Case Study Fluid & Electrolytes - Phosphorus

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Subjective assessment findings 1 – History of chronic kidney disease and diagnosis of end-stage renal disease. ESRD occurs when kidney function is less than 10% of normal. ESRD almost always follows CKD. Clients who have reached this stage need dialysis or a kidney transplant. The most common causes of ESRD in the U.S. are diabetes and high blood pressure. 2 – History of congestive heart failure CHF is a condition in which the heart can no longer pump enough oxygen-rich blood to the rest of the body. CHF may affect either the right side (right-sided heart failure) or the left side (left-sided heart failure) of the heart, but usually both sides are involved. As the heart loses pumping action, blood may back up into the lungs, liver, gastrointestinal tract, arms, and legs. The most common cause of CHF is coronary artery disease, a narrowing of the small blood vessels that supply blood and oxygen to the heart. 3 – History of hypertension High blood pressure is a primary cause of CHF. Hypertension caused by another medical condition or by a medication is called secondary hypertension. This client’s secondary hypertension is most likely due to CKD. 4 – Missed dialysis appointment 2 days ago. Clients diagnosed with ESRD develop metabolic acidosis when they are noncompliant with dialysis treatments. In the presence of acidosis, the client may experience hyperkalemia, hyponatremia, hypocalcemia, hyperphosphatemia, and hypermagnesemia. 5 – Fatigue and itching Manifestations of hyperphosphatemia are usually related to its underlying cause and may include joint pain, pruritus (itching), fatigue, shortness of breath, anorexia, nausea, vomiting, and sleep disturbances. 6 – Muscle aches, weakness, and severe cramping for 1 day The client is experiencing muscle aches, weakness, and severe cramping secondary to the hypocalcemia that accompanies

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