A nurse is caring for several clients at a community clinic. Which of the following clients is most at risk for developing type 2 diabetes mellitus?

Choice A reason:
Hemodialysis does not typically result in a significant decrease in RBC count. While there can be a minimal loss of red blood cells during the process, it is not the primary focus of the treatment. The main purpose of hemodialysis is to remove waste products and excess fluid from the blood when the kidneys are not functioning properly.

Choice B reason:
Calcium levels may vary during hemodialysis, and the treatment can be adjusted to prevent significant changes in calcium levels. Hemodialysis can remove some calcium from the blood, but it is usually not the most affected value, and calcium can be added to the dialysate solution if necessary.

Choice C reason:
Potassium is one of the primary electrolytes removed during hemodialysis. High levels of potassium, which can be life-threatening, are commonly seen in clients with renal failure. Hemodialysis effectively reduces high potassium levels, which is crucial for preventing complications such as cardiac arrhythmias.

Choice D reason:
Protein levels are not directly targeted by hemodialysis, and significant protein loss is not a usual outcome of the treatment. The dialysis membrane is designed to allow smaller molecules like urea and potassium to pass through while retaining larger molecules like proteins.

Choice A reason:
Venous insufficiency can contribute to the development of chronic wounds, particularly in the lower extremities. It is characterized by the inability of the veins to adequately return blood from the legs back to the heart, which can lead to pooling of blood and increased pressure in the veins. This can cause skin changes and ulcers, particularly around the ankles.

Choice B reason:
Malnutrition is indeed a systemic cause of chronic wounds. Adequate nutrition is essential for wound healing, as it provides the necessary proteins, vitamins, and minerals that play a crucial role in the repair process. Protein-energy malnutrition, deficiencies in vitamins C and D, zinc, and other nutrients can impair wound healing and lead to chronic wounds.

Choice C reason:
Infection is typically a local rather than a systemic cause of chronic wounds. While systemic infections can affect wound healing, local wound infections are more directly responsible for delayed healing and the chronicity of wounds. Bacteria can colonize the wound and impede the healing process, leading to a chronic wound.

Choice D reason:
Continued pressure, much like infection, is generally a local cause of chronic wounds. It is most commonly associated with the development of pressure ulcers in individuals who are bedridden or have limited mobility. The constant pressure on certain areas of the body can lead to tissue ischemia and necrosis, resulting in a chronic wound.