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1. Anjali Sarath
ADIME Note –CKD 5
1
Assessment: Patient reports that she lives with her daughter and their family. Patient’s daughter
prepares meals for the family but has not been educated on a renal diet by a dietitian. Pt sees a
dietitian at her HD unit who provides her with a report card of her labs and instructs her to eat
more protein. Diet history indicates that patient follows a “Renal diet” at home and eliminates
bananas, oranges, tomatoes or potatoes because they contain “too much potassium”. Nursing
notes indicate that the patient is consuming 60% of most meals.
68 YO African American female; Dx: Acute MI
PMH: Type 2 DM x 18 years, HTN x 43 years, Hemodialysis x 5 years
Ht: 5’8
Admission Wt: 163#; UBW: 156# (post HD)
BMI: 24.8
Labs: K+ 5.8 mg/dl, BUN 108 mg/dl, Cr 10.8 mg/dl, Hgb 11.0 mg/dl, Hct 36, Phos 6.5 mg/dl,
Albumin 2.5 mg/dl, Mg 3.2 mg/dl, Chol 272 mg/dl, RBG 186 mg/dl
Medications: Bumex, Phos-lo, Epogen, Nephrovite and glipizide, zocor
EER: 2100 -2500 kcal (based on 30-35 Kcal/Kg recommended for HD/CKD 5). Estimated
Protein Requirement: 76g (based on >1.2 g/Kg SBW for HD)
I/O: 1.2 L fluid; (recommendation for HD: 1-1.5 L fluid intake: < 1L fluid output)
Current diet order: Renal Diabetic diet; 1800 Kcal, 60 gm protein, 2 gm K+, 2 gm Na+, 1200 ml
fluid
Diagnosis:
Increased nutrient need (protein) R/T hemodialysis AEB elevated levels of BUN (108 mg/dl) and
creatinine (10.8 mg/dl)
Inadequate oral intake R/T poor appetite AEB nursing documentation of PO intake limited to
60% of daily meals.
Excessive fluid intake R/T nutrition-related knowledge deficit AEB edema in lower extremities
Intervention
Disagree w/ current recommendation. Goals: Meet energy intake of 2300 Kcal/day, protein
intake of 76g, 50% bioactive protein; limit fluid intake to 1.2 L/day; 2 gm K+, 2 gm Na+, 800
mg P

2. Anjali Sarath
ADIME Note –CKD 5
2
1. Increase protein density of PO meals with 75% of total protein derived from bioactive
protein as tolerated by patient.
2. Modify PO diet to include small, mineral-restricted (Na+
, K+
, P), nutrient-dense meals to
increase oral intake to 80% of daily meals.
3. Limit fluid intake to 1.2 L/day based on fluid output
4. Provide patient and caretaker with evidence-based information and hand-outs regarding
Renal diabetic diet as well as nutritional needs for HD.
Monitoring/Evaluation
1. Patient’s protein status will stabilize as measured by daily PO evaluation of protein
intake.
2. Patient’s oral intake will increase to meet current recommendations as measured by daily
PO evaluation and calorie count.
3. Patient’s fluid status and edema will improve as measured by records of fluid I/O and
daily physical examinations.
4. Patient and caretaker will state understanding of Renal diabetic diet and nutritional needs
for HD during HD consults and follow-ups.
Signature:
Anjali Sarath
Anjali Sarath, Student Dietitian