Chronic renal failure is irreversible destruction to the kidneys that gradually happens over a long period of time. A person’s kidney’s normally filters wastes and excess fluids from the blood, which gets excreted in the urine. Since George has chronic renal failure he has dangerous levels of fluid, electrolytes and wastes that are build up in his body. A couple of signs that are indicating George has chronic renal failure are his increased urinary output, his loss of appetite and his unintended weight loss. He’s also feeling more fatigued and he can’t keep his high blood pressure under control these are also signs. When George went to the doctor he had some blood test done, his results showed that his red blood cell count was low and as a result of that his hemoglobin was a little lower than what it should be. The kidneys play a major role in excreting wastes from the body, but they are also important in the endocrine system by producing essential hormones. One of the hormones is call erythropoietin; this hormone stimulates the bone marrow to produce red blood cells, the red blood cells contain hemoglobin and the hemoglobin carries oxygen throughout the body. When someone, like George has renal failure, their kidneys will not produce EPO like they did before, thus resulting in reduced levels of red blood cells in the body. The amount of hemoglobin varies according to the number of red blood cells in the blood. George also, had a urine test done, his GFR came out abnormal. This is because his kidneys aren’t functioning at a proper rate due to his chronic renal failure. If George was dealing with second stage chronic renal failure about 75% of his of his nephrons would be lost. When George reaches end-stage renal failure also called Uremia, he will have lost more than 90% of his nephrons and his GFR is insignificant. The fluid, electrolytes, and wastes are retained in his body and all of his body systems are affected. When he reaches this stage he will experience oliguria. George will probably be put on medication to help control his hypertension and he will also be put on medication to help with erythropoiesis and reduce phosphate levels. All his medications will have to be monitored closely and adjusted if necessary when he reaches end stage renal failure because of his kidneys decreased ability to excrete drugs in a timely manner. Once in end stage he will have to be put on dialysis or have a transplant. Betty was diagnosed with hypokalemia; which means she has lower than normal level of potassium in her bloodstream. Potassium is an electrolyte that is critical to the proper functioning of nerve and muscle cells. On her serum level results her potassium level is a little lower than what it should normally be. Since Betty is being treated for congestive heart failure and she is on diuretic drugs and this can cause hypokalemia. She had mentioned that her legs had been feeling weak and she has been having a feeling of “pins and needles” in them, known as paresthesias. She also, had mentioned that she had felt nauseated and did not have much of an appetite for the last two weeks; all of these support her diagnosis. Potassium is an important mineral for the body; the doctor probably recommended that Betty eat more proteins. Proteins are an excellent source of potassium. Also, baked potatoes and baked sweet potatoes are both good sources, same with tomatoes, dried and fresh fruits, calcium rich foods, leafy green vegetables, almonds, and beans are great sources of potassium that is why her doctor would recommend she eat more of them. Since Betty is taking a diuretic for her congestive heart failure she may be prescribed a small amount of an oral potassium supplement because the loss of potassium will continue as long as the medication is prescribed. It may be prescribed for a short time because if she eats foods rich in potassium she will not need to be on the supplement for long. She will need to come in and have her potassium levels checked to make sure she is not going over the normal range. It is important for Betty to be on Furosemide because it is used to treat fluid retention in people who are suffering with congestive heart failure. It is a loop diuretic or water pill that prevents the body from absorbing to much salt, allowing the salt to be passed in the urine. Potassium is one of the most important dietary electrolytes, potassium is essential for the conversion of blood sugar into glycogen. Glycogen is the storage form of blood sugar that is found in the muscles and liver. A potassium shortage will result in a lower level of stored glycogen. Since glycogen is used by the muscles for energy, if a person has a potassium deficiency they will experience more fatigue and muscle weakness.