NR 603 Week 3 Collaboration Cafe_Client 3 Ji-hoon Lee - CKD exacerbation and acute decompensated heart failure

client. Another factor to take into consideration is that the client has a history of not following medication regimen due to transportation and financial resources. For this client, I would consider ordering a B-type natriuretic peptide (BNP) level, Comprehensive metabolic panel (CMP), Complete blood count (CBC), Chest x- ray, and Electrocardiogram (ECG). BNP level will give us a good idea of how the heart is functioning and how fluid overloaded they are. The CMP gives a better understanding of how the kidneys are functioning based on creatinine and BUN levels, if the liver is affected by the liver enzymes and to take into consideration if there are electrolyte imbalances. A CBC gives insight into any infection or anemia is present. Chest x-ray will help determine if the client has any chest congestion, specifically pulmonary congestion related to dyspnea, or if there are pleural effusions and cardiomegaly. Lastly, an ECG can give us a quick snapshot at how the heart is functioning, there is any ischemia present, arrythmias or other cardiac issues. Depending on the results, it may be beneficial to get a transthoracic echocardiography (TTE) to get a better understanding of how the heart functions, what the ejection fraction is, and ventricle sizes. 3. Compare and contrast the management of each assigned diagnosis, including similarities and differences in pharmacologic and non-pharmacologic treatment, client education, referral, and follow-up care. Consider how the client’s unique past medical history and social history impact care decisions. a. Both ADHF and CKD exacerbation can be treated in similar ways and in different ways. Some nonpharmacologic management options include having the client follow a strict low sodium diet with a max of 2 grams per day and possibly fluid restriction. Educating the client to also participate in low-impact exercises can help. With CKD specifically, the client may have to go on a diet that also restricts protein intake due to limited kidney function (Chen, Knicely, & Grams, 2020). These nonpharmacological management options benefit both CKD and HF. Pharmacology wise, there are classes that can manage symptoms and both diseases. For ADHF specifically, the main drugs that are used to manage include diuretics (furosemide or thiazide diuretics), angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) if the ace inhibitors are not tolerated, beta-blockers or even sodium-glucose cotransporter-2 inhibitors (SGLT-2) that have been shown to reduce heart failure associated hospitalizations in individuals with type 2 diabetes (Heidenreich et al., 2022). CKD can also be managed with ACE inhibitors or ARBs to control blood pressure, renin- angiotensin-aldosterone system (RAAS) inhibitors to delay disease progression, or SGLT-2 inhibitors for renal benefits in individuals with type 2 diabetes (Sanchez, Thompson, Scott, Evans, Rao, Sorstadius, James, Nolan, Wittbrodt, Sultan, Stefansson, Jackson, & Abrams, 2021). Some education to provide the client with is to make sure they are watching what they ingest, food and liquid. Not having too much sodium or water intake is important. The client also should Heidenreich, P. A., Bozkurt, B., Aguilar, D., Allen, L. A., Byun, J. J.,