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