Case StudyEXAMINING KIDNEY DISEASE USING THE ADIME PROCEDURE

SCOTT LOZIER, DIETETIC INTERN AND MBA-CANDIDATE, DOMINICAN UNIVERSITY

Assessment

Resident: DK

Personal Information:

DOB: 7/9/1962 (52 yrs old)

Caucasian, Male

Allergies: Avelox

Primary Diagnosis: Acute Kidney Failure

Ambulates with a wheelchair

Diet Order:

No Added Salt (NAS), No Concentrated Sweets (NCS) with Nepro Protein Shake and Med Pass 2.0 supplements

Double order of meat

Vitals (as of 11/3)

Weights (#):

Current = 224.0

10/4 /2014= 220.0

10/9/2013 = 278.2

10/1/2012 = 320.0

Height: 74.0”

BMI: 28.8

IBW: 190# +/- 10%

Pulse: 78 bpm

Resp: 18 bpm

Blood Sugar: 90 mg/dL

O2 Saturation: 97%

Blood Pressure: 102/64 mmHg

24-Hour Dietary RecallBreakfast (8:00 AM)

1 bagel with 1 container of cream cheese

1 glass of water, no juice or milk

Lunch (12:00 PM)

Double portion of chicken, 6 oz.

Serving of corn, ½ cup

1 glass of water

Snack (after lunch)

1 bag of popcorn

Dinner (12:00 PM)

Double portion of steak, 4oz.

1 glass of water

Assessment Says appetite is good, PO is 51-

100%

No issues chewing or swallowing

No N/V/D/C

NKFA

No BLE

Food preferences used to drink lemonade but can’t because of phosphorus, bagels need to be toasted more, vegetables are bland

Lab Values

Test Result Normal Range

RBC 2.9 M/uL L 4.2-6.0

Hgb 10.0 g/dL L 12.0-18.0

Hct 29.7% L 36.0-52.0

MCV 104.2 FL H 80-100.0

MCH 35.1 PG H 26.6-32.6

BUN 50 mg/dL H 7-23

Creat 7.1 mg/dL H 0.4-1.6

eGFR 8.7 mL/min L <15 CKD Stage 5

Eosinophils 6.2% H 0.0-6.0

Medications

HumaLOG 100 unit/mL Insulin Milk of Magnesia Constipation Senna Constipation Colace Diarrhea Ferrous Sulfate Anemia Rena-vite (B-vitamin) Anemia Gabepentin Neuropathy Cholecalciferol & Vit D3 Pepcid GERD Sodium Bicarbonate Heartburn Renegal Phosphate binder Duoneb Solution Shortness of breath Acetaminophen Pain management Norco Tablet Pain management

Diagnosis

Medical Diagnoses

Acute Kidney Failure (Admitting Dx)

Lower Limb Amputation

Acute Osteomyelitis

Diabetes Mellitus Type II

Anemia

Osteoporosis

Muscle Weakness

Edema

Hypertension

Pressure Ulcer

GERD

Peripheral Vascular Disease

Lymphedema

Stevens-Johnson Syndrome

Esophageal Reflux

Admitting Diagnosis

Acute Kidney Disease

Philip has an eGFR of 8.7 mL/min

CKD Stage GFR

1 90 mL/min or Greater

2 60-89 mL/min

3 30-59 mL/min

4 15-29 mL/min

5 <15 mL/min

Secondary Diagnoses

Diabetes Mellitus Type II

Major contributor to kidney failure

Over filtration of blood to kidneys damages filtering system

Explains high levels of BUN and Creatinine

Muscle Weakness

Protein losses from Dialysis

Disturbs electrolyte balance in body and affects muscle contractions

Anemia

Losses of fluid affect amounts of water-soluble vitamins

Loss of protein affects muscle mass and iron stores

Intervention

Dialysis Treatment

Dialysis scheduled for Monday, Wednesday, and Friday Hemodialysis = artificial kidney machine that filters blood Hemodialysis via R arm fistula Major protein losses Need for protein supplements (1.2

g/kg) = 122 g PRO/day Also causes poor appetite Med Pass and encourage

eating (30-35 kcal/day) = 3054-3563 kcal/day

Nutritional Intervention

Therapeutic Diets & Diet Order NAS and NCS prevent excess sodium intake and controls

blood sugar Double meat Increases calories and protein lost during HD

Other Interventions Monitor electrolytes such as sodium, potassium, and sodium Fluids also need to be restricted Calcium and Vitamin D to prevent bone degeneration

Other Interventions

Physical Therapy Can help rebuild lost muscle mass and weakness Reduce nerve degeneration that occurs with Diabetes

Diabetic Shoes and Socks Diabetic socks help blood reach the lower legs and feet Diabetic shoes are larger for swelling, help to avoid pressure

ulcers

Monitoring/Evaluation

Monitoring/Evaluation

Track diet to ensure sufficient calories and protein consumed, electrolytes balanced

Lab values should be monitored BUN, Creatinine, Albumin, Hgb, Hct, etc.

Watch for signs of edema swelling, excessive weight gain between Dialysis treatments