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This Concept Map, created with IHMC CmapTools, has information related to: Renal2.1, Family assess Culture and religion, Diet using standard tools Assess baseline and current eating habits, Diet using standard tools Assess previous and curent appetite, activity intolerance intervention Exercise, Psychosocial assess Personal, Assess baseline and current muscle mass and strength EBP Exercise, activity intolerance ???? SOB, Dx: Chronic Kidney Disease due to Hypertensive nephrosclerosis Stage 5? may lead to Decrease lifespan of RBC Decrease production of erythropoietin, Dx: Chronic Kidney Disease due to Hypertensive nephrosclerosis Stage 5? Dx by 1- Decrease GFR for 3 or more mths GFR < 60ml/min for ɯ mths 2- Marker of kidney damage: -Proteinuria (albuminuria or LMW globulins) -Damage on imaging studies -Urine sediment examination (RBC and WBC), Assess current diet implement dietary changes Low sodium, non-adherence possible strategies Interventions: 1.Identify poor adherence 2. Emphasize the value of the treatment and medication regimens 3. Customize the treatment and medication plan in accordance with the patient’s preferences and needs 4. Elicit patient’s feelings about his or her ability to follow the regimen 5. Work with the patient to establish support systems 6. Decrease the complexity of the medication regimen by using once-a-day dosing and extended release medications. 7. Establish cues within the patient’s daily routine to help with adherence to medication doses 8. Continually give the patient feedback on his or her actions, Personal assess Hopes, Anemia Hgb 89g/L Treatment Darbepoetin alfa (growth factors), Personal assess QOL, Blood transfusion Risk for Vascular access thrombosis (blockages)* HTN Adverse cardiovascular events, Hemodialysis 3 times/week x 11mths may lead to RBC destruction Blood loss, Anemia Hgb 89g/L Possible consequences activity intolerance, Anemia Hgb 89g/L Possible consequences decreased QOL, Assessments: early recognition of hypotensive symptoms during hemodialysis: feeling hot lightheadedness nausea muscle cramps ???? Interventions: 1.Examine the target weight critically and adjust it if necessary 2.Diet: limit the intake of fluid and salt 3.Limit the intake of food during the haemodialysis 4.Adjust the (cardiovascular) medication 5.Lower the dialysis fluit temperature 6.Bring a decreased calcium concentration in the dialysis fluid back up to a normal concentration 7.Use sodium-profiling and/or ultrafiltration-profiling 8.Dialyse more often and/or longer 10.Excercise during haemodialysis 11.Sympathicomimetic medication 12.Use biofeedback technology to control blood volume reduction during dialysis, Anemia Hgb 89g/L Possible consequences Left Ventricular Hypertrophy Impairs cognitive function Weaken immune response Increase hospitalization Increase risk of mortality Risk of seizures