MEDizzy - A nurse is caring for a client diagnosed with end- stage

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Altered Fluid and Electrolytes

A nurse is caring for a client diagnosed with end- stage renal disease (ESRD). The client is 6 feet tall and weighs 180 pounds. The client’s total serum protein is 5.8 g/dL. An assessment by the nurse reveals 2+ pitting edema. The nurse determines that this client’s edema is most likely the result of:

ExplanationA normal serum protein total is 6.0 to 8.0 g/dL. ESRD clients often have low plasma protein from malnutrition and protein restriction. This reduces plasma oncotic pressure and results in fluid remaining in the interstitial space because pressure is not great enough to pull fluid into the capillaries. Although edema can result from increased capillary hydrostatic pressure, decreased plasma oncotic pressure, and increased capillary permeability, the low serum protein suggests reduced oncotic pressure is the most likely cause of the edema. Because the client’s kidneys are unable to excrete electrolytes, a higher level of serum electrolytes is present in ESRD.