Mr. T is a 68-year-old client diagnosed with chronic renal failure who will be starting dialysis in several weeks
When reviewing his lab results, the nurse notices elevated levels of C-reactive protein and tumor necrosis factor, both markers of an inflammatory process. What would be the best action the nurse could take next? 1. Instruct the client to use a low-protein diet.
2. Suggest vitamin supplements.
3. Assess the client for signs of wasting syndrome.
4. Refer the client to rheumatology.
3
Rationale: Elevated levels of C-reactive protein and tumor necrosis factor are markers for an inflammatory state common among clients with chronic kidney disease and contribute to anorexia and wasting syndrome. Protein stores are depleted in clients on dialysis due to the loss of amino acids into the dialysis fluid, and can result in compromised nutritional health. The benefit of vitamin supplementation for clients with chronic kidney disease is not well established, but may be beneficial in replacing
water-soluble vitamins lost during dialysis. Markers for inflammation are also present in clients with arthritis, but since this client is already diagnosed with chronic kidney disease it is most likely that is the cause.
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