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Bella Stoakes, Sarah Blaser, and Isaac Rider

ADIME NOTE FOR TOM T.

Nutrition Assessment

Food and Nutrition Related History:

Typically eats 3 meals and 2 snacks per day.


Client admits to having only a fair appetite as of late and avoids gluten-containing foods and dislikes most
vegetables.
Client admits that favorite foods include cereal and milk, bananas, apples, grapes, orange juice, steak, ham,
chicken, eggs, cheese, yogurt, mixed nuts, French fries, Coke, and coffee.
Client admits to having 2-3 glasses of wine with dinner each night.
Client occasionally eats out on the weekends and for lunch with coworkers.
Client has been taking MVI 2x daily as well as a kidney supplement his wife found on the internet.

Client History:

Stage 3 CKD with plans to initiate dialysis once Stage 5 is reached, HTN for 25 years, Celiac disease for 35 years
and smoked for 15 years but quit 20 years ago.
Currently taking Furosemide (diuretic).
Mother had CVD, Celiac disease, and DM. Father had CVD and HTN. Grandparents both had CVD.

Anthropometrics

Ht: 72 inches (182.9 cm, 1.829 m)


Wt: 200 pounds (90.8 kg)
BMI: 27.1 kg/m2 (Overweight)
UBW: 97.7 kilograms
%UBW: 92.8
IBW: 177 pounds (80.36 kg)
%IBW: 113%

Weight change: Client is at mild to moderate risk as he has lost 7.2% (15lbs) body weight in 3 months.

Nutrition Related Physical Findings:

Decrease in appetite recently, as stated by patient.

Labs/Tests/Procedures:

Na (135 mEq/L): Normal Borderline Hypernatremic


Glu (99 mg/dL): Normal- Borderline High
K+ (3.0 mEq/dL): Low
Ca (9.0 mg/dL): Normal
Phos (4.5 mg/dL): Normal- Borderline High
BUN (30 mg/dL): High
Cr (2.0 mg/dL): High for Males

Estimated Energy Needs:

Kcal: 2100-3200 kcal/day (Empirical Formula (CBW)- 23-35 kcal/kg)


Pro: 54.5- 72.6 g/day (Empirical Formula (CBW)- 0.6-0.8 g/kg)

Fluid: 3200 mL/day (Empirical Formula (CBW)- High need- 25 mL/kg)

Nutrition Diagnosis:

Undesirable food choices related to a food- and nutrition-related knowledge deficit regarding the relationship
between animal-based protein intake and advancement of chronic kidney disease as evidenced by high ratio of
animal based protein to plant based protein intake as well as a dislike for vegetables, as stated by patient.

Nutrition Intervention:

Meals and snacks; Modified protein diet; Discussed with client about how animal based protein puts unwanted
stress on the kidneys
Nutrition education; Nutrition relationship to health/disease; Discussed with client the benefit of consuming plant
based protein to prevent advancement to CKD
Nutrition education; Recommended modifications; Discussed with client how to decrease amount of animal based
protein in the diet and increase plant based protein

Goals:

1. Tom will substitute regular milk for soy milk 3-4x this week
2. Tom will add beans to his lunch 2x this week
3. Tom will decrease the amount of meat during dinner by 50% and replace it with quinoa 1x this week

Monitoring and Evaluation:

Food and nutrient intake; Types of foods/meals; Type, amount frequency


Anthropometrics; Weight/BMI
Biochemical; Electrolyte and renal profile; Creatinine, potassium, sodium
Behavior; Adherence to nutrition goals