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This document summarizes a nutrition assessment for a 69 year old African American female with end stage renal disease and diabetes who was admitted for an acute myocardial infarction. The patient undergoes hemodialysis 3 times per week and follows a renal diet at home, though her daughter who prepares meals has not received nutrition education. Lab results show elevated phosphorus and cholesterol. The nutrition intervention includes increasing calorie and protein intake, educating the patient and her daughter on limiting phosphorus, cholesterol, and saturated fat, and following up with the patient's outpatient dietitian to monitor diet compliance and labs.
This document summarizes a nutrition assessment for a 69 year old African American female with end stage renal disease and diabetes who was admitted for an acute myocardial infarction. The patient undergoes hemodialysis 3 times per week and follows a renal diet at home, though her daughter who prepares meals has not received nutrition education. Lab results show elevated phosphorus and cholesterol. The nutrition intervention includes increasing calorie and protein intake, educating the patient and her daughter on limiting phosphorus, cholesterol, and saturated fat, and following up with the patient's outpatient dietitian to monitor diet compliance and labs.
This document summarizes a nutrition assessment for a 69 year old African American female with end stage renal disease and diabetes who was admitted for an acute myocardial infarction. The patient undergoes hemodialysis 3 times per week and follows a renal diet at home, though her daughter who prepares meals has not received nutrition education. Lab results show elevated phosphorus and cholesterol. The nutrition intervention includes increasing calorie and protein intake, educating the patient and her daughter on limiting phosphorus, cholesterol, and saturated fat, and following up with the patient's outpatient dietitian to monitor diet compliance and labs.
ASSESSMENT Pt TW, 69 yo AA female with ESRD admitted with c/o chest pain after climbing stairs. Dx: Acute MI. PMH: Type II DM (18 years), HTN (44 years). Pt began HD 5 years ago, currently undergoes HD 3 days/per wk. FH: Current diet-Pt reports following a renal diet at home (assuming renal diet= 60g PRO, 2g K+, 2g Na+, 1200mL fluid per day; Restrictions= ADA Diabetic diet of 1800kcal/day). Pt visits monthly with dietitian at HD unit who gives her a report card of labs and tells her to eat more protein. Pt reports she doesnt eat bananas, oranges, tomatoes or potatoes because theyre high in K+. Pt lives with daughter who prepares her meals but hasnt been educated renal diet by a dietitian. Nurses notes- Pt consumes 60% of most meals. AD: Ht= 58; Wt= 163#; SBW post HD= 156#(70.9kg); %SBW post HD= 105%; BMI= 23.8kg/m2 (Normal) EER: 2482 kcal/day [based on 35 kcal/kg pts UBW, post HD (70.9kg); PA factor= 1.1; Metabolic Stress= MI, HD]. EPR: 85g protein/day, at least 50% (approx. 43g) HBV [based on 1.2g PRO/kg pts UBW, post HD (70.9kg)]. Fluids: 1200mL/day (based on 1-1.5L fluid intake if fluid output 1 L) Labs: (K+)= 5.8 mEq/L(WNL-CKD); (BUN)= 108 mg/dl (High); (Cr)= 10.8 mg/dl (WNL-CKD); (Hgb)= 11.0 g/dl (WNL-CKD); (Hct)= 36 (WNL-CKD), (Phos)= 6.5 mg/dL (High); (Albumin)= 2.5 mg/dl (Low); (Mg); (Chol)= 272 mg/dl (High); (RBG)= 186 mg/dl (WNL-CKD) (Mg)= 3.2 mg/dl [High-But Mg levels can run normal-mildly elevated in HD pts (1.24-4.04mg/dL), therefore supplementation not recommended (Nelms, pg. 547)]. Meds: Bumex, Phos-lo, Epogen, Nephrovite, glipizide, Zocor. Possible food-drug interactions: Grapefruit & Zocor (major), Nephrovite (Ca+ rich foods, supplements). PA: Edema of lower extremities, sounds congested. DIAGNOSIS 1. Inadequate energy intake related to r/t recent poor appetite secondary to CKD and acute MI and AEB by consumption of only 60% of meals. 2. Altered nutrition related lab values r/t Stage 5 CKD and inappropriate intake of phosphorus and dietary lipids as AEB serum phosphorus of 6.5mg/dL and serum cholesterol of 272mg/dL. 3. Food/nutrition related knowledge deficit r/t lack of education on contents and preparation of renal diet AEB by pt food/nutrition history and self-report. NUTRITION INTERVENTION Nutrition Rx: 2482 kcal/day; 85g PRO/day with 43g (approx. 50%) from high-biological value sources; total fat intake= 621-869 kcals (25-35% total kcals), 174kcals/day saturated fat (7% total kcal), phosphorus 800-1000mg/day; cholesterol <200mg/day; 2g (2000mg) sodium/day, calcium<2000, mg/day including binder load; 1200mL/day (based on 1-1.5L fluid intake if fluid output 1 L)*Recommend adjustment based on changes in output (increase to 2L/day if output >1L/day). 1. Work with pt to increase her meal consumption to a minimum of 75% of daily meals prior to discharge. 2. Provide nutritional education on the importance of limiting the following nutrients to pts health and disease progress: phosphorus intake to 800-100mg/day, cholesterol to <200mg/day, total fat intake to 25-35% total kcal and sat. fat intake to 7% total kcal.
Karen Brenes-415B- ADIME #1
3. Provide pt and her daughter with booklet on The National Renal Diet along with recommendations on high phosphorus foods and additives to avoid as well as good sources of HBV protein that are low in phosphorus and sodium. MONITORING & EVALUATION 1. Check in on pt daily regarding state of her appetite. Check daily with nursing staff to further monitor pts intake. Adjust pre-discharge intake goals if necessary. 2. Have pt state her understanding regarding the importance of limiting phosphorus, cholesterol and sat. fat intakes to recommended levels before discharge. 3. Recommend pt continue to work with dietitian at her HD unit to monitor her diet compliance and nutrition related lab values both before and after her dialysis treatments. SIGNATURE: