Henry is a 70-year-old African American male with end-stage renal disease (ESRD) started recently on hemodialysis 3 times per week and is having trouble with the diet changes. He dislikes the taste of his binders (Tums 8/ /calcium carbonate) and reports often forgetting to take them with meals. His nephrologist referred him for help implementing a renal diet. He went through a class but is having trouble remembering what he leamed. He is present at the appointment with his adult daughter. Henry was diagnosed with type 2 diabetes 10 years ago. The doctor said it was likely that he had DM for several years prior to diagnosis. Henry lives alone but his daughter lives a few miles away and takes him to his dialysis appointments or else he takes medical transportation. Henry is mostly homebound, and his daughter brings groceries. She describes him as "set in his ways." He often eats canned and frozen meals because they are easy to prepare, and he likes them. He feels fatigued and doesn't have energy to cook but will heat things up and his daughter will sometimes make food for him and bring it over. His ankles appear swollen. "I sleep a lot at dialysis so I can't sleep at night very well - plus I get a lot of muscle cramps which keeps me awake." His urine output is 240mL/ day and he has chronic constipation with a BM every 2 to 3 days. Anthropometrics: Height: 70 inches /178cm Weight: 153lbs/69.5kg BMI: Weight 1 year ago: 170lbs, Weight 3 months ago: 159lbs, Weight before last dialysis session: 165 lbs, Weight after last dialysis session: 160 tbs Here Is Henry's 24 Hour Recall: B: Often skips as he sleeps late and doesn't have much of an appetite lately. Drinks 1 cup coffee with 2 tbs half and half when he wakes up. 5: (11 am) 12 oz orange juice and 1 slice white toast with butter, small handful of M&M's L (1:00 pm): 2 cups canned tomato soup (tomato is his favorite) 12 saltine crackers and 8 oz 2% milk. 5: 1 large banana D (8 pm): Salisbury steak with mashed potatoes frozen dinner and 12 oz sweetened iced tea. S: (10 pm) 1 cup chocolate ice cream Medications and Supplements: atenolol, erythropoietin (EPO), ferrlecit, insulin (lantus basil insulin), zemplar, sertraline, miralax, calcium carbonate tablets Nutrition Physical Exam: Evidence of moderate wasting in the orbital, buccal, temporal and clavicular regions. Patient moves slowly and dentures appear to fit loosely. He falls asleep briefly during the nutrition intake. Ankles have evidence of edema.Nutrition Physical Exam: Evidence of moderate wasting in the orbital, buccal, temporal and clavicular regions. Patient moves slowly and dentures appear to fit loosely. He falls asleep briefly during the nutrition intake. Ankles have evidence of edema. Recent Labs and Blood Pressure: Blood Pressure (BP): 143/92 Question 1 Assess Henry's anthropometrics. Has he lost weight? Gained weight? Has he gained more than the recommended amount between dialysis sessions? Calculate his calorie, protein, and fluid ne.

1. Henry is a 70-year-old African American male with end-stage renal disease (ESRD) started
recently on hemodialysis 3 times per week and is having trouble with the diet changes. He dislikes
the taste of his binders (Tums 8/ /calcium carbonate) and reports often forgetting to take them with
meals. His nephrologist referred him for help implementing a renal diet. He went through a class
but is having trouble remembering what he leamed. He is present at the appointment with his adult
daughter. Henry was diagnosed with type 2 diabetes 10 years ago. The doctor said it was likely
that he had DM for several years prior to diagnosis. Henry lives alone but his daughter lives a few
miles away and takes him to his dialysis appointments or else he takes medical transportation.
Henry is mostly homebound, and his daughter brings groceries. She describes him as "set in his
ways." He often eats canned and frozen meals because they are easy to prepare, and he likes
them. He feels fatigued and doesn't have energy to cook but will heat things up and his daughter
will sometimes make food for him and bring it over. His ankles appear swollen. "I sleep a lot at
dialysis so I can't sleep at night very well - plus I get a lot of muscle cramps which keeps me
awake." His urine output is 240mL/ day and he has chronic constipation with a BM every 2 to 3
days. Anthropometrics: Height: 70 inches /178cm Weight: 153lbs/69.5kg BMI: Weight 1 year ago:
170lbs, Weight 3 months ago: 159lbs, Weight before last dialysis session: 165 lbs, Weight after
last dialysis session: 160 tbs Here Is Henry's 24 Hour Recall: B: Often skips as he sleeps late and
doesn't have much of an appetite lately. Drinks 1 cup coffee with 2 tbs half and half when he
wakes up. 5: (11 am) 12 oz orange juice and 1 slice white toast with butter, small handful of
M&M's L (1:00 pm): 2 cups canned tomato soup (tomato is his favorite) 12 saltine crackers and 8
oz 2% milk. 5: 1 large banana D (8 pm): Salisbury steak with mashed potatoes frozen dinner and
12 oz sweetened iced tea. S: (10 pm) 1 cup chocolate ice cream Medications and Supplements:
atenolol, erythropoietin (EPO), ferrlecit, insulin (lantus basil insulin), zemplar, sertraline, miralax,
calcium carbonate tablets Nutrition Physical Exam: Evidence of moderate wasting in the orbital,
buccal, temporal and clavicular regions. Patient moves slowly and dentures appear to fit loosely.
He falls asleep briefly during the nutrition intake. Ankles have evidence of edema.Nutrition
Physical Exam: Evidence of moderate wasting in the orbital, buccal, temporal and clavicular
regions. Patient moves slowly and dentures appear to fit loosely. He falls asleep briefly during the
nutrition intake. Ankles have evidence of edema. Recent Labs and Blood Pressure: Blood
Pressure (BP): 143/92 Question 1 Assess Henry's anthropometrics. Has he lost weight? Gained
weight? Has he gained more than the recommended amount between dialysis sessions?
Calculate his calorie, protein, and fluid needs.Assess Henry's anthropometrics. Has he lost
weight? Gained weight? Has he gained more than the recommended amount between dialysis
sessions? Calculate his calorie, protein, and fluid needs. Question 2 Assess his 24-hour recall. Is
his calorie, protein, and fluid intake appropriate for his needs? Are there any nutrients of concern
for his lifecycle stage and state of health (ESRD, diabetes, HTN)? Question 3 Assess his labs and
blood pressure; what in his diet could contribute to these values? Question 4 Assess for any
potential drug-nutrient interactions (DNis) and side effects.Assess his labs and blood pressure;
what in his diet could contribute to these values? Question 4 Assess for any potential drug-nutrient
interactions (DNis) and side effects. Question 5 Outline your short-term and long-term goals for
Henry to help him manage his health while on dialysis.