The nurse is caring for a patient with chronic renal failure (CRF) that has developed decreased erythropoietin synthesis. The nurse assesses the patient for:


• Erythropoietin is synthesized in the renal cortex. A decrease in production related to CRF leads to anemia, manifesting as weakness and fatigue. Dyspnea, pallor, malaise, and poor concentration are also common symptoms of anemia.

• In a person with CRF, a low hemoglobin (Hgb) is most likely caused by low erythropoietin production.

• Nausea is not associated with anemia.

• Intercostal retractions, cyanosis, wheezing, and hypercapnia are generally related to problems with ventilation and perfusion.

• Cyanosis is seen less in those with anemia because the bluish color of deoxyhemoglobin cannot be seen without a high enough hemoglobin count.

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