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Gg is a 42 y/o woman being admitted to the medical floor for complaints of fatigue and dehydration.
While taking her history, you discover that she has diabetes mellitus and has been insulin dependent since
the age of 10. She has undergone hemodialysis for the past 3 years. Your initial assessment of Gg reveals
pale, thin slightly drowsy woman. Her skin is warm and dry to touch with poor skin turgor and her
mucous membranes are dry. Her vital signs are 140 / 88, PR – 116, RR – 18 and temp 37.7*C. She tells
you she has been nauseated for 2 days so she has not been eating and drinking. She reports severe
diarrhea. Serum calcium, phosphate, magnesium and complete blood count have been drawn but the
results are not yet available.
5. Are these values normal? If not, what are the abnormalities? Answer utilizing the table.
RBC value is below normal.
6. Gg’s physician notes that she is anemic, which is most likely the cause of her increasing fatigue.
Why is Gg anemic?
When kidneys are diseased or damaged, they do not make enough EPO. As a result, the bone
marrow makes fewer red blood cells, causing anemia. When blood has fewer red blood cells, it
deprives the body of the oxygen it needs.
Gg is sent for a hemodialysis treatment. Over the next 24 hours, Gg’s nausea subsides and she is able to
eat normally. While you are helping with her morning care, she confides in you that she doesn’t
understand the renal diet. “ I just get blood drawn every week and meet with the dialysis dietitian every
month – I just eat what she tells me to eat.”
7. What information would you give to Gg about her new medications? Gg asks, “Why do I need a
prescription for vitamins/ I can just take something on sale at the drug store right?” How do you
respond?
Vitamins are the important micronutrients, which is used by the body for carrying out several
metabolic processes and also in the development of the body. It aids in improving vision and also
strengthens the bone.
They are also used by certain enzymes as a co-factor to carry out vital reactions of our body. It’s
deficiency can lead to stress, anxiety, trauma and other serious problems. During kidney failure,
the vital balance of nutrients gets affected, which in turn disrupts the vitamin store in the body.
8. Identify (8) potential problems, determine how you would assess the problem and then delineate
nursing intervention and patient education strategies for each.
9. When monitoring Gg’s response to the epoetin, what adverse effect would you expect?
Headache, body aches, cough, or injection site irritation/pain may occur. If any of these effects
last or get worse, tell your doctor or pharmacist promptly. Epoetin alfa may sometimes cause or
worsen high blood pressure, especially in patients with long-term kidney failure.
10. During the following week, which laboratory result is most important to monitor while Gg is on
epoetin, explain.
Epoetin is a medication, which is prescribed for the treatment of anemia due to which the red
blood cells decrease abnormally. It is used for the patients who take dialysis treatment to reduce
the need for blood transfusion.
RBC, Hemoglobin and Hematocrit values are the important laboratory results that should be
monitored while taking Epoetin.
Gg is discharged to home and goes to the local dialysis center 3x a week, she also keeps appointment to
check her laboratory and diet changes.
11. When Gg visits the dialysis center, what is the most accurate indicator of fluid loos or gain?
Weight is a significant factor that indicates if the patient has loss or gained some weight before
and after dialysis.
Upon Gg’s visit you nursing diagnosis is excess fluid volume RT decreased urine output, dietary excess
and retention of sodium and water. Create your plan of care for Gg. Give at least (5) nursing intervention
and its rationale. What are the expected outcomes?
Monitor weight regularly using the same scale and preferably at the same time of day wearing the
same amount of clothing. Sudden weight gain may mean fluid retention. Different scales and
clothing may show false weight inconsistencies.
Monitor input and output closely. Dehydration may be the result of fluid shifting even if overall
fluid intake is adequate.
Monitor and note BP and HR. Sinus tachycardia and increased BP are evident in early stages.
Note for presence of edema by palpating over the tibia, ankles, feet, and sacrum. Dependent areas
more readily exhibit signs of edema formation.
Review serum electrolytes, urine osmolality, and urine specific gravity. All are indicators of fluid
status and guide therapy.
Outcomes