Question

K.B. is a 32-year-old woman being admitted to the medical floor for complaints of fatigue and dehydration. While taking her history, you discover that she has diabetes mellitus (DM) and has been insulin dependent since the age of 8. She has undergone hemodialysis (HD) for the past 2 years because of end stage renal disease (ESRD). Your initial assessment of K.B. reveals a pale, thin, slightly drowsy woman. Her skin is warm and dry to the touch with poor skin turgor, and her mucous membranes are dry. Her vital signs are 140/88, 116, 18, 99.9 ° F (37.7 ° C). She tells you she has been nauseated for 2 days so she has not been eating or drinking. She reports severe diarrhea. The following blood chemistry results are back. Chart View Laboratory Test Results Sodium 145 mEq/L Potassium 6.0 mEq/L Chloride 93 mEq/L Bicarbonate 27 mEq/L BUN 48 mg/dL Creatinine 5.0 mg/dL Glucose 238 mg/dL

1. Explain any laboratory results that might be of concern.

The rest of K.B.'s physical assessment is within normal limits. You note that she has an arteriovenous (AV) fistula in her left arm.

2. What is an AV fistula? Why does K.B. have one?

K.B. is sent for an HD treatment. Over the next 24 hours, K.B.'s nausea subsides, and she is able to eat normally. While you are helping her with her morning care, she confides in you that she doesn't understand her diet. "I just get blood drawn every week and meet with the dialysis dietitian every month—I just eat what she tells me to eat. It's so hard!"

3. Because K.B. is on HD and has DM, what are her special nutritional needs? Name at least four specific components of the diet recommended for K.B

Answer 1

1)feom the above case study we should concern about her serum potassium and BUN level, these two levels are increased

Serum potassium ,patient value is 6 mEq/L ,Normal level is 3.5 - 5.5mEq/L

Blood urea nitrogen (BUN),patient value is 40mg/dl and normal value is 7 to 20 mg/dl

These two value is increased, patient have mild hyperkalemia, it may cause cardiac problems such as cardiac dysrrhyhmias and later heart failure so we should concern regarding this potassium value

Increased BUN indicate accumulation of nitrogenous waste due to poor elimination so immediate dialysis is needed to prevent complication.

2)AV fistula

Arteriovenous fistula or AV fistula is referred as the connection between artery and vein it mainly used for the hemoglobin dialysis. It is created by anestemosing the artery and vein. Through this AV fistula blood bypass some capillaries.

The patient is end stage renal disease patients and she underwent hemodialysis before 2 year, so she may have this AV fistula.

3)nitritional recommendation is important in patient with diabetes and on hemodialysis.the following of correct dietary patterns help to improve survival rate .The dietary recommendations include

:low carbohydrate diet because patient have diabetes.

:high protein diet because patient is on hemodialysis. High protein diet is recommended to prevent complication from protein loss.

:high fat diet (saturated) because energy source is from fat. And try to avoid transfat.

:potassium restricted diet to keep heart healthy.avoid foods high in potassium like orange, kiwi, prunes etc. The range of restrictions include less than 3g/day.

:restrict phosphorus to less than 800mg/day.