Final answer:
In end-stage renal disease, a nurse monitors for symptoms such as metabolic acidosis, heart arrhythmias, uremia, fatigue, and changes in urine output. Diagnosis involves checking serum creatinine and blood urea nitrogen levels and may include imaging and urine tests. Ultimately, renal replacement therapy is required for survival.
Step-by-step explanation:
A client with end-stage renal disease (ESRD) typically exhibits a range of symptoms due to the severely diminished kidney function. Nurses monitor for signs of metabolic disturbances such as metabolic acidosis or alkalosis, imbalances in electrolytes like potassium, calcium, and phosphate, and signs of fluid overload which can lead to edema and hypertension. Cardiovascular complications include heart arrhythmias. Additionally, systemic effects such as uremia (elevated urea levels in the blood), anemia, fatigue, changes in appetite, and alterations in urine output, whether excessive urination or oliguria (reduced urine output), are closely observed. These symptoms arise because the kidneys can no longer effectively filter waste, balance body fluids, or manage the production of red blood cells.
Diagnosis of ESRD involves measuring serum creatinine and blood urea nitrogen levels, with medical imaging and urine tests helping to identify the underlying cause and to confirm the diagnosis. In ESRD, renal replacement therapy (RRT) through dialysis or kidney transplantation becomes necessary due to the loss of kidney function.