Physicians - maximum of 0.75 AMA PRA Category 1 Credit(s)™
ABIM Diplomates - maximum of 0.75 ABIM MOC points
Nurses - 0.75 ANCC Contact Hour(s) (0.5 contact hours are in the area of pharmacology)
IPCE - 0.75 Interprofessional Continuing Education (IPCE) credit
This activity is intended for nephrologists, primary care physicians, nurses, nurse practitioners, and physician assistants.
The goal of this activity is that learners will be better able to improve the quality of life in patients with chronic kidney disease (CKD) on dialysis by improving their competence to screen, diagnose, manage, and educate these patients in a team-based management approach.
Upon completion of this activity, participants will:
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This activity was planned by and for the healthcare team, and learners will receive 0.75 Interprofessional Continuing Education (IPCE) credit for learning and change.
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Awarded 0.75 contact hour(s) of nursing continuing professional development for RNs and APNs; 0.50 contact hours are in the area of pharmacology.
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CME / ABIM MOC / CE Released: 11/4/2022
Valid for credit through: 11/4/2023, 11:59 PM EST
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The following cases are modeled on the interactive grand rounds approach. The questions within the activity are designed to test your current knowledge. After each question, you will be able to see whether you answered correctly and read evidence-based information that supports the most appropriate answer choice. The questions are designed to challenge you; you will not be penalized for answering the questions incorrectly. At the end of the activity, there will be a short post-test assessment based on the material presented.
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Lucas is a 67-year-old man who started hemodialysis (HD) 3 months ago. The nurse notices that despite initiation of dialysis treatment, Lucas still appears groggy and unwell. When asked how he is feeling, he states he hasn’t been sleeping well.
The nurse asks Lucas whether there have been any specific symptoms keeping him awake, he states he has been kept awake by itching. He notes that his skin has been very dry since he started swimming at the local pool in the evenings.
The nurse relays these symptoms to the care team. On your exam, you notice excoriation on the patient’s neck and back and suspect that his itching and lack of sleep might be related to his kidney disease.
History |
Findings |
Medical |
History of hypertension Pre-diabetic |
Medications |
Lisinopril Amiodipine Atorvastatin Cetirizine (self-administered) |
Allergies |
Penicillin |
Family |
Paternal grandfather (55 years old): deceased, acute cardiac arrest Mother (89 years old): deceased, unspecified natural causes Father (81 years old): deceased, congestive heart failure Brother (69 years old): history of hypertension, previous cardiac arrest
|
Psychosocial |
Reports difficulty sleeping |
Immunizations |
All immunizations are up to date. Patient has received fourth COVID-19 booster |
Physical Examination |
Findings |
Vital signs |
Height: 5’11’’ Weight: 210 lb BMI: 29 BP: 143/100 mmHg Heart rate: 82 bpm |
General |
Normal |
Skin |
Widespread xerosis, visible excoriations on neck and back |
Chest and lungs |
Normal |
Heart |
Normal |
Abdomen |
Normal |
Upper/lower extremities |
Normal |
BMI, body mass index; BP, blood pressure.
Test |
Result |
Reference Range |
CBC with differential/platelet |
||
White blood cell count |
7000 cells/mcL |
4500 to 10,000 cells/mcL |
Lymphocytes, absolute
|
2000 cells/mcL |
800 to 5000 cells/mcL (absolute) |
Monocytes, absolute |
500 cells/mcL |
400 to 1000 cells/mcL (absolute) |
Granulocytes, absolute |
2500 cells/mcL |
1800 to 8300 cells/mcL (absolute) |
Neutrophils, absolute |
2000 cells/mcL |
1800 to 8300 cells/mcL (absolute) |
Eosinophils, absolute
|
400 cells/mcL |
0 to 800 cells/mcL (absolute) |
Basophils, absolute
|
20 cells/mcL |
0 to 100 cells/mcL (absolute) |
Hemoglobin |
10 g/dL |
Male: 13.8 to 17.2 g/dL Female: 12.1 to 15.1 g/dL |
Platelet count 230 |
230 thousand/mcL |
150 to 400 thousand/mcL |
Creatinine |
||
Creatinine |
12 mg/dL |
Male: 0.7 to 1.3 mg/dL (61.9 to 114.9 µmol/L) Female: 0.6 to 1.1 mg/dL (53 to 97.2 µmol/L) |
Urine CRP Test |
||
CRP |
5 mg/dL |
< 1.0 mg/dL |
Renal metrics |
||
Kt/V |
1.8 |
1.26 |
Urea reduction ratio |
80% |
67% |
CBC, complete blood count; CRP, C-reactive protein.