Chapter 16 Laboratory Assessment

cardiac arrhythmia. The low hemoglobin and hemato- crit are also consistent with ESRD. Further workup is not recommended because the client is on Epogen, pro- vided at dialysis, for his anemia. Mild hyperglycemia is present.

Blood draw in relationship to mealtime needs to

be considered. This client may have eaten breakfast before dialysis, and this may be representative of a 2-hour postprandial result. If this is the case, adequate control is present at this time. A fasting glucose level can be suggested, as two consecutive fasting blood sugars of 126 are needed before diabetes can be diag- nosed. Evaluation of this client’s diet history for high-phosphorus foods and administration of the phos- phorus binder, calcium carbonate, is recommended because of the hyperphosphatemia and hypocalcemia. If evaluation of the diet history reveals low to moder- ate phosphorus intake, then the administration of the binder should be considered. If the binder was not taken with meals, this could be the cause of the abnor- mal laboratory values. The registered dietitian should instruct caregivers in more effective administration of the calcium carbonate. The albumin level is borderline. Adequate protein intake can help prevent future decline.

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