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    Case Study 19 - Renal

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    Joaquin Enez is a 24-year-old female Pima Indian admitted for kidney replacement therapy due to stage 3 chronic kidney disease. She has a family history of type 2 diabetes and is obese with a BMI of 31.4 kg/m2. Her lab work shows uncontrolled diabetes with high glucose, sodium, potassium, phosphorus, and creatinine. She is on a renal diet to limit sodium, potassium, phosphorus and fluid intake. The nutrition diagnosis is altered nutrition-related lab values due to uncontrolled diabetes and renal dysfunction. The intervention is to provide renal diet education and counseling to control blood glucose and electrolyte levels through dietary modifications.

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    Case Study 19 - Renal

    Uploaded by

    api-489592025
    155 views4 pages
    Joaquin Enez is a 24-year-old female Pima Indian admitted for kidney replacement therapy due to stage 3 chronic kidney disease. She has a family history of type 2 diabetes and is obese with a BMI of 31.4 kg/m2. Her lab work shows uncontrolled diabetes with high glucose, sodium, potassium, phosphorus, and creatinine. She is on a renal diet to limit sodium, potassium, phosphorus and fluid intake. The nutrition diagnosis is altered nutrition-related lab values due to uncontrolled diabetes and renal dysfunction. The intervention is to provide renal diet education and counseling to control blood glucose and electrolyte levels through dietary modifications.

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    Joaquin Enez is a 24-year-old female Pima Indian admitted for kidney replacement therapy due to stage 3 chronic kidney disease. She has a family history of type 2 diabetes and is obese with a BMI of 31.4 kg/m2. Her lab work shows uncontrolled diabetes with high glucose, sodium, potassium, phosphorus, and creatinine. She is on a renal diet to limit sodium, potassium, phosphorus and fluid intake. The nutrition diagnosis is altered nutrition-related lab values due to uncontrolled diabetes and renal dysfunction. The intervention is to provide renal diet education and counseling to control blood glucose and electrolyte levels through dietary modifications.

    Copyright:

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

    Case Study 19 - Renal

    Uploaded by

    api-489592025
    Joaquin Enez is a 24-year-old female Pima Indian admitted for kidney replacement therapy due to stage 3 chronic kidney disease. She has a family history of type 2 diabetes and is obese with a BMI of 31.4 kg/m2. Her lab work shows uncontrolled diabetes with high glucose, sodium, potassium, phosphorus, and creatinine. She is on a renal diet to limit sodium, potassium, phosphorus and fluid intake. The nutrition diagnosis is altered nutrition-related lab values due to uncontrolled diabetes and renal dysfunction. The intervention is to provide renal diet education and counseling to control blood glucose and electrolyte levels through dietary modifications.

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    Patient Name: ​Joaquin, Enez

    Referring Physician​ L. Nila

    Age ​24 yo Gender ​Female​ Height ​60 in / 152.4 cm​ Weight ​170 lbs / 77.3 kg

    ASSESSMENT

    Demographics:

    1. Ethnicity: Native American (Pima Indian)


    2. Family History: Parents have T2DM
    3. Primary Care Provider: Reservation Health Services

    Food Allergies: NKFA

    Admission Diagnosis: N/A

    Weight History: 4-kg weight gain in the past 2 weeks

    Weight Goal: N/A

    Usual Weight: 161 lbs, 73.3 kg

    %Usual Body Weight: 105%

    Ideal Weight: 100# / 45.5 kg

    %Ideal Body Weight: 161% (Obese)

    Adjusted Body Weight: 124.6 # / 56.5 kg

    BMI: 31.4 kg/m​2 ​(Obese)

    Activity level: Sedentary

    Nutrition Focused Physical Findings:

    Skin: Dry-yellowish brown


    Extremities: 3+ pitting edema to knees
    Neurologic: asterixis
    Appetite: Anorexia
    Medications:

    Glucophage, 850 mg twice daily

    Past Medical History

    1. Diagnosed with Stage 3 chronic kidney disease 2 years ago. Acute symptoms developed
    over the last 2 weeks
    2. Recently stopped taking prescribed hypoglycemic agent & has never filled prescription
    for anti-hypertensive medication
    3. Declining GFR, increasing creatinine and urea concentrations, elevated serum
    phosphate, and normochromic, normocytic anemia
    4. Being admitted for kidney-replacement therapy
    5. Family history of T2DM

    Relevant Lab Values

    1. Sodium 130 mEq/L (136-145 mEq/L)


    2. Potassium 5.8 mEq/L (3.5-5.1mEq/L)
    3. Phosphate 6.4 mg/dL (2.2-4.6 md/dL)
    4. BUN 69 mg/dL (6-20 mg/dL)
    5. Creatinine serum 12.0 mg/dL (F 0.6-1.1 mg/dL)
    6. Est GFR 4 mL/min/1.73m​2​ (>60 mL/min/1.73m​2​)
    7. Glucose 282 mg/dL (70-99 mg/dL)
    8. Protein, total 5.9 g/dL (6-7.8 g/dL)
    9. Albumin 3.3 g/dL (3.5-5.5 g/dL)
    10. RBC 3.1 x 10​6​/mm​3​ (F 4.2-5.410​6​/mm​3​)
    11. Hcb 10.5 g/dL (F 12-16 g/dL)
    12. Hct 33% (F 37-47%)
    13. HbA1c 9.2% (<5.7%)
    14. pH urinalysis 7.9 (5-7)
    15. Protein urinalysis +2 mg/dL (neg)

    Nutrient Requirements:

    Energy: 1,978 kcal/day (35 kcal/kg/day using adjusted weight 56.5 kg)

    Protein: 45.2 PRO/day (0.8 g pro/kg/day using adjusted weight 56.5 kg)

    Fluid needs: 1,000 mL + urine output


    Nutrient Intake:

    Based on 24-hr recall, the patient consumes a high amount of processed foods, high
    sodium, and high phosphorus diet. Patient also reports that she consumes alcohol 1-2
    beers daily.

    Current Diet Order:

    Diet PTA low simple sugar, 0.8 g protein/kg of body weight, 2-3 g Na

    35 kcal/kg, 1.2 protein/kg, 2 g K, 1 g phosphorus, 2g Na, 1000mL fluid + urine output per
    day

    NUTRITION DIAGNOSIS

    Altered nutrition-related laboratory values (NC - 2.2) R/T uncontrolled T2DM and renal
    dysfunction AEB high blood glucose (282 mg/dL), high Na (130 mEq/L), high K (5.8 mEq/L),
    high P (6.4 mg/dL), low albumin (3.3 g/dL), and excess protein, glucose and ketones in urine.

    NUTRITION INTERVENTION

    1. Food and/or Nutrient Delivery


    a. Limit sodium intake
    i. No additional salt when cooking, avoid processed foods
    b. Limit potassium intake
    c. Limit phosphorus intake
    i. Avoid meats, dairy products, nuts, and chocolate
    d. Limit fluid intake to 1000 mL + output/d
    i. Avoid coffee, ice tea, ice cream, soup
    ii. REC drinking liquids at room temperature, sugar-free tart candies
    e. REC limiting dairy intake to one serving per day
    f. REC avoiding alcohol consumption
    g. REC PRO sources with high biological value
    i. Fish, Poultry, Eggs
    h. REC compliance with medications
    2. Nutrition Education
    a. REC renal diet education
    3. Coordination of Care
    a. Refer to social worker
    4. Nutrition Counseling/Goals
    a. Biochemical markers/lab values within normal ranges
    i. BG: <200mg/dL
    ii. Na: 136-145 mEq/L
    iii. K: 3.5-5.1mEq/L
    iv. P: 2.2-4.6 md/dL
    v. Albumin: 3.5-5.5 g/dL
    b. Weight changes
    i. Lose 0.5 to 1 lbs per week until normal BMI is reached
    ii. Avoid 5% fluid weight gain in between dialysis treatment

    NUTRITION MONITORING/EVALUATION

    1. M/E biochemical markers all relevant lab values, presence of edema, and weight
    changes.
    a. Follow-up between 1 - 3 days

    RD Signature: Date: 11/6/2019

    Lauren Okamoto
    Amy Nguyen
    Jazmine Melchor
    Ranielle Soriano

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