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Chronic Kidney Disease

Stage 5 Click to

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I.General Information

Name:

G Surname

T Firstname

Age: 26-year-old Sex: Female Clinical Diagnosis: Stage 5 Chronic Kidney Disease Stage 5

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II. Medical History

PAST: A history of renal insufficiency hypertension and diabetes mellitus type 2. Current symptoms: anorexia, nausea and vomiting, edema, shortness of breath, and inability to urinate. MEDICINES: Captopril Vitamin/Mineral supplement Glucophage Erythropoietin Nutrition History She is 50 and weighs 170 lbs. usual body weight
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OVERVIEW
of Past and Present Illness:

Renal failure or kidney failure (formerly called renal insufficiency) describes a medical condition in which the kidneys fail to adequately filter toxins and waste products from the blood. The two forms are acute (acute kidney injury) and chronic (chronic kidney disease), a number of other diseases or health problems may cause either form of renal failure to occur.

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Renal failure is described as a decrease in glomerular filtration rate. Biochemically, renal failure is typically detected by an elevated serum creatinine level. Problems frequently encountered in kidney malfunction include abnormal fluid levels in the body, deranged acid levels, abnormal levels of potassium, calcium, phosphate, and (in the longer term) anemia as well as delayed healing in broken bones. Depending on the cause, hematuria (blood loss in the urine) and proteinuria (protein loss in the urine) may occur. Long-term kidney problems have significant repercussions on other diseases, such as cardiovascular disease. 7/14/12

Hypertension or High Blood Pressure is a measurement of the force against the walls of your arteries as your heart pumps blood through your body. Normal blood pressure 120/80 mmHg High blood pressure (hypertension) 140/90 mmHg or above most of the time. If your blood pressure numbers are 120/80 or higher, but below 140/90, it is called pre-hypertension. Causes, incidence, and risk factors Many factors can affect blood pressure, including:

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Type 2 diabetes mellitus comprises an array of dysfunctions resulting from the combination of resistance to insulin action and inadequate insulin secretion. It is disorders are characterized by hyperglycemia and associated with microvascular (ie, retinal, renal, possibly neuropathic), macrovascular (ie, coronary, peripheral vascular), and neuropathic (ie, autonomic, peripheral) complications.

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Patients diagnosis:
Chronic Kidney Disease (Stage 5)

A person with Stage 5 CKD has end stage renal disease (ESRD) with a GFR of 15 ml/min or less. At this advanced stage of kidney disease the kidneys have lost nearly all their ability to do their job effectively, and eventually dialysis or a kidney transplant is needed to live.
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Symptoms that can occur in Stage 5 CKD include: Loss of appetite Nausea or vomiting Headaches Being tired Being unable to concentrate Itching Making little or no urine Swelling, especially around the eyes and ankles Muscle cramps
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Laboratory Tests BUN (Blood Urea Nitrogen)

Laboratory Results 69 mg/dL

Normal Range M: 8-24 mg/dL F: 6-21 mg/dL

Interpretation BUN: kidneys arent working well

Creatinine

12 mg/dL

M: 0.7-1.2 mg/dL F: 0.5-1.0 mg/dL

creatinine: poor clearance due to impared kidneys

Glucose HbA1c Potassium

200 mg/dL 8.9% mg/dL 7mEq/L

82-110 mg/dL 3.5-5.5% mg/dL 3.5-5.5 mEq/L

Patient is diabetic Patient is diabetic Hyperkalemia

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PATHOPHISIOLOGY

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IV. Recent Literature updates to Kidney Failure


Kidney Failure Patients Benefit
From Frequent Or Extended Dialysis Treatments
by VR Sreeraman on February 24, 2012 at 2:09 PM Organ Donation News
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Patients suffering from kidney failure may benefit from frequent and longer dialysis treatments which may improve survival compared with conventional dialysis. The findings suggest that daily or nightly dialysis sessions at home or in the clinic are viableand perhaps superioralternatives for some patients with kidney failure. Most kidney failure patients who undergo dialysis receive treatments at outpatient facilities three times per week, for three to four hours per visit. Researchers suspect that more frequent and longer treatments might be more effective, but these would be inconvenient for most patients and would take up too much of their time. Therefore, nighttime dialysis while patients sleep (at home or in a clinic) or daily treatments at home might be good options. Several groups of researchers set out to test these
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V. Assessment of Nutritional Status

Anthropometry

Age: 26 Height:50 / 152.4cm Weight:170lbs/ 77.5 kg BMI: 33.2 *(Obesity = BMI of 30 or greater) Based on patients G.Ts BMI, she is considered to fall in the obese category.

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BUN

Biochemical Assessment
RESULTs 69mg/dL

INDICATIONs a high blood urea nitrogen level means kidneys aren't working wellcan also be due to urinary tract obstruction, congestive heart failure or gastrointestinal bleeding

Creatinine

12 mg/dL

blood suggest diseases or conditions that affect kidney function.

Glucose HbA1c Potassium

200mg/dL 8.9%

impaired glucose tolerance (pre-diabetes) High Acuteorchronic kidney failure

7 mEq/L

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Clinical Assessment
A history of renal insufficiency hypertension and diabetes mellitus type 2. Current symptoms: anorexia, nausea and vomiting, edema, shortness of breath, and inability to urinate. Nutritional Diagnosis: Altered nutrition-related laboratory values including elevated serum potassium as related to dietary choices high in potassium as evidenced by serum potassium of 7 mEq/L .
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Dietary Assessment

It is based on observed food consumption Qualitative Method & Quantitative Method: can further observe in diet history in which patient GT eats everything with no restrictions (assuming from the food exchange list.) Basically eats everything with no restrictions

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VI. Nutrition Care Plan


Patient G.T who basically eats everything with no restrictions is admitted with a diagnosis of Stage 5 Chronic Kidney Disease and presents a history of renal insufficiency hypertension and diabetes mellitus type 2 her current symptoms include anorexia, nausea and vomiting, edema, shortness of breath, and inability to urinate and initiated with plan of having 7/14/12 hemodialysis.

People on hemodialysis generally need to increase their protein, and limit fluids, sodium, potassium and phosphorus, and in some cases, calcium. Those who choose PD usually need to increase their protein and limit phosphorus, but may have fewer limits on fluid and potassium.
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A healthy diet for stage 5 CKD may recommend:

Including grains, fruits and vegetables, but limiting or avoiding whole grains and certain fruits and vegetables that are high in phosphorus or potassium A diet that is low in saturated fat and cholesterol and moderate in total fats, especially if cholesterol is high or if you have diabetes or heart disease Limiting intake of refined and processed foods 7/14/12

Taking special renal vitamins high in water soluble B vitamins and limited to 100 mg of vitamin C Vitamin D and iron tailored to individual requirements Limiting phosphorus to1000 mg or based on individual requirements Limiting calcium to 2000 mg (no more than 1500 mg from calcium based phosphorus binders). 7/14/12

Short term Goals:

Encourage intake. Promote blood pressure control. Maintain glucose, mineral, and electrolyte balance

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Long term Goals:


Prevent chronic complications of immunosuppressive therapy: Excessive weight gain Hyperlipidemia Hypertension Corticosteroid-induced hyperglycemia and/or osteoporosis

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Nutritional Goal & Intervention

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VII.DEFINITION OF TERMS

Chronic kidney disease (CKD) - also known as chronic renal disease, is a progressive loss in renal function over a period of months or years. The symptoms of worsening kidney function are unspecific, and might include feeling generally unwell and experiencing a reduced appetite. Obesity- is a medical condition in which excess body fat has accumulated to the extent that it may have an adverse effect on health, leading to reduced life expectancy and/or increased health problems Diabetes mellitus type 2 formerly non-insulindependent diabetes mellitus (NIDDM)7/14/12 or adult-

Hypertension (HTN) or high blood pressure, sometimes arterial hypertension- is a chronic medical condition in which the blood pressure in the arteries is elevated. Anorexia nervosa - is an eating disorder characterized by excessive weight loss, and irrational fear of gaining weight and distorted body self-perception. Edema (formerly known as dropsy or hydropsy)-, is an abnormal accumulation of fluid beneath the skin or in one or more cavities of the body that produces swelling.
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Nausea- is an uneasiness of the stomach that often accompanies the urge to vomit, but doesn't always lead to vomiting. Vomiting- is the forcible voluntary or involuntary emptying ("throwing up") of stomach contents through the mouth. Urinary Retention- inability to urinate

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QUESTIONS:

Explain how current symptoms are related to CKD.

From the pathophisiology ,If blood glucose levels are elevated consistently for a significant period of time, the kidneys filtration mechanism is stressed, allowing blood proteins to leak into the urine. As a result, the pressure in the blood vessels of the kidney increases. It is thought that the elevated pressure serves as the stimulus the level of nephropathy. The earliest detectable change in the course of diabetic nephropathy is a thickening in the glomerulus. At this stage, the kidney may start 7/14/12

Correlate the laboratory with the patients diagnosis. VALUES RESULTs NORMAL INDICATIONs
BUN 8-18 H 69mg/dL a high blood urea nitrogen level means kidneys aren't working wellcan also be due to urinary tract obstruction, congestive heart failure or gastrointestinal Creatinine 0.6-1.2 H 12 mg/dL bleeding High level of creatinine indicates impaired renal function. (mg/dL) Creatinine clearance is used to estimate GFR, the primary diagnostic Glucose 70-110 H 200mg/dL criteria High blood glucose indicates uncontrolled DM, which leads to (mg/dL) diabetic nephropathy. HbA1c 3.9-5.2 H 8.9% HbA1C indicates long-term uncontrolled hyperglycemia, (%) indicating diabetic nephropathy as the likely cause of the patients chronic kidney Potassium 3.5-5 H 7 mEq/L disease. High serum potassium indicates compromised filtration in the (mEq/L) kidneys

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Replace food exchange list with nurtion theraphy for CKD;include the nutrients that are usually controlled with CKD patients requiring dialysis plus the food source of each nutrient.

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When patient GT begins dialysis, energy and protein recommendations will increase. Adequate energy intake is essential for protein to be used for growth and repair of lean tissue. In an absence of sufficient energy, protein is diverted from its important functions to supply energy (4 calories/gram). The dialysis procedure has been implicated as a potential catabolic factor predisposing the CKD patient to protein calorie malnutrition. Data demonstrates that dialysis is an overall catabolic event, decreasing the circulating amino acids, accelerating rates of whole body and muscle 7/14/12

Why is it recommended for patients to have at least 50% of their protein from sources that have high biological value? Proteins sources that have high biological value are those that have complete essential amino acids required by the human body and are easily assimilated into body tissue are called proteins with High Biological Value (HBV). Proteins with HBV include such as meat, poultry, fish, eggs, milk, cheese and yogurt. Low biological value proteins are found in plants, legumes, grains, nuts, seeds and vegetables. One of the by-products of protein metabolism is urea (toxic) which is unfavorable to CKD patients as the kidneys are unable 7/14/12 to remove

IX. REFERENCE:

New England LMS (2007), (Escott-Stump, 2008) http://www.emedicinehealth.com/inability_to_urina te/article_em.htm http://www.medindia.net/news/kidney-failurepatients-benefit-from-frequent-or-extendeddialysis-treatments-97937-1.htm#ixzz1o7eclTcV www.lusimartin.blogspot.com http://nursingdepartment.blogspot.com/2009/03/p athophysiology-of-diabetes-milletus.html American Dietetic Association. Guidelines for Nutrition Care of Renal Patients. Third edition. 7/14/12 2002.

Powerpoint: KRISTINE ANNE SORIANO

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