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MEDICAL SURGICAL NURSING End-Stage Renal Disease (ESRD) is a progressive, irreversible deterioration in renal function which ultimately leads to uremia or azotemia. Mrs. Mirana has been recently diagnosed with ESRD and has been told that she will need to undergo dialysis soon to correct her fluid and electrolyte imbalances as well as metabolic waste products. 1. Which of the following clinical manifestations is not expected in Mirana? a. BP: 167/99 mmHg b. pink frothy sputum and dyspnea c. breath smells like urine d. crushing chest pain which radiates to the jaw and arm RATIONALE: D. Pericarditis (due to irritation of the pericardial lining by uremic toxins) can be present in the patient, which manifests as a sharp, pleuritic, retro-sternal (under the sternum) or left precordial (left chest) pain. A crushing pain that radiates to the jaw and arm is characteristic of MI. Pulmonary edema (pink frothy sputum and dyspnea) is caused by fluid overload. Hypertension is due to sodium and water retention or from activation of the RAAS. Uremic fetor (breath has the odor of urine) is due to accumulation of waste products like urea. (p. 798-800, Understanding Medical Surgical Nursing by Williams and Hopper, 3 rd edition, 2007; p. 1326-1327, Brunner & Suddarth’s Textbook of Medical- Surgical Nursing, 10th edition, 2003) 2. Changes in serum electrolytes and metabolites prove to be a major abnormality seen in ESRD. Which of the following electrolyte values is least expected in Mrs. Mirana? a. Hypocalcemia b. Hyperphosphatemia c. Hyperkalemia d. Increased bicarbonate levels RATIONALE: D. Metabolic acidosis occurs because the kidneys are unable to excrete increased loads of acid. The kidney tubules are unable to excrete ammonia (NH3-) and reabsorb sodium bicarbonate (HCO3-). This results in increased ammonia levels (acid) and decreased bicarbonate (base) levels in the blood. Serum calcium and phosphate levels have a reciprocal or inversely proportional relationship in the body. With decreased filtration through the glomerulus of the kidney, there is an increase in the serum phosphate level and a reciprocal decrease in the serum calcium level. Hyperkalemia is due to decreased renal excretion of potassium and metabolic acidosis (K moves out of cell). (p. 797-800, Understanding Medical Surgical Nursing by Williams and Hopper, 3 rd edition, 2007; p. 1327-1328, Brunner & Suddarth’s Textbook of Medical-Surgical Nursing, 10th edition, 2003)
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3. Complications of ESRD can be prevented and delayed by administering the prescribed pharmacologic therapy. After providing education to Mrs. Mirana regarding her medications, which of the following statements made by the patient requires additional education? a.
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This note was uploaded on 03/29/2012 for the course BSN 101 taught by Professor Prof.emilsisco during the Spring '12 term at University of the Philippines Diliman.

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