A client with chronic kidney disease (CKD) complains of severe itching. Which terms should the nurse use to document this finding? (Select all that apply)

Choice A reason: Urticaria, commonly known as hives, refers to raised, itchy wheals on the skin often caused by an allergic reaction. While itchy, it is not the standard clinical term for the systemic, metabolic-induced itching associated with the accumulation of uremic toxins in chronic kidney disease patients. Choice B reason: Atopic dermatitis is a chronic inflammatory skin condition, often hereditary, characterized by eczema flares. It is a primary skin disorder rather than a secondary manifestation of renal failure. Documenting uremic itching as atopic dermatitis would be medically inaccurate in a patient with chronic kidney disease. Choice C reason: Excoriation refers to skin lesions or abrasions produced by the mechanical action of scratching. Patients with severe uremic pruritus often scratch their skin relentlessly to find relief, leading to visible linear breaks in the skin surface which must be documented by the nurse during a physical assessment. Choice D reason: Pruritus is the correct medical term for itching. In chronic kidney disease, this is specifically referred to as uremic pruritus. It is caused by the deposition of calcium-phosphate crystals in the skin and the irritation of sensory nerve endings by high levels of serum urea and other nitrogenous wastes. Choice E reason: Psoriasis is an autoimmune skin disease resulting in the rapid turnover of skin cells, creating silvery scales. It is not caused by renal failure. While a CKD patient could coincidentally have psoriasis, the "severe itching" reported is a direct symptom of their metabolic state, not this specific dermatological disease.