Question

Joni Winters, a 64-year-old female client, is admitted with a fractured hip. She has chronic renal failure and has continuous peritoneal dialysis (CAPD) exchanges every 6 hours. The Tenckhoft peritoneal catheter site has redness and swelling which goes across the abdomen. The client states that her abdomen is tender to touch all over, and the nurse notes the abdomen is rigid. The bowel sounds are decreased, and the peritoneal dialysate is in the dwelling phase of the cycle. The vital signs are T, 101°F; BP, 140/90 mm Hg; HR, 110 beats/minute; RR, 28 breaths/minute. Answer each question below:

d. For the 5 electrolytes in Letter C, explain why each of these is lower or higher than normal. (Not just because she missed her dialysis).

e. What will the lab values of specific gravity and urine creatinine clearance be if the client cannot have her dialysis?

f. Explain why her blood pressure and heart rate would be elevated if she did not have her dialysis.

g. Why will the client be anemic in renal failure? What medication will be given to help improve this problem

Answer 1

d. For the 5 electrolytes in Letter C, explain why each of these is lower or higher than normal. (Not just because she missed her dialysis).

Electrolytes details not available . Usually patients with CRF develop hypernatremia or dilutional hyponatremia, hyperkalemia, hypocalcemia, hyperphosphatemia and metabolic acidosis. These all changes are due to decrease glomerular filtration.

e. What will the lab values of specific gravity and urine creatinine clearance be if the client cannot have her dialysis?

urine speicific gravity between 1.007 and 1.010. Usually it is fixed in chronic renal failure because of permanent changes in the glomeruli.

Urine creatinine clearance: decreased ccreatinine clearance> 130ml/min(normal 100 -130ml/mt) and elevated serum creatinine level, > 1mg/dl.(normal 0.5- 1mg/dl)

f. Explain why her blood pressure and heart rate would be elevated if she did not have her dialysis.

Due to water retention. when excess amount of fluid is retained in the body,heart has to take additional effort to pump blood to systemic circulation, and at the same time vascular resistance also high due to hypervolemia . These two changes result increase heart rate and blood pressure, if the patient did not have dialysis.

g. Why will the client be anemic in renal failure? What medication will be given to help improve this problem?

Reason 1.Erythropoein (EP) production will decrease. EP is necessary for production of RBC from bone marrow. Hence, these clients are anemic.

reason2: iron deficiency anemia due to decreased availability of iron. decrease RBC survival rate, blood loss, low absorption

Management includes:

• Inj.Erythropoein or hemopeitin
• Iron therapy - by oral or intravenous infusion. Avoid IM injection of iron, it will cause bruising if patient administered heparine during dialysis.
• dietary supplements.