Leo Ontiveros - 415A-03

ADIME #1

A: 69 y/o AA female with ESRD. Pt was admitted with chest pain after walking up the stairs to
her home, diagnosed with an acute MI. Pt history states she began HD 5 years ago, has dialysis
on Tuesday, Thursday and Saturday. PMH reveals Type 2 DM (18 years) and HTN (44 years).
Pt lives with daughter who prepares pt meals with no education on renal diet. Diet history
reveals pt follows renal diet at home, sees dietitian once a month who recommended
increased protein intake, and she does not consume bananas, oranges, tomatoes, or potatoes
due to potassium. Nurse reports pt is consuming 60% of most meals.
Dx: Acute MI
Ht: 58 Wt: 163# UBW: 156# (WNL) UBW%: 104% (WNL) IBW: 140# IBW%: 116%
BMI: 24.8 (Normal)
Labs: K+ 5.8 mg/dl (H), BUN 108 mg/dl (H), Cr 10.8 mg/dl (WNL), Hgb 11.0 mg/dl (WNL), Hct
36 (WNL), Phos 6.5 mg/dl (H), Alb 2.5 mg/dl (L), Mg 3.2 mg/dl (WNL), Chol 272 mg/dl (H), RBG
186 mg/dl (H)
Meds: Bumex, Phos-lo, Epogen, Nephrovite, Glipizide, Zocor
Physical Assessment: Edema of the lower extremities and sounds congested
Estimated energy requirements: 2300 kcal/day (Based on 33 kcal/kg x post-dialysis weight
[UBW])
Estimated protein needs: 85 grams/day (Based on 1.2 g/kg x post-dialysis weight [UBW])
Current Diet: Renal Diabetic
D: Food and nutrition-related knowledge deficit of CKD diet R/T excessive potassium, saturated
fat and fluid intake AEB edema of the lower extremities and potassium 5.8 mg/dl, BUN 108
mg/dl, Chol 272 mg/dl.
Inadequate energy intake R/T suboptimal PO intake AEB 60% PO intake of 1800 Kcal diet and
47% PO intake of 2300 EER.
Altered nutrition-related laboratory values including high potassium and phosphorus R/T dietary
choices high in potassium and phosphorus and not keeping with Renal Diet parameters AEB
potassium 5.8 mg/dl, and phosphorus 6.5 mg/dl.
I: 1. Recommend modifications of high potassium and phosphorus foods with diet education
handout. Modify diet to 2 grams potassium per day and 8001000 mg/d phosphorus per day
along with less than 7% of total fat from saturated fats. Provide handout demonstrating how to
leech vegetables.
2. Modify diet to increase intake to estimated energy requirement of 2300 kcals/day instead of
the 1800 kcal diet. Educate patient and daughter on proper meal plans for CKD diet. Provide
handout that teaches calorie and macronutrient counting. Provide sample menus that includes
breakfast, lunch, and dinner with food choices such as applesauce, whole milk, margarine,
coleslaw, baked chicken, carrots, roast pork, green beans, white rice.
3. Limit fluid intake to 1200 ml per day. Fluids can be controlled by limiting high-salt foods,
taking pills with mealtime liquids, keeping lips moist, and frozen fruits.

M/E: 1. Monitor potassium and phosphorus lab values for 24 hours for a decline to normal
range.
2. Monitor cholesterol lab value for a decline to normal values during follow up visit in 2 weeks.
3. Patient will record food intake in a food journal and share during follow up visit in 2 weeks.
Weigh patient and update BMI during visit.
4. During the biweekly visits, perform a physical assessment to check for edema.