Prioritizing Nursing Care for a Client with Chronic Kidney Disease

QUESTION

87. In caring for a client with chronic kidney disease (CKD), the nurse notes that the client’s serum phosphate level
is elevated, with a converse decrease in serum calcium. Which nursing care goal is a priority, based on these
findings? A. Prevent injury B. Protect skin integrity. C. Prevent infection. D. Manage fluid volume.

ANSWER

Prioritizing Nursing Care for a Client with Chronic Kidney Disease

Caring for clients with chronic kidney disease (CKD) requires an understanding of the complex physiological changes that occur as a result of impaired kidney function. One common manifestation of CKD is the alteration in electrolyte balance, often resulting in elevated serum phosphate levels and decreased serum calcium levels. This particular imbalance has significant implications for the client’s health and requires careful nursing intervention.

Priority Nursing Care Goal: Prevent Injury

Among the options provided, the priority nursing care goal for a client with elevated serum phosphate levels and decreased serum calcium levels is to prevent injury. The correlation between these electrolyte imbalances and the risk of injury is well-documented. Elevated serum phosphate levels can lead to a condition known as hyperphosphatemia, which has the potential to disrupt calcium homeostasis and result in a phenomenon called hypocalcemia. Hypocalcemia, or low serum calcium levels, can lead to various complications, including muscle weakness, cramps, and even tetany.

Rationale for Priority

Muscle Function and Neuromuscular Excitability:Calcium plays a crucial role in muscle function and neuromuscular excitability. A decrease in serum calcium levels can lead to muscle weakness, making the client susceptible to falls and potential injuries.

Risk of Fractures: Hypocalcemia weakens bones, increasing the risk of fractures. Clients with CKD are already at a higher risk of bone disorders due to impaired mineral metabolism. The combination of elevated phosphate levels and decreased calcium levels exacerbates this risk.

Tetany and Seizures: Severe hypocalcemia can lead to tetany, a condition characterized by involuntary muscle contractions. In severe cases, it can progress to seizures, further compromising the client’s safety.

Nursing Interventions

Fall Prevention: Implement measures to prevent falls, such as providing assistive devices, ensuring a clutter-free environment, and offering assistance with ambulation.

Education: Educate the client and family about the importance of calcium-rich diet and phosphate-binding medications to manage electrolyte imbalances.

Regular Monitoring: Continuously monitor serum calcium and phosphate levels and collaborate with the healthcare team to adjust the client’s treatment plan as needed.

Evaluation

Assess for Muscle Weakness: Monitor the client’s muscle strength and address any signs of weakness promptly.

Client Education: Evaluate the client’s understanding of dietary modifications and medication management to prevent further electrolyte imbalances.

Injury Incidents: Monitor and document any incidents of falls or injuries, and assess their potential relationship with electrolyte imbalances.

In conclusion, preventing injury is a priority nursing care goal for a client with chronic kidney disease who presents with elevated serum phosphate levels and decreased serum calcium levels. By addressing this priority, nurses play a crucial role in promoting the client’s safety, preventing complications associated with electrolyte imbalances, and enhancing their overall quality of life.