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Case StudyEXAMINING KIDNEY DISEASE USING THE ADIME PROCESS
SCOTT LOZIER, DIETETIC INTERN AND MBA-CANDIDATE, DOMINICAN UNIVERSITY
Assessment
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
Vitals (as of 11/3)
Weights (#): Current = 224.0 10/4 /2014= 220.0 10/9/2013 = 278.2 10/1/2012 = 320.0
Height: 74.0”BMI: 28.8IBW: 190# +/- 10%Pulse: 78 bpmResp: 18 bpmBlood Sugar: 90 mg/dL O2 Saturation: 97%Blood Pressure: 102/64 mmHg
24-Hour Dietary RecallBreakfast (8:00 AM)
1 bagel with 1 container of cream cheese
1 glass of water, no juice or milkLunch (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
Lab Values
Test ResultNormal 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
Medications HumaLOG 100 unit/mL Insulin Milk of Magnesia Constipation Senna Constipation Colace Diarrhea Ferrous Sulfate Anemia Rena-vite (B-vitamin) Anemia Gabepentin Neuropathy Cholecalciferol & Vit D3 Pepcid GERD Sodium Bicarbonate Heartburn Renegal Phosphate binder Duoneb Solution Shortness of breath Acetaminophen Pain management Norco Tablet Pain management
Diagnosis
Medical Diagnoses
Acute Kidney Failure (Admitting Dx) Lower Limb Amputation Acute Osteomyelitis Diabetes Mellitus Type II Anemia Osteoporosis Muscle Weakness Edema Hypertension Pressure Ulcer GERD Peripheral Vascular Disease Lymphedema Stevens-Johnson Syndrome Esophageal Reflux
Admitting Diagnosis
Acute Kidney Disease DK has an eGFR of 8.7 mL/min CKD Stage GFR1 90 mL/min or Greater2 60-89 mL/min3 30-59 mL/min4 15-29 mL/min5 <15 mL/min
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 CreatinineMuscle Weakness Protein losses from Dialysis Disturbs electrolyte balance in body and affects muscle contractionsAnemia Losses of fluid affect amounts of water-soluble vitamins Loss of protein affects muscle mass and iron stores
Intervention
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
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 HDOther Interventions Monitor electrolytes such as sodium, potassium, and sodium Fluids also need to be restricted Calcium and Vitamin D to prevent bone degeneration
Other Interventions
Physical Therapy Can help rebuild lost muscle mass and weakness Reduce nerve degeneration that occurs with DiabetesDiabetic Shoes and Socks Diabetic socks help blood reach the lower legs and feet Diabetic shoes are larger for swelling, help to avoid pressure
ulcers
Monitoring/Evaluation
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