The nurse assesses a client during the dwell time of a peritoneal dialysis cycle. Which assessment would require immediate intervention?

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During peritoneal dialysis, dialysate is infused into the abdominal cavity and the tubing is then clamped to allow the fluid to dwell for a specified period. After the dwell time, the catheter is unclamped and the fluid drains out via gravity. During the instillation and dwell portions of the cycle, clients are monitored closely for indications of respiratory distress (eg, difficulty breathing, rapid respirations, crackles) that can result from instilling the dialysate too rapidly, overfilling of the abdomen, or fluid entering the thoracic cavity (Option C). Crackles can also occur if over time there is more dialysate infused than is removed (fluid gain). (Option A) Clients receive peritoneal dialysis due to chronic kidney failure. The client's blood pressure is likely elevated secondary to the renal failure. This assessment is important to monitor, but crackles in the lungs are the priority. (Option B) Clients with renal failure typically have electrolyte abnormalities (eg, acidosis) that lead to nausea. This is not a priority. (Option D) Edema in the extremities can also indicate volume overload. However, this could be due to many other factors (eg, blood pressure medications such as amlodipine) or fluid overload from kidney disease. It is not a priority over crackles, which indicate direct seeping of excess peritoneal cavity fluid into the thorax through diaphragmatic channels. Educational objective: Clients receiving peritoneal dialysis should be monitored carefully for signs and symptoms of respiratory compromise, including difficulty breathing, rapid respirations, and crackles.

The Nurse Assesses a Client During the Dwell Time of a Peritoneal