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    Adime-Kidney Disease Portfolio

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    This document summarizes a nutrition assessment for a 24-year-old Native American female patient with stage 3 chronic kidney disease and type 2 diabetes. The patient has gained weight recently and has abnormal lab values indicating declining nutrition status. Her current diet consists of high sodium, potassium, and phosphorus foods. The nutrition care plan aims to meet her increased calorie and protein needs while limiting fluids and restricting intake of sodium, potassium, and phosphorus through diet education. Goals are to improve her lab values and manage her weight through dietary changes.

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    Adime-Kidney Disease Portfolio

    Uploaded by

    api-477636568
    421 views4 pages
    This document summarizes a nutrition assessment for a 24-year-old Native American female patient with stage 3 chronic kidney disease and type 2 diabetes. The patient has gained weight recently and has abnormal lab values indicating declining nutrition status. Her current diet consists of high sodium, potassium, and phosphorus foods. The nutrition care plan aims to meet her increased calorie and protein needs while limiting fluids and restricting intake of sodium, potassium, and phosphorus through diet education. Goals are to improve her lab values and manage her weight through dietary changes.

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    This document summarizes a nutrition assessment for a 24-year-old Native American female patient with stage 3 chronic kidney disease and type 2 diabetes. The patient has gained weight recently and has abnormal lab values indicating declining nutrition status. Her current diet consists of high sodium, potassium, and phosphorus foods. The nutrition care plan aims to meet her increased calorie and protein needs while limiting fluids and restricting intake of sodium, potassium, and phosphorus through diet education. Goals are to improve her lab values and manage her weight through dietary changes.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    421 views4 pages

    Adime-Kidney Disease Portfolio

    Uploaded by

    api-477636568
    This document summarizes a nutrition assessment for a 24-year-old Native American female patient with stage 3 chronic kidney disease and type 2 diabetes. The patient has gained weight recently and has abnormal lab values indicating declining nutrition status. Her current diet consists of high sodium, potassium, and phosphorus foods. The nutrition care plan aims to meet her increased calorie and protein needs while limiting fluids and restricting intake of sodium, potassium, and phosphorus through diet education. Goals are to improve her lab values and manage her weight through dietary changes.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
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    of 4

    Date 11/6/19

    Time 5:45pm

    Patient Name: Enez Joaquin

    Referring Physician: L. Nila

    Age 24 Gender: F Height: 5’ (1.524m) Weight: 170 (77.3kg)

    ASSESSMENT

    Demographic: Married, Native American, Secretary, high school education.

    Social considerations: lives on the reservation, with limited access to (reservation) healthcare.

    Weight History: gained 4kg in past 2-weeks

    Weight Goal: maintain UBW; gain <4%BW between dialysis visits

    Usual (dry) Weight/%UBW: 73.3kg (105%)

    Ideal Weight/%IBW: 45kg (170%)

    BMI: 33.3, obese

    Activity level: Ambulatory

    Food Allergies: NKFA

    Nutritional status: Nutrition status declining due to anorexia, N&V, leading to limited intake.
    Edema RT to poor protein status.

    Medications:

    ● Glucophage (metformin)
    ● Capoten/captopril
    ● Sodium bicarbonate
    ● EPO
    ● Renal caps
    ● Renvela
    ● Hectorol

    Past Medical History: Diagnosed with T2DM 11 years ago (poorly controlled), Diagnosed with
    Stage 3 CKD 2 years ago
    Relevant Lab Values

    ● Sodium (low)
    ● Potassium (high)
    ● Chloride (low)
    ● CO2 (high)
    ● Bicarbonate (low)
    ● BUN (high)
    ● Serum Cr (high)
    ● BUN/Cr ratio (low)
    ● GFR (low)
    ● Glucose (high)
    ● Phosphate (high)
    ● Calcium (low)
    ● Osmolality (high)
    ● Protein (low)
    ● Albumin (low)
    ● Cholesterol (high)
    ● VLDL (high)
    ● TG (high)
    ● HbA1C (high)
    ● RBC (low)
    ● Hb (low)
    ● Hct (low)
    ● pH (high)
    ● protein (high)
    ● glucose (high)
    ● ketones (high)
    ● pCO2 (low)
    ● HCO3- (low)

    Nutrient Requirements

    ● Energy: 35 kcal/kg/d: increased needs for dialysis


    ○ 35 x (73.3- pre fluid loaded wt)= 2,565 kcal
    ● Protein: 1.2 g/kg/d: increased needs for dialysis
    ○ 1.2 x current wt (77.3)= 93g
    ● Fluid: 1,000 mL + output

    Nutrient Intake: PO, patient complains of anorexia, N&V


    Dietary Intake:

    Breakfast: cold cereal, bread or fried potatoes, fried eggs (occasionally), coffee

    Lunch: Bologna sandwich, potato chips, coke

    Dinner: Chili con carne, indian fry bread, iced tea

    Snacks: crackers and peanut butter

    (PTA) diet order: Low simple sugar, 0.8 g pro/kg 2-3g Na

    Current Diet Order: 35 kcal/kg, 1.2 g/kg, 2g K+, 1g phosphorus, 2 g Na+, 1000mL fluid + urine
    output/day

    NUTRITION DIAGNOSIS

    Altered Nutrition Related Lab values (NC-2.2) RT decreased kidney fx and stage 5 diagnosis of
    CKD AEB elevated serum creatinine (12.0mg/dL), elevated potassium (5.8mEq/L), elevated
    phosphorus (6.4mg/dl) decreased GFR (4ml/min/1.73 cm2), low sodium (130Eq/L), and low
    albumin (3.3 g/dL).

    NUTRITION INTERVENTION

    Goals

    ● Meals and snacks


    ○ Meet energy needs of 35 kcal/kg/d
    ○ Meet protein needs of 1.2 g/kg/d
    ■ ensure 50% of protein comes from high BV sources
    ○ Limit fluid to 1,000mL + output per day
    ○ Limit food sources of sodium, potassium, phosphorus
    ■ Phosphorus: Whole grains, legumes, processed foods, sodas
    ■ Potassium: avocado, cantaloupe, potatoes, nuts, salt substitutes
    ■ Sodium: processed foods, salts
    ● Education
    ○ Importance of weight management between dialysis treatments
    ○ Food sources of potassium, phosphorus, sodium
    ○ Timing of Renal caps after dialysis
    ○ Strategies for reducing fluid intake and foods that count as fluids
    ■ Ice creams and ice pops, Jell-O, soups, high water content fruits and
    vegetables
    ■ Take small sips of water, chew gum or suck on tart, sugar-free candies
    ○ Nutrition education on high BV proteins
    ○ Education on not using salt substitutes
    ● Maintain normal ranges of creatinine, potassium, phosphorous through dietary changes.
    ○ Limit potassium to 2g/d
    ○ Limit phosphorus intake to 1g/d

    NUTRITION MONITORING/EVALUATION

    ● Monitor daily
    ○ Lab values
    ○ Body weight
    ○ I/O fluid balance
    ● Evaluate 24-hr food record within one week

    RD Signature

    Jenna Laughlin, Imogene Carson, Cameron Vinoskey, Angel Estrella

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