A nurse is caring for a client who has malnutrition. Which of the following findings should the nurse report to the provider?

Choice Areason: Increasing phosphorus intake is not advisable for clients with chronic kidney disease, as they may have hyperphosphatemia, a condition of high phosphorus levels in the blood. Hyperphosphatemia can cause bone loss, calcification of soft tissues, and itching.

Choice Breason: Increasing potassium intake is not advisable for clients with chronic kidney disease, as they may have hyperkalemia, a condition of high potassium levels in the blood. Hyperkalemia can cause muscle weakness, numbness, tingling, and cardiac arrest.

Choice C reason: Limiting protein intake is advisable for clients with chronic kidney disease, as protein metabolism produces urea, which is excreted by the kidneys. High protein intake can increase the workload and damage of the kidneys, and cause uremia, a condition of high urea levels in the blood. Uremia can cause nausea, vomiting, fatigue, and mental confusion.

Choice D reason: Limiting calcium intake is not advisable for clients with chronic kidney disease, as they may have hypocalcemia, a condition of low calcium levels in the blood. Hypocalcemia can cause muscle spasms, seizures, and cardiac arrhythmias.

Choice A reason: Dietary restrictions will not eventually allow the intake of gluten to resume. Gluten is a protein found in wheat, barley, rye, and some oats. It causes damage to the small intestine in people with celiac disease. The only treatment for celiac disease is a lifelong gluten-free diet.

Choice B reason: This condition may cause secondary lactose intolerance. Lactose is a sugar found in milk and dairy products. It is broken down by an enzyme called lactase in the small intestine. People with celiac disease may have reduced levels of lactase due to the damage to the small intestine caused by gluten. This can lead to lactose intolerance, which is the inability to digest lactose properly. Symptoms of lactose intolerance include bloating, gas, diarrhea, and abdominal pain after consuming dairy products.

Choice C reason: Nutritional therapy for this condition does not include limiting proteins and calories. People with celiac disease need adequate amounts of proteins and calories to maintain their health and prevent malnutrition. They also need to ensure that they get enough vitamins, minerals, and fiber from gluten-free sources.

Choice D reason: A normal diet cannot resume after a period of remission. Celiac disease is a chronic autoimmune disorder that does not have a cure. Even if the symptoms improve or disappear, the damage to the small intestine can still occur if gluten is consumed. Therefore, a strict gluten-free diet must be followed for life.