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Renal Mini Case Study

Renal Mini Case Study. By Melissa Jakubowski. Patient Information. Initials: M.H. Female 72 years old Full code NKFA 1 st date of chronic HD Tx: 8/10/2010 1 st date of Tx at Fresenius: 8/20/2010. Socioeconomic/Family Status. Retired Lives at home with husband Husband prepares meals

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Renal Mini Case Study

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  1. Renal Mini Case Study By Melissa Jakubowski

  2. Patient Information • Initials: M.H. • Female • 72 years old • Full code • NKFA • 1st date of chronic HD Tx: 8/10/2010 • 1st date of Tx at Fresenius: 8/20/2010

  3. Socioeconomic/Family Status • Retired • Lives at home with husband • Husband prepares meals • Denies alcohol/illicit drug use • H/o of smoking, quit 35 years ago

  4. Anthropometric Data • Height: 62” • Weights: • EDW: 54.50kg (119.9 lbs.) • Pre-weight: 55.80kg (122.8 lbs.) • Post-weight: 54.30kg (119.5 lbs.) • No recent weight gain/loss • BMI: 22.0 (LBW) • IBW: 131-158 lbs. • 91.5% IBW • IDWG: 1.3kg

  5. Interdialytic Weight Gain • IDWG Recommendations: • <3kg on weekdays • <4kg on weekends Or • <5% of EDW • Equals 2.7kg for this patient • IDWG: 1.3kg

  6. Biochemical Data

  7. Abnormal Lab Values

  8. Serum Albumin History

  9. Admitting Diagnosis Diagnosis Pathophysiology ESRD (on HD) secondary HTN Hypertensive nephropathy & nephrosclerosis Lupus (SLE) Kidney mass

  10. Past Medical History

  11. HD Access Currently Infection Temporary

  12. Medications

  13. Prednisone Side Effects • ↑ N urinary excretion • Induces negative nitrogen balance • Pathophysiology of low albumin

  14. Abnormal Lab Values Prednisone

  15. Zocor Patient Education • Avoid/limit grapefruit and other citrus fruits which inhibit the liver enzymes responsible for metabolizing Zocor

  16. Supplements • Dialyvite: Renal MVI, primarily containing B-complex vitamins, folic acid, essential minerals • Vitamin C: limited to 60-100mg/day to avoid formation of calcium oxalate kidney stones • Protein supplement 3x/week (Nepro or Zone Bar)

  17. Nutrition Needs Calorie Protein 30-35kcal/kg: 1600-1900 Harris-Benedict: 1500 Mifflin-St. Jeor: 1000 1.2-1.3g/kg: 65-71g

  18. Fluids • Fluid restriction of 1500mL (standard restriction for HD patients that produce < 1 L of urine/day) • 1500mL = 50 fl. oz.

  19. Current Dietary Recommendations • ↑ protein diet (65-71 g/day) • P restriction (800-1200 mg/day) • K restriction (2000 mg/day) • Na restriction (1500-2000 mg/day) • Fluid restriction (1500 mL/day)

  20. PES Statement • Increased protein, calorie, and vitamin & mineral needs related to ESRD on HD as evidenced by LBW (BMI = 22) and low serum albumin (3.5g/dl)

  21. Interventions • Nutrition Rx: continue as recommended • Protein supplement: continue as ordered • Dialyvite & P-binder: continue as prescribed • Encourage intake of high biological value (HBV) protein foods (eggs, meat, poultry, fish) • Continued HD diet education

  22. Goals To be achieved by next follow-up (48 hours): • Lab (alb): to trend toward standard • EDW: stable • IDWG per standards • Pt. to report: • Dietary adherence to nutrition rx • 100% supplement intake • Oral intake amount per her normal; good appetite • MVI and P-binder taken daily as prescribed

  23. Monitoring/Evaluation • Labs, especially K, P, Ca, Alb, PTH • Pt. self-report: oral supplementation intake, oral intake/appetite, and GI Sx • Level of the knowledge: continued verbalization of nutrition rx • Weights (EDW, pre-weight, post-weight) to determine IDWG and assess adherence to fluid restriction and dialysis sufficiency • Change in medical history, especially regarding the kidney mass

  24. Questions???

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