Question

Mrs. G is a 61-year-old female who is being seen as part of ongoing care. During her assessment, she tells the nurse that she has been feeling much worse over the course of the past 2 weeks. Her skin is very dry and itchy, she has headaches, and she complains of feeling exhausted. Mrs. G was diagnosed with type 2 diabetes 8 years ago and has developed chronic kidney disease, in which she takes diuretic medications and has a modified diabetic diet that is low in protein. Her last GFR was checked one month ago and was 28 mL/min.

The physician orders lab work and diagnostic testing. Her lab results are as follows: Hgb: 3.8/mcl, Platelets: 100,000 mnl, BUN: 32mg/dL, Creatinine: 3.8 mg/dL, Na: 131 mEq/L, K: 3.7 mEq/L, Glucose: 166 mg/dL. Her urinalysis shows that she has excess protein and glucose in the urine. Her GFR is 14 mL/min. The nurse notes that Mrs. G seems very fatigued and appears disoriented at times throughout the assessment.

Based on Mrs. G’s lab results and symptoms, the physician has determined that the patient’s kidney disease has progressed and now she is in a state of end-stage renal disease (ESRD). The nurse receives the following orders for medications to give the patient:

Epogen 100 units/kg SQ

Periactin 4 mg PO tid

Following administration of the medications, the nurse receives further orders to prepare Mrs. G for hemodialysis. The patient has not undergone dialysis in the past and she does not have an access port for the procedure. She is scheduled for placement of a vascular access device and then will receive her first round of dialysis in her hospital room upon them.

What is a primary nursing diagnosis for Mrs. G and why?

1. excess fluid volume related to dysfunctioning of kidney as evidenced by what?
2. imbalanced nutrition intake; less than body requirement related to food restrictions as evidenced by what?
3. activity intolerance related to low level of hemoglobin as evidenced by what?
4. disturbed carbohydrate metabolism related to less production of insulin as evidenced by what?
5. risk of bleeding related to low platelets count as evidenced by what?
6. risk of low self-esteem related to disease condition as evidenced by what?

Answer 1

Primary diagnosis is excess fluid volume because it is indicator to develop other complications like breathing difficulty ,overload etc..

1)excess fluid volume related dysfunctioning of kidney as evidenced by she takes diuretic medications

2)imbalanced nutrition intake less than body requirement related to food restrictions as evidenced by she has been feeling worse and complains feeling exhausted

3)activity intolerance related low level of hemoglobin as evidenced by she appears fatigue and unable to do any activities

4)disturbed carbohydrate metabolism related to less production of insulin as evidenced by excess protein and glucose in the urine

5)