I. IntroductionMr. D is a 57-year-old Hispanic man who presents to the emergency room by ambulance with a fractured femur. He was found in the bathroom of his accounting office by one of his employees. Upon arrival at the hospital, Mr. D appeared very lethargic. His speech is slurred and he is disoriented. Vital signs and laboratory work are obtained for evaluation.Vitals:• Height 6'2"• Weight 220 lbs.• BP 180/90• HR 104• Resp. 24• Temp. 100.1Labs:• K+ 6 .1• Na 149• Ca 1.4 • P04 4.6 • Glucose 255 • Hgb 12 • Hct 26 • Protein 6.0 • Albumin 2.7 • BUN 101 • Creatinine 49 • GFR 12 Mr. D's wife arrives at the hospital an hour later. She provides the nurse with MD's medical history including type II diabetes, depression, hypertension, and a recent diagnosis of ESRD. He has been on hemodialysis for 4 months. Mr. D's wife also reports that he was hospitalized a year ago due to complications of kidney disease characterized by a marked deterioration of kidney function. he's very tired lately She says he goes to his office 2 days a week, about 4-6 hours a day She says he doesn't do anything else he loved. previously he was unable to help with household chores and his appetite was significantly diminished. Yet he continues to go to the office. Mr. D's wife says she was extremely worried about him and asked him to retire; he refuses. Mr. D puts his lack of energy at the service of dialysis. Mr. D's wife states that she has recently noticed a significant decrease in his appetite and swelling in his feet. She says he is sometimes noncompliant with his medications. ...... middle of paper ......n following the advice of his wife and retired from his accounting firm. Mr. D says he is enjoying retirement and because of his busy schedule, he does not expect to return to work. He wants to focus on his health. References Brunner & Suddarth (2007). Textbook of medical-surgical nursing. (6th ed.). Lippincott Williams and Wilkins Hall, J. (2011). Textbook of medical physiology. (12th ed.). Philadelphia, PA: SaundersElsevier. Horigan, A., Rocchiccioli, J., and Trimm, D. (2012). Dialysis and fatigue: implications for nurses – a case study analysis. MedSurg Nursing, 158. Retrieved from http://go.galegroup.com/ps/i.do?id=GALE%7CA292087372&v=2.1&u=tel_a_tbr&it=r&p=GPS&sw=wKarch, A. (2012). Lippincott's Guide to Nursing Medicines. New York, New York: Lippincott, Williams and WilkinsPotter, P. and Perry, A. (2008). Fundamentals of Nursing. (6th ed.). St. Louis, Missouri: ElsevierMosby.