebral edema. This syndrome is most common during initial treatments but can occur in any session. While it requires symptomatic management and potentially a reduction in treatment efficiency for future sessions, it is a known and generally non-fatal complication. It does not demand the same instantaneous, life-saving intervention as the detection of air in the circuit, which can lead to immediate cardiovascular collapse [1].References (research sources) - [1]Diagnosis, Treatment, and Prevention of Hemodialysis Emergencies.Research articleSaha M, Allon M. (2017) · DOI: 10.2215/cjn.05260516 ## 임상 시나리오 Air in Dialysis Circuit: Emergency ResponseImmediate action for suspected air embolism If air bubbles are visible in the arterial or venous line, this indicates a breach in the extracorporeal circuit and a high risk of air embolism. The first and only action is to stop the blood pump immediately and clamp the venous line to prevent air from entering the patient's circulation. Modern machines have air detectors and safety clamps, but do not rely on them if air is visualized. Turn the patient onto their left side in Trendelenburg position to trap air in the right atrium, and administer 100% oxygen. CautionNever ignore visible air in the lines. This is a life-threatening emergency that takes priority over all other dialysis complications like hypotension or cramping. Human error in circuit management is a primary cause. ## 핵심 개념 - **Air Embolism** — A life-threatening condition where air enters the vascular system, potentially obstructing blood flow to vital organs; immediate intervention includes clamping the line, placing the patient in left lateral Trendelenburg, and administering oxygen. - **Peritoneal Dialysis (PD)** — A dialysis modality using the peritoneal membrane for filtration via a catheter in the abdomen; it does not involve an extracorporeal blood circuit or arterial/venous lines. - **Hemodialysis (HD)** — A dialysis modality that filters blood outside the body through a machine, requiring vascular access and an extracorporeal circuit where air embolism is a critical risk. - **Dialysis Disequilibrium Syndrome** — A neurological complication from rapid fluid and solute shifts during dialysis, presenting with nausea, headache, and restlessness, typically managed by slowing the treatment rate. ## 같은 주제 문제 - [A nurse is caring for a client receiving hemodialysis. 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