3. Resident: DK
Personal Information:
DOB: 7/9/1962 (52 yrs old)
Caucasian, Male
Allergies: Avelox
Primary Diagnosis: Acute Kidney Failure
Ambulates with a wheelchair
Diet Order:
No Added Salt (NAS), No Concentrated Sweets (NCS) with Nepro
Protein Shake and Med Pass 2.0 supplements
Double order of meat
5. 24-Hour Dietary Recall
Breakfast (8:00 AM)
1 bagel with 1 container of cream
cheese
1 glass of water, no juice or milk
Lunch (12:00 PM)
Double portion of chicken, 6 oz.
Serving of corn, ½ cup
1 glass of water
Snack (after lunch)
1 bag of popcorn
Dinner (12:00 PM)
Double portion of steak, 4oz.
1 glass of water
Assessment
Says appetite is good, PO is 51-100%
No issues chewing or swallowing
No N/V/D/C
NKFA
No BLE
Food preferences used to drink
lemonade but can’t because of
phosphorus, bagels need to be
toasted more, vegetables are bland
6. Lab Values
Test Result Normal Range
RBC 2.9 M/uL L 4.2-6.0
Hgb 10.0 g/dL L 12.0-18.0
Hct 29.7% L 36.0-52.0
MCV 104.2 FL H 80-100.0
MCH 35.1 PG H 26.6-32.6
BUN 50 mg/dL H 7-23
Creat 7.1 mg/dL H 0.4-1.6
eGFR 8.7 mL/min L <15 CKD Stage 5
Eosinophils 6.2% H 0.0-6.0
10. Admitting Diagnosis
Acute Kidney Disease
DK has an eGFR of 8.7 mL/min
CKD Stage GFR
1 90 mL/min or Greater
2 60-89 mL/min
3 30-59 mL/min
4 15-29 mL/min
5 <15 mL/min
11. Secondary Diagnoses
Diabetes Mellitus Type II
Major contributor to kidney failure
Over filtration of blood to kidneys damages filtering system
Explains high levels of BUN and Creatinine
Muscle Weakness
Protein losses from Dialysis
Disturbs electrolyte balance in body and affects muscle contractions
Anemia
Losses of fluid affect amounts of water-soluble vitamins
Loss of protein affects muscle mass and iron stores
13. Dialysis Treatment
Dialysis scheduled for Monday, Wednesday, and Friday
Hemodialysis = artificial kidney machine that filters blood
Hemodialysis via R arm fistula
Major protein losses Need for protein supplements (1.2
g/kg) = 122 g PRO/day
Also causes poor appetite Med Pass and encourage
eating (30-35 kcal/day) = 3054-3563 kcal/day
14. Nutritional Intervention
Therapeutic Diets & Diet Order
NAS and NCS prevent excess sodium intake and controls
blood sugar
Double meat Increases calories and protein lost during HD
Other Interventions
Monitor electrolytes such as sodium, potassium, and sodium
Fluids also need to be restricted
Calcium and Vitamin D to prevent bone degeneration
15. Other Interventions
Physical Therapy
Can help rebuild lost muscle mass and weakness
Reduce nerve degeneration that occurs with Diabetes
Diabetic Shoes and Socks
Diabetic socks help blood reach the lower legs and feet
Diabetic shoes are larger for swelling, help to avoid pressure
ulcers
17. Monitoring/Evaluation
Track diet to ensure sufficient calories and protein
consumed, electrolytes balanced
Lab values should be monitored BUN, Creatinine,
Albumin, Hgb, Hct, etc.
Watch for signs of edema swelling, excessive weight
gain between Dialysis treatments
