Questions for Medical Nutrition Therapy: A Case Study Approach 5th ed.

Case Study C – Chronic Kidney Disease (CKD) Treated with Dialysis

(Case 19 in text)

Instructions: Answer the questions below. You may print your answers or e-mail them to your instructor.

1. Describe the basic physiological functions of the kidneys.

2. List the diseases/conditions that most commonly lead to chronic kidney disease (CKD)? Explain the role of diabetes in the development of  CKD.

3. Outline the stages of CKD, including the distinguishing signs and symptoms.

4. From your reading of Mrs. Joaquin’s history and physical, what signs and symptoms did she have that correlate with her chronic kidney disease?

5. What are the treatment options for Stage 5 CKD? Explain the differences between hemodialysis and peritoneal dialysis.

6. Explain the reasons for the following components of Mrs. Joaquin’s medical nutrition therapy:

Nutrition Therapy

Rationale

35   kcal/kg

1.2   g protein/kg

2   g K

1   g phosphorus

2   g Na

1000   mL fluid + urine output

7. Calculate and interpret Mrs. Joaquin’s BMI. How does edema affect your interpretation?

8. What is edema-free weight? Calculate Mrs. Joaquin’s edema-free weight.

9. What are the energy requirements for CKD?

10. Which of Mrs. Joaquin’s symptoms would you expect to begin to improve when she starts dialysis?

11. Calculate what Mrs. Joaquin’s energy needs will be once she begins hemodialysis.

12. What are the differences in protein requirements among stages 1 and 2 CKD, stage 3 and 4 CKD, hemodialysis, and peritoneal dialysis patients? What is the rationale for these differences?

13. Mrs. Joaquin has a PO4 restriction. Why? What foods have the highest levels of phosphorus?

14. 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 fluid restriction is generally recommended for someone on hemodialysis? Is there a standard guideline for maximum fluid gain between dialysis visits? If a patient must follow a fluid restriction, what can be done to help reduce his or her thirst?

15. Why is it recommended for patients to have at least 50% of their protein from sources that have high biological value?

16. A. Based on Mrs. Joaquin’s energy needs, calculate her carbohydrate, protein, and fat needs, Using the Renal Exchange list, plan a 1-day diet that meets her energy needs and complies with her diet orders (see question 6)

B. Using Mrs. Joaquin’s typical intake and the prescribed diet, write a sample menu. Justify your changes; why did you make the change to comply with her nutrition prescription.

Diet PTA

Sample Menu

Breakfast: Cold cereal (¾ c unsweetened)

Bread (2 slices) or fried potatoes (1 med potato)

1 fried egg (occasionally)

Lunch: Bologna sandwich (2 slices white   bread, 2 slices bologna, mustard)

Potato chips (1 oz)

1 can Coke

Dinner: Chopped meat (3 oz beef)

Fried potatoes (1 ½ medium)

HS Snack: Crackers (6 saltines) and peanut butter (2   tbsp)

17. What resources and counseling techniques would you use to teach Mrs. Joaquin about her diet?

18. List the nutrition-related health problems that have been identified in the Pima Indians through epidemiological data. Are the Pima at higher risk for complications of diabetes? Explain. What is meant by the “thrifty gene” theory?

19. It is inevitable that there will be individuals who suffer from a disease that cannot be cured. How can you use God’s word in your work with these people? See 1 Thessalonians 3:1-3