A 76-Year-Old Woman Who Has Resided in a Nursing Home

question 869

Multiple Choice

A 76-year-old woman who has resided in a nursing home for two years is seen, along with her family, to discuss her medical plans.  She has chronic kidney disease with an estimated glomerular filtration rate (eGFR) of 7 ml/min/1.73 m².  Her other medical problems include type 2 diabetes mellitus, chronic congestive heart failure, moderate cognitive impairment, recurrent falls, a previous hip fracture, and impaired vision.  She gets up in a chair for approximately 1 hour per day.  She needs help with all activities of daily living except for feeding herself.  She relates that she is comfortable and voices no complaints.
On examination, her BMI is 19 kg/m² and she appears frail.  There is 2+ pitting pedal edema bilaterally, bibasilar fine inspiratory crackles, and a stage 2 sacral pressure ulcer.
An ultrasound of her kidneys at the time of admission to the nursing home revealed no obstruction.
Which of the following is the best management plan?

• A)Hemodialysis
• B)Further evaluation for causes of renal failure
• C)Low protein diet
• D)Palliative care
• E)Peritoneal dialysis

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Definitions:

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Costs that change in proportion to the level of production or sales, such as materials and labor.

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