The nurse performs peritoneal dialysis (PD) on the client with stable chronic renal failure. Which does the nurse determine is an undesirable outcome of therapy? The client:
1. Loses 3 pounds of body weight after dialysis
2. Experiences a persistent irregular heart rhythm
3. Reports feeling full during the dialysate infusion
4. Drains more fluid than dialysate volume instilled
2
2. An irregular heart rhythm associated with dialysis cues the nurse to evaluate the client's serum electrolytes, especially the potassium level (calcium and magnesium levels are important in maintaining the cardiac rhythm, also) because hypokalemia is associated with ventricular arrhythmias. Nevertheless, the nurse considers other causes of an irregular cardiac rhythm besides electrolytes such as hypoxia, fluid im-balance, and myocardial ischemia.
1 and 4. The amount of fluid PD is able to draw off the client depends on the dialy-sate mixture. The provider prescribes a client-suited mixture that begins with a hypertonic dextrose solution; and, interestingly, the provider adds other solutes to draw off suitable amounts of fluid and electrolytes and can include potassium to avoid exhausting the client's potassium reserve. The nurse expects the client to lose fluid volume during dialysis, reflected by the client's weight loss and by the excess output from the dialysis catheter.
3. The nurse expects the client to report abdominal fullness during dialysis, indicating that a large volume of fluid is in the abdomen.
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