HESI Case Study - Chronic Kidney Disease exam with complete solution graded A+

Meet the client - The client is an older adult with a long history of type 2 diabetes mellitus and hypertension. The client record notes a family history of polycystic kidney disease (PKD). The client was diagnosed with stage 4 chronic kidney disease (CKD) two years ago. The client calls the nephrology office to speak to the clinic nurse. The client reports loss of appetite, fatigue, nocturia, and occasional shortness of breath. Etiology - The client's current medications include a angiotension receptor blocker (ARB), a diuretic, and an oral diabetic medication. The client's most recent lab work (3 months ago) includes: Hemoglobin: 10.5 g/dL (105 g/L) Hematocrit: 30.0% (0.3 proportion of 1.0) Creatinine: 2.25 mg/dL (171.56 mcmol/L) Blood Urea Nitrogen (BUN): 25 mg/dL (8.92 mmol/L) Glomerular Filtration Rate (GFR): 28 mL/min/1.73m2 Sodium: 132 mEq/L (132 mmol/L) Potassium: 3.8 mEq/L (3.8 mmol/L) Calcium: 8.9 mg/dL (2.23 mmol/L) Phosphorus: 4.0 mg/dL (1.29 mmol/L) Parathyroid Hormone (PTH): 98 pg/mL (98 ng/L) The nurse reviews the client's medical history. What part of the medical history should the nurse consider relevant to the client's current history? - Hypertension. Hypertension is one of the primary causes of CKD. The vast majority of clients with CKD have hypertension, which may be either the cause or the result of CKD. Polycystic kidney disease. PKD gene mutation will develop kidney cysts by age 30. Half of these people develop chronic kidney disease (CKD) by age 50 years.Diabetes Mellitus. Uncontrolled diabetes is a leading causative factor in renal disease. Which additional symptoms should the nurse ask about? - Nausea Ammonia is a breakdown product of urea. When ammonia accumulates in the gastrointestinal tract, it causes irritation, nausea, vomiting, a metallic taste in the mouth, and bleeding. Decreased attention span. Problems ranging from lethargy to seizures or coma, which may indicate uremic encephalopathy. Itching Calcium phosphate crystals and urea accumulate in the skin, causing itching. Based on the client's symptoms, what should the nurse suspect? - The client has uremia and may need to start dialysis. Classic signs of uremia are nausea, vomiting, fatigue, weight loss, anorexia, muscle cramps, pruritis, and a change in mental status. The nurse determines that the client is demonstrating progression of chronic kidney disease and is uremic. The nurse is teaching the client about progression of chronic kidney disease (CKD). Which evaluation statement documented by the nurse indicates the client's understanding of the disease process? - The client acknowledges that renal replacement therapy will need to be initiated immediately to rid the body of waste and maintain fluid balance. CKD is fatal unless some form of renal replacement therapy such as dialysis or organ transplantation is done