A nurse is providing peritoneal dialysis to a child and observes there is minimal dialysate outflow at the end of the outflow time. Which of the following actions should the nurse take?
Increase the dwell time during the next dialysis infusion.
Instruct the child to change position.
Increase oral fluid intake.
Assess for a bruit at the site of the peritoneal catheter.
The Correct Answer is B
Choice A rationale
Increasing the dwell time during the next dialysis infusion is not appropriate. The issue is with the outflow, not the dwell time. Increasing the dwell time could exacerbate the problem.
Choice B rationale
Instructing the child to change position is correct. Changing position can help facilitate the drainage of dialysate by allowing gravity to assist in the outflow process.
Choice C rationale
Increasing oral fluid intake is not relevant to the issue of minimal dialysate outflow. The problem lies with the mechanical process of dialysis, not fluid intake.
Choice D rationale
Assessing for a bruit at the site of the peritoneal catheter is not directly related to resolving minimal dialysate outflow. A bruit indicates blood flow through a vascular access, not the peritoneal catheter.
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Correct Answer is A
Explanation
Choice A rationale
A dietitian should be consulted for a newly admitted child to assess and plan for the child’s nutritional needs, especially if the child has specific dietary requirements or is at risk for malnutrition.
Choice B rationale
An occupational therapist may be involved later in the child’s care, but they are not typically the first referral for a newly admitted child.
Choice C rationale
A physical therapist may be involved later in the child’s care, but they are not typically the first referral for a newly admitted child.
Choice D rationale
A speech-language pathologist may be involved later in the child’s care, but they are not typically the first referral for a newly admitted child.
Correct Answer is A
Explanation
Choice A rationale
Providing a doll for the 3-year-old child to imitate parental behaviors helps the child understand and adjust to the new role of being an older sibling. It allows the child to practice nurturing behaviors and can reduce feelings of jealousy or displacement by involving them in the care of the newborn.
Choice B rationale
Preparing the child for a change in all of their routines can be overwhelming and may cause unnecessary stress. It is more effective to maintain as much consistency as possible in the child’s routine while gradually introducing changes related to the new sibling.
Choice C rationale
Telling the child that they will now have a new playmate may create unrealistic expectations. A newborn is not immediately capable of playing, and this statement may lead to disappointment and frustration for the 3-year-old.
Choice D rationale
Waiting for the newborn to come home before moving the 3-year-old from the crib to a bed can create a sense of displacement and jealousy. It is better to make this transition well before the newborn’s arrival to allow the older child to adjust to the change independently of the new sibling.