What will Mrs. Joaquin’s protein requirements be when she begins hemodialysis? What standard guidelines have you used to make these recommendations? Mrs. Joaquin’s protein requirements will increase to 1. 2 g/kg once she begins hemodialysis. 1. 2 x 66. 4=80 g of protein According to Mrs. Joaquin’s edema-free weight, she should be receiving approximately 80 grams of protein a day. This will ensure that she is receiving adequate amounts of protein to prevent muscle wasting. Low-protein diets are associated with high risks of muscle wasting and compliance difficulties.
Dietitians suggest that patients will illnesses consume a high protein diet in order to maintain health. CKD patients that are not receiving dialysis cannot consume a high protein diet or their blood nitrogen levels will begin to rise. Dialysis helps to excrete the excess nitrogen from the body that the kidneys are not able to excrete (Rolfes, Pinna, & Whitney, 2012, p. 854). What are the considerations for differences in protein requirements among predialysis, hemodialysis, and peritoneal dialysis patients? For predialysis patients, the protein requirement is 0. 60-0. 75 g/kg.
The protein requirement is lower than healthy individuals due to the fact that CKD patients do not have the ability to excrete nitrogenous waste from their bodies (Rolfes, Pinna, & Whitney, 2012, p. 853). For hemodialysis, protein requirements are anything equal to or greater than 1. 2 g/kg. CKD patients who have started hemodialysis are allowed more protein due to the fact that dialysis helps to eliminate excess nitrogenous waste from the body that the kidneys are no longer able to do. The protein requirements are higher than healthy individuals to ensure that muscle wasting does not occur.
CKD patients or any ill patient needs to ensure that they are receiving enough energy and protein for muscle maintenance (Rolfes, Pinna, & Whitney, 2012, p. 853). In peritoneal dialysis, the protein requirement is equal to or greater than 1. 2-1. 3 g/kg (Rolfes, Pinna, & Whitney, 2012, p. 853). Peritoneal dialysis patients need more protein than hemodialysis patients because they tend to lose more protein than hemodialysis. More protein is lost while the patient drains the dialysate from his or her stomach (“Protein and Your Peritoneal Dialysis Diet”).
Mrs. Joaquin has a ? PO? _4 restriction. Why? What foods have the highest levels of phosphorus? When a person has normal kidney function, the extra phosphorus that is consumed in the diet is excreted from the body. When the kidneys become impaired, excess phosphorus cannot be removed from the body very well. Excess phosphorus in the body can cause harm and cause calcium to be pulled out of the bones. High phosphorus and calcium can also lead to high calcium deposits in the blood, lungs, eyes, and heart (“Phosphorus and Your CKD Diet”, 2017). Some foods that have high levels of phosphorus are:
Beverages: beer, cocoa, chocolate drinks, dark colas, and bottled beverages with phosphate additives Dairy products: cheese, ice cream, milk, pudding, liquid nondairy creamer, and yogurt Protein: oysters, beef liver, chicken liver, organ meats Other foods: chocolate candy, oat bran muffins, caramels, pizza, and most processed foods (“Phosphorus and Your CKD Diet”, 2017) Mrs. Joaquin tells you that one of her friends can drink only certain amounts of liquids and wants to know if that is the case for her. What foods are considered to be fluids? What recommendations can you make for Mrs. Joaquin?
If a patient must follow a fluid restriction, what can be done to help reduce his or her thirst? Mrs. Joaquin has begun hemodialysis which restricts her to 1000 mL of fluids a day. CKD patients can no longer excrete fluid from their bodies due to their impaired kidney function. Dialysis patients are recommended to gain no more than 2 pounds of fluid weight per day. The fluid that is being retained in the body can only be excreted during their next dialysis treatment, which is why there is a fluid restriction. Foods that can be considered liquids are: creamy soups, Jell-O, milkshakes, pudding, fruit smoothies, and yogurt (Wax & Zieve, 2016).
Some suggestions for Mrs. Joaquin to help reduce her thirst are: Eat frozen fresh fruit Eat crispy cold vegetables Add lemon slices to their water Eliminate caffeine Sour candy (sour candy activates the saliva glands) Add fresh mint to your diet (“Top 10 Low-Sodium, Thirst-Quenching Foods for the Kidney Diet”) Several biochemical indices are used to diagnose chronic kidney disease. One is glomerular filtrations rate (GFR). What does GFR measure? What is a normal GFR? Mrs. Joaquin’s GFR is 28 mL/min. Interpret her value. GFR measures a person’s level of kidney function.
GFR and a person’s level of kidney function will also determine the stage of kidney disease that a person is in. A normal GFR, which can still be seen in stage one kidney disease, is 90 mL/min or above. Mrs. Joaquin’s GFR is 28 mL/min which classifies her as stage 4 kidney disease. Stage 4 kidney disease is indicated by a GFR of 29 to 15. Stage 4 kidney disease means that she has severe loss of kidney function (“Glomerular Filtration Rate (GFR)”, 2017). Evaluate Mrs. Joaquin’s chemistry report. What labs support the diagnosis of Stage 5 CKD? The major lab value that supports the diagnosis of stage 5 CKD is Mrs. Joaquin’s BUN lab value.
Her BUN lab value is 69 mg/dL. The reference range for BUN is 8-18 which means that Mrs. Joaquin’s BUN is significantly higher than normal. Another lab value that supports stage 5 CKD is creatinine serum. The reference range for creatinine serum is 0. 6-1. 2 mg/dL. Mrs. Joaquin’s creatinine serum level is 12 mg/dL which is also significantly higher. Mrs. Joaquin’s HDL cholesterol is low (50 mg/dL) and her LDL is high (135 mg/dL). High levels of cholesterol can be a main factor in reduced blood flow to the kidneys which can result in loss of kidney function (“Cholesterol and Chronic Kidney Disease”).
Mrs. Joaquin’s lab values also show that she has hyperphosphatemia and her calcium levels are becoming diminished. Which of Mrs. Joaquin’s other symptoms would you expect to begin to improve? With Mrs. Joaquin beginning hemodialysis, I would expect her edema begin to improve in her extremities, face and eyes. With her edema improving, I would then expect her shortness of breath to improve and the 3-pillow orthopnea to begin improving, as well. Her malaise should also begin improving as all the other symptoms begin improving. She should slowly start feeling better when ultimately her edema begins to improve.
Her weight will start resembling her actual weight when she begins starting hemodialysis and her excess fluid and waste is excreted from her body. I would expect for Mrs. Joaquin’s to begin feeling better overall. Explain why the following medications were prescribed by completing the following table. Medication Indications/Mechanism Nutritional Concerns Capoten/ captopril Antihypertensive medication Take on an empty stomach (1 hour before meals), adequate fluid intake, decrease Na, decrease calories, avoid salt substitutes, and caution with K and Mg supplements.
Erythropoietin Hormone secreted by the kidneys that is necessary for production of new RBCs. Anemia is a concern; increase iron intake Sodium bicarbonate Antacid, Alkalinizing agent Decrease Na intake and take Fe supplement separately. Caution with milk – may cause milk-alkali syndrome Renal caps Multivitamin soft gels that provide water-soluble vitamins Anemia can be masked while taking this drug Renvela Phosphate binder Take with each meal; Low phosphorus diet Hectorol Hyperparathyroidism Treatment in renal dialysis Do not take Vitamin D or Mg supplements.
With dialysis: adequate, but not excessive Ca and a low phosphorus diet. Glucophage Antihyperglycemic agent Prescribe diabetic diet. Decrease calories if weight loss is needed (Dr. Goodwin Powerpoint) (Pronsky, Elbe, & Ayoob, 2015) (“Renal Caps – FDA prescribing information, side effects and uses”) What health problems have been identified in the Pima Indians through epidemiological data? Explain what is meant by the “thrifty gene” theory. Are the Pima at higher risk for complications of diabetes? Explain. It has been shown that the Pima Indians have the highest reported incidences of diabetes.
The epidemiological data showed that the Pima Indians with non-insulin-dependent diabetes also suffered from hypertension. Two other health problems that were reported and associated with the non-insulin-dependent diabetes are retinopathy and nephropathy (De Courten, Pettitt, & Knowler, 1996). The thrifty gene theory was proposed by J. V. Neel who was a genetic epidemiologist. Neel believed that diabetes was a single gene disorder and was assumed to be characterized by metabolic abnormalities that were present from birth. It was suspected that this abnormality conferred some selective advantage.
The gene would allow for insulin to be released more rapidly which was first seen as a more efficient glucose disposal. The gene as also seen as beneficial in the way that it enabled nutrients to be stored more efficiently which could benefit in times of feast and famine. Fats were able to be stored more efficiently which was great for when the Pima Indians went through times of famine. Energy was able to be stored for later use. Later on, this gene was seen to be the cause of diabetes and the complications associated to diabetes (Gale, 2014).
From studies that have been performed, Pima Indians, as well as other American Indian populations, have had a higher incidence of diabetes. The Pima and other American Indian populations have had equally has high incidences from the disabling or fatal complication of diabetes. The incidences of diabetes and its complications in Pima have increased during the last couple of decades. Studies have been researching to find if the high risk for diabetes and its complications in Pima are due to familial, genetic origin or if they are due to the nature of the gene (Knowler, Saad, Pettitt, Nelson, & Bennett, 1993).