Synthesis of the disease (Client centered) Anemia Anemia is common in people with kidney disease.

Healthy kidneys produce a hormone called erythropoietin, or EPO, which stimulates the bone marrow to produce the proper number of red blood cells needed to carry oxygen to vital organs. Diseased kidneys such as in the client, however, often dont make enough EPO. As a result, the bone marrow makes fewer red blood cells. Other common causes of anemia pertaining to the client may include blood loss from hemodialysis and low levels of iron and folic acid. These nutrients from food help young red blood cells make hemoglobin, their main oxygen-carrying protein. The anemic client also tires easily and looks pale. problems. Nephrosclerosis Nephrosclerosis, hardening of the walls of the small arteries and arterioles of the kidney. This condition is caused by the clients hypertension, which she had been diagnosed with for years. In addition to the hypertension, the nephrosclerosis is also due to the renal involvement. The symptoms of nephrosclerosis include impaired vision, blood in the urine, loss of weight, and the accumulation of urea and other nitrogenous waste products in the blood, a condition known as uremia, which the client had experienced in the past. Treatment includes the administration of antihypertensive drugs, elimination of infection and of any obstruction, and other measures for relief of chronic renal failure. Risk Factors A. Non- Modifiable Factors 1. Age Client is 78 years old. Older clients are at risk for CKD because of reduced cardiac contractile function, vascular compliance, renal plasma flow, and renal mass. The older adult has more difficulty maintaining a homeostatic fluid balance. The ability to retain sodium declines with age, as does the ability to concentrate urine. Older clients are also more likely to have pre-existing renal damage from such diseases as hypertension. 2. Family history The clients mother died due to a heart attack. The three other siblings presently all have hypertension. Anemia may also be a contributing factor to potential heart

B. Modifiable Factors 48

1. Diet The client is fond of eating foods high in sodium, such as processed foods, junk foods such as chips, and fast food like Jollibee. Her diet may be a contributing factor to her longstanding hypertension. 2. Hypertension Client has a history of hypertension, which is an underlying cause to CKD. The clinical syndrome consists of slowly progressive renal failure, low grade proteinuria and bland urine sediment. Kidney disease can also cause new hypertension or exacerbate preexisting hypertension. High blood pressure puts more stress on blood vessels throughout the body, including the kidney filters (nephrons). Hypertension is the number two cause of kidney failure. 3. Hypercholesterolemia Is a condition characterized by very high levels of cholesterol in the blood. The condition occurs when excess cholesterol in the bloodstream is deposited in the walls of blood vessels, particularly in the arteries that supply blood to the heart (coronary arteries). The abnormal build-up forms plaque that narrow and harden artery walls. The clients diet may be a factor to this condition. (http://ghr.nlm.nih.gov/condition=hypercholesterolemia)

Signs and symptoms with rationale A. Anemia Anemia is characterized by a decreased level of hemoglobin (120) and hematocrit (0.35) in the blood (as evidenced by a laboratory result last 11/7/13) which is the result of decreased synthesis of erythropoietin by the kidneys, this is manifested in the form of pale palpebral conjunctiva, weakness, easy fatigability, generalized muscle weakness, cold intolerance, and pale buccal mucosa. These symptoms were present on 11/08/13 and 11/12/13. B. Hypertension (Client is chronically hypertensive) There is usually an elevated blood pressure in patients with renal failure due to activation of the rennin angiotensin aldosterone system and water retention leading to congestion of fluids in the blood. He manifested this symptom on 11/08/13 and 11/12/13. C. Inability to concentrate urine Loss of sodium in urine becomes evident leading to hyponatremia. Dilute Polyuria can lead to dehydration.

49

D. Decreased renal blood flow is due to further destruction of nephrons resulting to activation of renin- angiotensin-aldosteron activating, leading to hypertension. E. Chronic renal failure At this point kidneys cannot regulate volume and solute composition causing loss of non-excretory renal functions and loss of excretory renal functions. F. Loss of non-excretory renal functions immune disturbances which can affect the number of WBC in the body, wherein risk for infection occurs.

G. Increased in serum triglycerides levels is thought to result from decrease removal rather than increase production. H. Fatigue (11/08/13 and 11/12/13) Lesser energy can be synthesized by the muscle fibers that are related to decreased oxygen supply by the blood secondary to anemia. I. Shortness of Breath (11/08/13 and 11/12/13) Clients with anemia may suffer from dyspnea (shortness of breath) because the transport of oxygen is impaired. Hemoglobin is lacking or the number of RBCs is too low to carry the adequate oxygen to tissues and hypoxia develops. J. Body Malaise (11/08/13 and 11/12/13) Due to decreased oxygen supply by the blood secondary to anemia. K. Pale palpebral conjuctiva and pale buccal mucosa (11/08/13 and 11/12/13) Due to decreased oxygen supply by the blood secondary to anemia. L. Uremia Develops secondary to inability of kidney to eliminate nitrogenous waste in the blood.

50