During a home visit, a nurse observes a patient performing a peritoneal dialysis exchange. Which technique observed by the nurse indicates that the patient requires additional teaching?

Choice A rationale Monitoring vital signs and daily weight is a critical component of peritoneal dialysis management. Weight changes are the most accurate indicator of fluid volume status and the effectiveness of ultrafiltration. Blood pressure readings help identify complications such as hypovolemia or fluid overload. This practice demonstrates that the patient understands the importance of tracking physiological responses to therapy, ensuring that the prescribed dextrose concentration in the dialysate is effectively removing the necessary fluid. Choice B rationale Daily inspection of the catheter exit site is essential for the early detection of exit-site infections or peritonitis. Redness, warmth, swelling, or purulent drainage are clinical indicators of bacterial colonization. Teaching patients to recognize these signs allows for prompt medical intervention, which prevents the infection from tracking along the catheter into the peritoneal cavity. This observation confirms the patient is adherent to necessary safety protocols and understands the risks associated with long-term peritoneal access. Choice C rationale Peritonitis is the most common and serious complication of peritoneal dialysis, often caused by the introduction of skin flora during the connection process. The use of sterile gloves and meticulous hand hygiene reflects proper aseptic technique, which is vital for maintaining the sterility of the closed system. This behavior indicates that the patient has mastered the complex steps required to prevent contamination, thereby reducing the likelihood of inflammation and scarring of the peritoneal membrane. Choice D rationale Draining dialysate effluent onto the floor is a gross violation of infection control and safety standards. The effluent contains metabolic waste products and can be a medium for bacterial growth. This action creates a significant slip hazard and contaminates the environment where sterile procedures are performed. Proper disposal involves draining the fluid into a toilet or a designated drainage container. This observation clearly identifies a need for immediate re-education regarding hygiene, safety, and waste management.