Clinical Care

Conference
By Aimee Merkle-Scotland
Riverside Health and Rehabilitation
December 5, 2017
Introduction
Major Dx:
Pt: JN ● Chronic Kidney Disease- Stage IV
● Type 2 Diabetes Mellitus
Gender: F ● Postlaminectomy syndrome
● Hyperlipidemia
Age: 76

Admission date: 9/16/17

Date seen: 10/3/17

Dx: Chronic
Kidney Disease
Stage 4
● Diabetes mellitus is the leading
cause
● Fluid and waste build up
● Decreased filtration rate
● Kidney function decreases with
each stage
Chronic Kidney Disease (Stage IV)
Medical Nutrition Therapy

● Energy needs: 30-35kcal/kg IBW

● 0.6-1.0g/kg IBW
● Controlling edema: 1500 to 2000mg Sodium
● Potassium restricted 2.3 to 3.1g
● Phosphorus restricted to 1.8-1.2g
● Calcium supplementation

Diabetes type 2 recommended diet:

● Consistent carbohydrate diet
● Physical activity
Course of Hospitalization

● Physical Therapy
○ Bed Mobility tasks, transfers, ambulation
● Occupational Therapy
○ Wheelchair training and supported standing 1-3 minutes
○ Transfers- especially to toilet
● Speech therapy
○ Minimal oral dysphagia - report of esophageal issues
○ Swallowing strategies
Diet Order

Low K diet (2g K)

Regular/whole texture

Thin consistency
Nutritional Needs
● Calorie needs: 1193 kcal
● Carbohydrate:
○ 50% total kcal: 597kcal
● Protein:
○ 0.8g/kgIBW = 88g
○ 352kcal
● Fat:
○ 20% total kcal: 244kcal
● Fluid:
○ 2.5L
Medications

Medication Use Significance

Humalog Insulin Increase in weight

Atorvastatin Antihyperlipidemic Side effects include constipation

and edema

Morphine Analgesic, narcotic, opiod Constipation and edema

Important Abnormal Labs

Lab Pt’s Value Normal Limits

eGFR 24.2mL/min >60mL/min

BUN 54mg/dL 7-17mg/dL

Creatinine 2.0mg/dL 0.5-1.0mg/dL

FBG 122 70-99mg/dL

K 5.3mmol/L 3.5-5.1mmol/L
Anthropometric Data

● Ht: 62in
● Wt: 216lbs
● BMI: 39.3
● Adjusted body weight: 140.3lbs

● BP: 179/80
mmHg
● Temperature:
99.7
Physical signs
● Edema
● Bruising on arm
● Swollen gland
 PES Statement
Altered nutrition-related laboratory value, potassium, RT 2g
potassium diet AEB elevated potassium laboratory value of
5.3mg/dL.
Intervention

● Reduce potassium intake to 1.5g

● Nutritional Education for patient and family:
○ Limiting sodium
○ Low potassium foods
○ Low phosphorus foods
● Foods to avoid
 Monitoring and
Evaluation
Frequent biochemical laboratory
tests to monitor potassium levels.
 Thank you!
Any questions?
References
https://www.vivehealth.com/products/digital-bathroom-scale
https://www.medicalnewstoday.com/articles/270644.php
https://medlineplus.gov/ency/imagepages/9766.htm
https://emedicine.medscape.com/article/1899031-overview
http://www.desimd.com/health-education/nephrology/chronic-kidney-disease-ckd
http://treat-kidney.blogspot.com/2015/09/after-getting-chronic-kidney-disease.html
https://medcomic.com/medcomic/stages-of-chronic-kidney-disease/
https://www.deathtodiabetes.com/nephropathy-natural-treatment.php (in extra images - the chart)
http://nathealthcare.globaldns.org/locations/riverside-health-and-rehabilitation-center/
https://www.davita.com/kidney-disease/diet-and-nutrition/diet-basics/potassium-and-chronic-kidney-disease/e/479
https://nobullnutrition.co/2016/07/11/sodiumintake/
https://www.kaleidahealth.org/services/display.asp?s=471
https://www.spine-health.com/treatment/pain-management/medications-neuropathic-pain
https://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwjI99Wm8PHXAhXDTd8KHe_NCGYQjx
wIAw&url=http%3A%2F%2Fblogs.rdxsports.com%2Fbest-diet-tips%2F&psig=AOvVaw0j6znP7nB6TJcMWHNK0wLX&ust=1512529136105002
https://www.st-marys.org/centers-services/laboratory-services/
Food & Medication Interaction book
Krause’s Food and the Nutrition Care Process
Mayo Clinic Staff. “Chronic Kidney Disease.” Mayo Clinic. Mayo Foundation for Medical Education and Research, 1998-
2017. Web. <https://www.mayoclinic.org/diseases-conditions/chronic-kidney-disease/symptoms-causes/syc-
20354521>