Physiological Adaptation Q 144
Kenneth, who was diagnosed with uremic syndrome has the potential to develop complications. Which among the following complications should the nurse anticipates:
A. Flapping hand tremors
B. An elevated hematocrit level
C. Hypotension
D. Hypokalemia
Correct Answer: A. Flapping hand tremors
Elevation of uremic waste products causes irritation of the nerves, resulting in flapping hand tremors. The classic description has been in hepatic diseases but other causes can commonly cause asterixis including azotemia and respiratory disease. Asterixis is a disorder of motor control characterized by an inability to actively maintain a position and consequent irregular myoclonic lapses of posture affecting various parts of the body independently.
Option B: Hematocrit levels in uremic syndrome are usually very low, which leads to a higher risk of starting dialysis. Anemia-induced fatigue is thought to be one of the major contributors to the uremic syndrome. Erythropoietin (EPO), a hormone necessary for red blood cell production in bone marrow, is produced by peritubular cells in the kidney in response to hypoxia.
Option C: Life-threatening complications, such as hypertension, occur in clients with uremic syndrome. Cardiac arrest may occur from severe underlying electrolyte abnormalities, such as hyperkalemia, metabolic acidosis, or hypocalcemia. Renal dysfunction may contribute to associated fluid retention, which may lead to uncontrolled hypertension and congestive heart failure.
Option D: Several underlying electrolyte abnormalities such as hyperkalemia and hypocalcemia leads to cardiac arrest. Hyperkalemia (potassium >6.5 mEq/L) may be an acute or chronic manifestation of renal failure, but regardless of the etiology, a potassium level of greater than 6.5 mEq/L is a clinical emergency. As renal function declines, the nephron is unable to excrete a normal potassium load, which can lead to hyperkalemia if dietary intake remains constant.