The patient is a 68-year-old with a history of diabetes, hypertension (HTN), coronary artery disease (CAD), and recently diagnosed with end-stage renal disease (ESRD). She has been placed on hemodialysis three times a week for one month. She presents to the emergency department (ED) with fatigue, generalized weakness, muscle cramps, tingling sensation in arms and legs, and lightheadedness following 3 days of illness during which her husband reports she has complained of nausea and had a poor appetite and was not able to go for her scheduled dialysis 2 days ago.
Orders
- 12 lead EKG
- CBC
- Basic metabolic panel
- Chest X-ray
- Place on continuous cardiac monitor
- CT scan of abdomen
- Blood cultures times 2 sets
- Echocardiogram
Lab Results
Laboratory Test: Glucose
Result : 75 mg/dL (4.2 mmol/L)
Reference Range: 74 to 106 mg/dL (4.1 to 5.9 mmol/L)
Flow sheet
Initial vital signs: BP 146/82 mm Hg, heart rate 114 beats/minute, respiratory rate 18 breaths/minute, SpO2 98% on room air, temperature 98.2 F (36.8 °C) orally.
Vital signs: BP 156/88 mm Hg, heart rate 116 beats/minute, respiratory rate 22 breaths/minute, SpO2 98% on room air, temperature 98.0 F (36.7 °C) orally.
Vital signs: BP 150/88 mm Hg, heart rate 116 beats/minute, respiratory rate 20 breaths/minute, SpO2 98% on room air, temperature 98.1 F (36.7 °C) orally.
For each assessment finding, explain whether the actions taken were effective or ineffective.
Client Findings
A.
DenIes cramps, weakness, ornausea
B.
BP 116/68 mm Hg, HR 75 bpm
C.
Potasslum level 3.6 mEq/L3.6mmol/L)
D.
Verbalizes commitment to dialysisappointments
E.
Client states that she will need to resume her Lisinopril to control blood pressure
F.
Client is eager to add dark green vegetables and potatoes to her diet
The correct answer and Explanation is :
Let’s evaluate each assessment finding and the actions taken:
A. Denies cramps, weakness, or nausea
Action Taken: Not specified in this part of the report. However, if the patient denies these symptoms, it’s important to continue monitoring for any recurrence or new symptoms. Given her history and presentation, it would be crucial to assess for any underlying causes that could still contribute to her initial symptoms.
Effectiveness: The action of monitoring symptoms is effective if done regularly, but it’s important to ensure that any underlying issues (such as electrolyte imbalances or inadequate dialysis) are addressed. Since the patient reported these symptoms initially, follow-up is crucial to ensure they do not return or worsen.
B. BP 116/68 mm Hg, HR 75 bpm
Action Taken: The blood pressure and heart rate are now within normal ranges. This suggests that any initial issues with hypertension or tachycardia have been addressed, likely through treatment adjustments or medications.
Effectiveness: This is effective. Stable and normalized blood pressure and heart rate are crucial, especially in a patient with a history of CAD and hypertension. It indicates that the interventions to manage her blood pressure and heart rate are working.
C. Potassium level 3.6 mEq/L
Action Taken: The potassium level is within the normal range (3.5-5.0 mEq/L), indicating no hyperkalemia or hypokalemia. This is significant since abnormal potassium levels can cause cardiac complications, especially in patients undergoing dialysis.
Effectiveness: This is effective. Maintaining normal potassium levels is critical, especially for a patient on dialysis, as dialysis helps to regulate electrolyte levels. A normal potassium level suggests effective management and no immediate risk of complications related to potassium imbalances.
D. Verbalizes commitment to dialysis appointments
Action Taken: The patient has expressed a commitment to attending dialysis sessions.
Effectiveness: This is effective in terms of patient compliance and engagement. Consistent attendance at dialysis is essential for managing ESRD and preventing complications. This verbal commitment indicates that the patient understands the importance of regular dialysis.
E. Client states that she will need to resume her Lisinopril to control blood pressure
Action Taken: The patient wants to resume Lisinopril, a medication used for hypertension and to protect renal function.
Effectiveness: This could be effective if the medication is appropriate for the patient’s current condition, especially considering her ESRD. However, it’s crucial to review her current renal function and ensure that Lisinopril is suitable given her renal status. In patients with ESRD, dose adjustments or alternative medications may be necessary due to potential impacts on kidney function.
F. Client is eager to add dark green vegetables and potatoes to her diet
Action Taken: The patient wants to add these foods to her diet.
Effectiveness: This is generally ineffective or potentially harmful. Dark green vegetables and potatoes are high in potassium, which can be problematic for patients with ESRD and on dialysis. Dietary management is crucial for ESRD patients to avoid complications from excess potassium. The patient should be counseled on dietary restrictions to manage electrolyte levels effectively.
In summary:
- A: Monitoring is necessary, but effectiveness depends on continued observation and management of symptoms.
- B: Effective; normalized BP and HR indicate successful management of these parameters.
- C: Effective; normal potassium levels suggest proper electrolyte balance.
- D: Effective; commitment to dialysis is crucial for treatment adherence.
- E: Potentially effective, but requires careful consideration of renal function before resuming Lisinopril.
- F: Potentially ineffective; dietary adjustments should be guided by renal dietary restrictions to avoid complications.