Question

Mr. Wilson is a 64 year old male. He recently learned that he has chronic Kidney Disease Stage IV. He is visiting with you and his nephrologist for the first time today.

Dr. Phillips, the nephrologist, met with Mr. Wilson and performed an initial assessent. Following the initial intake and assessment Dr. Phillips recognizes that Mr. Wilson is in need of diet education and recommends that he visit with you, the registered nurse, for nutritional advice.

Initial Assessment

Height 6'2 (74inches)

Weight: 266 lbs

Blood Pressure: 140/90

HgbA1c: 10

Glumerular Filtration Rate (GFR): 26

You begin by interviewing Mr. Wilson to learn about his past medical history, social and environmental situation. He is 64 years old. He reports that this is a new diagnosis of CKD (stage IV) and that he is very concerns about his diagnosis. You learn the following information during your visit:

1. Mr. Wilson lives with his wife and they eat most of their meals from restaurant.

2. Mr. Wilson has high blood pressure and does not watch his sodium intake.

3. Mr. Wilson has uncontrolled diabetes

4. He is not physically. active on a daily basis.

5. Mr. Wilson smokes 1 pack of cigarettes per day.

Case Study Question

1. Based on what you learned about Mr. Wilson in your interview , briefly explain his modifiable risk factors for Chronic kidney Disease. What lifestyle changes could he make to protect his kidney?

2. Based on your client's height and weight, how many grams of protein would you recommend that your client consume per day?

3. Discuss the recommendation that you would make for Mr. Wilson's sodium and potassium intake (in milligrams). What foods should be limited to restricted sodium and potassium in the diet (list 5)

4. Discuss the rationale for phosphorus restriction in Mr. Wilson's diet. What foods should be limited to restrict phosphorus in the diet (list5)?

5. Briefly discuss treatment option for Mr. Wilson if his CKD progresses to End Stage Renal Disease (ESRD)

Answer 1

1, Based on Mr.wilson in interview his risk factors for chronic kidney disease include:
- His weight is increased
-Blood pressure he is having hypertension 140/90
-Uncontrolled diabetes
-Smoking habit
-Physically inactive
-No diet diet restriction
Life style changes recommneded for patient is :
-Diet changes avoiding outside food and low intake of sodium,potassium,phosphorus and protein..
-inprove his physical activity
-He has to avoid cigarettes..
-Must reduce his weight by monitoring body mass index regularly..
-control his blood glucose level by checking glucose level regualrly..
2, Based on Mr.wilson height and weight he need 97grams of protein per day..
3,Recommended potassium level for client is 1500 to 2,700 mg/day and sodium intake 1500 to 2000 per day..low potassium and sodium diet include:
-1cup corn flakes
-2slices white bread
-1/2cup milk
-1 hamburger roll,
-1/2cup frozen green beans
4, when kidney functioning normally it can remove phosphorus well from the body..but with CKD it can not do that function.so high phosphorus can damage the kidney..high phosphorus and calcium level can make dangerous calcium depositis in blood vessels,lungs,eyes and heart..so client has to take only 800 to 1000 mg per day phosphorus to be taken..phosphorus restriction diet include:
-A small amount of brie or swiss cheese
-Frozen fruit pops
-cereals,rice and pasta
-bagels or english muffins
-All natural lean beaf
5, treatement plan include:
Hemodialysis it removes wastes and extra fluid from your blood..
Fistula by opening circulatory system it is easy to attach with dialysis machine..
Graft it is need minor operation and fistula involves joining an artery with nearby vein..
Catheter is an another type of catheter placed in a large vein in patient neck or chest..
Home dialysis is having multiple benefits in home setup..Home dialysis include better weight control,anemeia,adequacy,albumin well maintained..
Peritoneal dialysis it is more widely a acceptable method of treating patient with kidney failure and ESRD..
-Medication to be continued timely with water restriction
-Hypertensive medication and diabetes medication must be taken regularly..
-Avoid over-the -counter medication
-Make physical activity part of your life
-Avoid food from outside and eat diet with low sodium,potassium,protein and phosphorus diet..
-stop smoking and get enough sleep..