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K.B. is a 32-year-old woman being admitted to the medical floor for fatigue and dehydration. While taking her history, you discover that she has diabetes mellitus (DM) and has been insulin dependent since the age of 8 . She has undergone hemodialysis (HD) for the past 2 years because of end-stage renal disease (ESRD). Your initial assessment of K.B. reveals a pale, thin, slightly drowsy woman. Her skin is warm and dry to the touch with poor skin turgor, and her mucous membranes are dry. Her vital signs are , . She tells you she has been nauseated for 2 days so she has not been eating or drinking. She reports severe diarrhea. The following blood chemistry results are back.
Laboratory Test Results:
The rest of K.B.'s physical assessment is within normal limits. You note that she has an arteriovenous (AV) fistula in her left arm. K.B.'s admission CBC yields the following results:
Laboratory Test Results:
K.B. is sent for an HD treatment. Over the next 24 hours, K.B.'s nausea subsides, and she is able to eat normally. While you are helping her with her morning care, she confides in you that she does not understand her diet. "I just get blood drawn every week and meet with the dialysis dietitian every month-I just eat what she tells me to eat. It's so hard!"
The following day, K.B. is discharged feeling much better and with a good understanding of her dietary restrictions. Her iron stores have been evaluated and found to be low. Her physician has instructed her to resume her preadmission medications, with the addition of ferrous fumarate oral suspension bid between meals with water, if tolerated (or with meals if distress occurs) and epoetin (Epogen) to be given 3 times a week intravenously with dialysis. She is also given a prescription for Nephrocaps vitamin supplements to be taken daily. You spend some time with K.B. to explain the new medications. Using the Teach-Back technique, you ask K.B. to explain what she has learned. Which statement by K.B. reflects need for further teaching?
a. "The liquid iron will cause my bowel movements to turn black or dark green." b. "I should dilute the liquid iron and drink it with a straw so that it won't stain my teeth." c. "I won't need to take the iron supplements as long as I get the Epogen during dialysis." d. "Hopefully I will feel less tired all the time when these medicines start building up my red blood cells."