help with restating my nursing dx... its too long

[bjb12]

My pt had hyperchloremic metabolic acidosis, insulin dependent diabetes mellitus, chronic kidney disease stage 4, HTN. This is the dx that I know is too long:

Fatigue r/t oxygen deficiency r/t low RBC's and low hgb levels r/t improper production of erythropoieton by diseased kidneys which stimulates the bone marrow to produce the proper number of RBC's needed to carry Oxygen to vital organs AEB Hgb 9.5 and RBC 2.96 and GFR 20.

I'm putting too much info in there so my instructor knows I understand why the pt is fatigued d/t low rbcs and hgb bc her kidneys are bad... but I don't know which part to just throw out. I guess I've been staring at it too long.

Others I'm using:

Risk for impaired skin integrity r/t decreased sensation and circulation to lower extremities AEB dry skin on ankles and shin areas.

Risk for imbalanced fluid volume (still working on the rest)

Ineffective tissue perfusion: Renal (still working on rest)

Once I get rolling I'm good... its just getting that initial dx going.

[TheSquire, DNP, APRN, NP]

My thought is to drop the last 'r/t' statement - if you have a section to explain pathophys, put that info there instead.

[tbell2]

Fatigue r/t oxygen deficiency r/t low RBC's and low hgb levels r/t improper production of erythropoieton by diseased kidneys which stimulates the bone marrow to produce the proper number of RBC's needed to carry Oxygen to vital organs AEB Hgb 9.5 and RBC 2.96 and GFR 20.

I would probably cut out most of the patho.

Fatigue r/t oxygen deficiency secondary to impaired kidney function AEB Hgb 9.5 and RBC 2.96 and GFR 20.