The nurse has reviewed the Nurses' Notes, Vital Signs, and Laboratory Results from 3 months ago.

Exhibits

The nurse is reviewing the client's plan of care. Which of the following findings indicate the client's condition has improved? Select all that apply.

Rationale:

A. A client who has dementia: Dementia affects cognitive function but does not inherently increase susceptibility to respiratory complications from mold exposure. While general health monitoring is important, this client is not at high risk for mold-related adverse effects.

B. A client who has osteoarthritis: Osteoarthritis primarily affects joints and mobility. It does not compromise the respiratory system or immune response in a way that would increase vulnerability to mold exposure.

C. A client who has cystic fibrosis: Clients with cystic fibrosis have impaired mucociliary clearance and chronic respiratory vulnerability, making them more susceptible to respiratory infections and complications from environmental mold exposure. Mold inhalation can exacerbate pulmonary symptoms and lead to significant health risks.

D. A client who has chronic hypertension: Hypertension affects the cardiovascular system but does not directly increase susceptibility to respiratory complications from mold. This client is not considered high risk for adverse effects from mold exposure.

Rationale:

A. Oliguria: Clients with end-stage kidney disease (ESKD) often experience oliguria or significantly reduced urine output due to severe loss of nephron function. This contributes to fluid retention, electrolyte imbalances, and accumulation of waste products in the body.

B. Hypotension: ESKD more commonly leads to hypertension rather than hypotension because of fluid overload and activation of the renin-angiotensin-aldosterone system. Hypotension may occur only during dialysis or with certain medications but is not an expected finding in untreated ESKD.

C. Edema: Fluid retention caused by decreased glomerular filtration and impaired renal excretion leads to peripheral and sometimes generalized edema. Edema is a classic sign of ESKD and indicates compromised fluid balance.

D. Anemia: Impaired kidney function reduces erythropoietin production, leading to decreased red blood cell synthesis and resultant anemia. Clients often require erythropoiesis-stimulating agents or supplemental iron to manage this complication.

E. Bradypnea: Respiratory rate is not typically decreased in ESKD. If present, bradypnea would suggest a separate neurologic or respiratory issue rather than a direct effect of kidney failure. Clients may develop Kussmaul respirations if metabolic acidosis is severe, but bradypnea is not expected.