Page 1831 - Saunders Comprehensive Review For NCLEX-RN

illness and prepare the client for long-term dialysis
and transplantation, or explain to the client about her
or his choice to decline dialysis or transplantation;
with elderly clients, provide information that kidney
function is declining and in time may reach end-stage
renal disease and require dialysis; encourage healthy
lifestyle and discuss choices.
E. Special problems in kidney disease and interventions (Box 54-6)
1. Activity intolerance and insomnia
a. Fatigue results from anemia and the
buildup of wastes from the diseased
kidneys.
b. Provide adequate rest periods.
c. Teach the client to plan activities to
avoid fatigue.
d. Mild central nervous system (CNS)
depressants may be prescribed to
promote rest.
2. Anemia
a. Anemia results from the decreased
secretion of erythropoietin by
damaged nephrons, resulting in
decreased production of red blood
cells.
b. Monitor for decreased hemoglobin and
hematocrit levels.

c. Administer hematopoietics such

as epoetin alfa or darbepoetin alfa, as
prescribed to promote maturity of the
red blood cells.
d. Administer folic acid as prescribed.
e. Administer iron orally as prescribed,
but not at the same time as phosphate
binders.
f. Administer stool softeners as prescribed
because of the constipating effects of
iron.
g. Note that oral iron is not well absorbed
by the GI tract in CKD and causes
nausea and vomiting; parenteral iron
may be used if iron deficiencies persist
despite folic acid or oral iron
administration.

h. Administer blood transfusions;

prescribed only when necessary (acute

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