Post on 10-Aug-2015
Case StudyEXAMINING KIDNEY DISEASE USING THE ADIME PROCEDURE
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: 28.8
IBW: 190# +/- 10%
Pulse: 78 bpm
Resp: 18 bpm
Blood 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 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
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
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
Philip 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
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
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 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
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
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