Nurse’s notes:1615- The client presents to the emergency dep…
Nurse’s notes:1615- The client presents to the emergency department with reports of shortness of breath, weakness, nausea, and muscle cramping. The client has a history of Type 2 Diabetes Mellitus, End-Stage Renal Disease (ESRD) on hemodialysis, and hypertension. An arteriovenous (AV) fistula is present in the upper left arm. The client normally attends dialysis 3 times per week. The client reports missing 2 dialysis appointments related to a lack of transportation. Client states, “I feel as if my heart is racing and I am just so tired.”Physical Assessment Findings SystemFindings RespiratoryTachypnea, crackles at lung bases, SpO2 94% on room air CardiacIrregular heart rate, tachycardia (112 bpm), elevated BP (170/94 mmHg), no murmurs Neurologic Alert and oriented x4, anxious GastrointestinalNausea, decreased appetite, abdomen soft, non-tender GenitourinaryAnuric (reports no urine output), bladder non-distended MusculoskeletalMuscle cramping, numbness, tingling and decreased strength in lower extremities, +1 pedal edema Vital SignsValue Temperature98.4°F (36.9°C) Heart Rate112 bpm, irregular Blood Pressure156/78 mmHg Respiratory Rate24 breaths/min SpO294% on room air Nurse’s Notes:1625- Lab here to draw labs. ECG complete Lab TestValueNormal Range Serum Potassium7.6 mEq/L3.5-5.0 mEq/L Serum Sodium132 mEq/L135-145 mEq/L Serum Chloride100 mEq/L98-106 mEq/L Serum Bicarbonate (CO2)18 mEq/L22-29 mEq/L Serum Calcium7.9 mg/dL8.5-10.5 mg/dL Serum Phosphorus5.8 mg/dL2.5-4.5 mg/dL Serum Creatinine9.2 mg/dL0.6-1.2 mg/dL Blood Urea Nitrogen (BUN)105 mg/dL7-20 mg/dL Glomerular Filtration Rate (GFR)8 mL/min>60 mL/min Blood Glucose168 mg/dL70-110 mg/dL (fasting) Hemoglobin (Hgb)9.1 g/dL13.5-17.5 g/dL (M) Hematocrit (Hct)28%38-50% (M) White Blood Cell (WBC) Count6,000 /mm³4,500-11,000 /mm³ Platelet Count190,000 /mm³150,000-450,000 /mm³Electrocardiogram (ECG)Tall peaked T waves, widened QRS complexes Nurse’s Notes:1630- Contacted provider, and orders were received for IV glucose and insulin to lower potassium and prepare for the client to be transported to the dialysis unit.1645- Client transported to dialysis.Nurses’ Notes:2000- Client stabilized after dialysis and discharge orders received. Teaching provided on end-stage renal disease with hemodialysis management.Which client statements indicates understanding of discharge teaching? (Select all that apply)
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