A client arrives at the emergency room with symptoms of peptic ulcer disease. Which of these symptoms should the nurse identify as the priority?

Choice A: RBC count The red blood cell (RBC) count is not typically decreased by hemodialysis. Hemodialysis does not remove cells from the blood. However, patients with chronic kidney disease often have anemia, which is a low RBC count, due to a decrease in the production of erythropoietin by the kidneys. Erythropoietin is a hormone that stimulates the bone marrow to produce RBCs. Anemia in these patients is treated with erythropoiesis-stimulating agents, not dialysis.

Choice B: Protein Protein levels are not directly affected by hemodialysis. However, patients on hemodialysis may have lower protein levels due to dietary restrictions or protein loss during the treatment. It is important for patients to manage their protein intake to prevent malnutrition and maintain overall health.

Choice C: Potassium Potassium levels are expected to decrease following hemodialysis. Potassium is an electrolyte that is normally filtered out by the kidneys. In patients with kidney failure, potassium levels can build up in the blood and cause serious heart problems. Hemodialysis removes excess potassium from the blood, which helps to prevent complications such as cardiac arrhythmia. The normal range for serum potassium is 3.5 to 5.0 mmol/L. After a hemodialysis treatment, a nurse should expect to find a decrease in potassium levels in the laboratory data of a client. This is because hemodialysis effectively removes excess potassium, which can accumulate in the blood due to reduced kidney function. Maintaining proper potassium levels is crucial for preventing heart complications in patients with kidney failure.

Choice D: Calcium Calcium levels are not typically decreased by hemodialysis. In fact, calcium levels can be affected by the dialysate used during hemodialysis. Some dialysates contain calcium, and this can actually increase the patient’s blood calcium levels. Patients with kidney failure may also have secondary hyperparathyroidism, which affects calcium levels, and they may be treated with calcium supplements or vitamin D analogs to manage their calcium levels.

Choice A reason: Hypophosphatemia refers to an abnormally low level of phosphate in the blood. The normal range for serum phosphate in adults is typically around 2.5 to 4.5 mg/dL. In the context of acute kidney injury (AKI), the kidneys’ ability to excrete phosphate is impaired, which can actually lead to hyperphosphatemia, not hypophosphatemia. Therefore, while phosphate levels are important to monitor in AKI, hypophosphatemia is not typically expected.

Choice B reason: Hypercalcemia is characterized by an elevated level of calcium in the blood, with the normal range being approximately 8.5 to 10.2 mg/dL. AKI can sometimes be associated with hypercalcemia, particularly if there is extensive tissue breakdown or rhabdomyolysis. However, it is not as commonly expected as hyperkalemia. Hypercalcemia in AKI is more often secondary to other underlying conditions rather than a direct result of the kidney injury itself.

Choice C reason: Hyperkalemia is a common electrolyte imbalance in AKI and refers to a high level of potassium in the blood. The normal range for serum potassium is about 3.5 to 5.0 mEq/L. In AKI, the kidneys’ ability to excrete potassium is compromised, leading to an accumulation of potassium in the blood. This can be life-threatening, causing cardiac dysrhythmias and muscle weakness. Hyperkalemia is a key concern in AKI management and is often expected in this condition. While all the listed electrolyte imbalances can occur in various clinical scenarios, hyperkalemia is the most commonly expected electrolyte disturbance in a patient with acute kidney injury. It is crucial for healthcare providers to monitor and manage electrolyte levels carefully in AKI to prevent complications.

Choice D reason: Hypernatremia means an elevated sodium level in the blood, with the normal range being 135 to 145 mEq/L. While sodium balance can be affected in AKI, hypernatremia is not typically expected. It is more commonly associated with conditions that cause a loss of water or an intake of sodium, such as diabetes insipidus or excessive salt ingestion. In AKI, the focus is often on managing fluid overload rather than sodium excess.