R. G. is a 61-year-old female patient who is being seen as part ofongoing care. During her assessment, she tells


R. G. is a 61-year-old female patient who is being seen as part ofongoing 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. R. 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 1 month ago and was 28 mL/ min/ 1.73m2. The physician orders lab work and diagnostic testing. Her lab results are as follows: Hgb: 3.8/ mcl, Platelets: 100,000/ mcL, BUN: 32 mg/ dL, Cr: 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/ 1.73m2. The nurse notes that R. G. seems very fatigued and appears disoriented at times throughout the assessment.1. Describe how chronic renal failure differs from acute renal failure. 2. At what point is a person with chronic renal failure considered to be in end-stage renal disease? Based on R. G.’ s lab results and symptoms, the physician has determined that the patient’s kidney disease has progressed and she now is in a state of end-stage renal disease (ESRD). The nurse receives the following orders for medications to give to the patient: Epogen 100 units/ kg SQ Periactin 4 mg PO tid3. Describe why these drugs would be ordered for R. G.’ s condition. 4. What signs or symptoms would the nurse expect to see that would indicate that these medications are working? Following administration of the medications, the nurse receives further orders to prepare R. 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 return.5. What information should the nurse include as part of teaching about the vascular access device and dialysis? 6. Explain how a vascular access device works to use for dialysis. 7. Describe the basic process of hemodialysis. R. G. has returned from the cath lab with a vascular access device in place and is started on hemodialysis. Her first treatment takes place in her hospital room with a portable machine but she will later need ongoing dialysis when her condition stabilizes. The nurse reviews information with the patient about lifestyle changes and self-care now that she has ESRD.8. Explain what medications the patient would most likely need on a routine basis now that she will need regular hemodialysis. 9. What are the patient’s options for receiving hemodialysis once her condition stabilizes? 10. Review the important information the nurse should provide to this patient about placement and care of a vascular access device. 11. What follow-up tests would be necessary to ensure that the hemodialysis is working?   Health Science Science Nursing NURS 222 Share (0)

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