The nurse is caring for an older adult client with chronic renal failure who is scheduled for dialysis in two hours. Which finding is most concerning?
1. Hematocrit 58%
2. Platelet count 99,000/microliter
3. Diffuse pulmonary crackles
4. Increased jugular venous distention
1. Hematocrit 58%
Explanation: 1. Chronic renal failure results in a two-fold increase in the chance of being diagnosed with anemia. Erythropoietin (EPO), a hormone the body normally makes with functioning kidneys, is often given for this. A hematocrit or hemoglobin above normal places the client at risk for stroke or myocardial infarction. This level is 20% above normal. The EPO injections must be temporarily held.
2. This is a low platelet count. It is not dangerously low and is not related to the renal failure.
3. Fluid overload can manifest as jugular venous distention, crackles, dyspnea, etc. This will resolve with the dialysis treatment scheduled.
4. Fluid overload can manifest as jugular venous distention, edema, tachycardia, etc. This will resolve with the dialysis treatment scheduled.
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