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A 68-year-old patient with a history of diabetes presents with

  

A 68-year-old patient with a history of diabetes presents with weakness and fatigue. The patient appears to be pale, and the skin demonstrates bruising. The patient’s spouse reports that the patient has been acting confused for the last 2 days. The patient has peripheral edema and crackles in the lungs. His blood pressure is 160/86. The patient has a history of neuropathy secondary to the diabetes, and his blood glucose is periodically out of control as revealed by an elevated hemoglobin A1c on previous visits. The practitioner suspects chronic kidney disease due to diabetic nephropathy. Previous lab values, including blood urea nitrogen (BUN), creatinine, and creatinine clearance, have demonstrated minimal alterations from normal. 

  

1. What considerations are made in providing care for this patient?

  

1. Which laboratory tests should be ordered to evaluate the patient’s suspected kidney disease at this time? 

  

1. What patient education should be provided?

  

1. What additional diagnostic tests should be completed to evaluate the patient’s condition?

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