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Advanced Medical Nutrition Therapy > MNT for Renal Disease Part 3 > Flashcards

MNT for Renal Disease Part 3 Flashcards

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USMLE® Step 1 flashcards
1
Q

Nutrition assessment for someone with chronic kidney disease includes…

A

-Current diagnosis
-Cause of CKD
-Stage of CKD
-Treatment plan
-Urine output
-PMHx
-Comorbid conditions
-Medications and food-drug interactions
-Anthropometric assessment and estimated dry weight
-NFPE
-Biochemical assessment

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2
Q

Nutrition assessment should also include a diet interview, which includes…

A

-Changes in appetite
-GI c/o; altered taste
-Dietary restrictions (comprehension and adherence)
-Nutrition supplements
-Diet recall: assessment of intake of kcal, protein, sodium, potassium, calcium, fluid, vitamins and minerals
-Ability to shop and prepare meals

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3
Q

For biochemical assessment, we need to consider the ____ ranges for patients in end-stage renal disease on dialysis

A

Acceptable

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4
Q

What is the acceptable range for potassium in someone on dialysis?

A

3.5-5.5 mEg/L

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5
Q

A higher level of potassium may indicate…

A

-Excessive intake
-Food-drug interactions

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6
Q

What is the acceptable range for phosphorus in someone on dialysis?

A

3.0-6.0 mg/dL

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7
Q

A higher level of phosphorus may indicate…

A

-Not taking phosphate binders
-Excessive dietary intake

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8
Q

What is the acceptable range for BUN in someone on dialysis?

A

50-100 mg/dL

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9
Q

A higher level of BUN may indicate…

A

-Inadequate dialysis
-Excessive protein intake
-Gastrointestinal bleed
-Hypercatabolism
-Dehydration

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10
Q

A lower level of BUN may indicate…

A

-Low protein intake
-Hypervolemia
-Liver failure

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11
Q

Serum albumin is not a good indicator of ___ ___ and can be impacted by many factors

A

Nutrition status

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12
Q

Serum albumin is, however, a good predictor of ___ and ___ in CKD (usually the lower levels are, the sicker the patient is)

A

Morbidity and mortality

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13
Q

Serum albumin levels may be impacted by dialysis because ___ is lost during dialysis

A

Protein

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14
Q

The goal for CKD patients is an albumin level over ___ g/dL

A

4.0

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15
Q

If albumin is low, increase intake of ___-___ foods

A

Protein-rich

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16
Q

Goals of MNT for CKD:

A

-Maintain or improve nutritional status
-Reduce the accumulation of metabolic byproducts to minimize uremic symptoms
-Slow progression of renal disease
-Control hypertension
-Minimize fluid and electrolyte imbalances
-Prevent renal osteodystrophy
-Provide a healthy and palatable diet

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17
Q

We should individualize nutrition requirements based on…

A

-Stage of CKD and treatment modality
-Nutritional status (use upper end of energy and protein ranges for patients with malnutrition)
-Comorbidities

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18
Q

Those with CKD have ____ kcal needs to spare protein and prevent catabolism

A

Higher

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19
Q

Those with CKD should get ___-___ kcal/kg

A

25-35

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20
Q

Weight used is based on ___ ___ (EDW, IBW, current weight, ABW)

A

Clinical judgment

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21
Q

If someone is on peritoneal dialysis, we should consider calories from ____

A

Dialysate

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22
Q

With peritoneal dialysate, dextrose can be absorbed from the dialysate and contribute on average ___-___ kcal/day

A

400-800

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23
Q

What are the three steps for calculating calories absorbed from peritoneal dialysis dialysate:

A
  1. Add the grams of dextrose from all exchanges in a day
  2. Multiply by 60% for CAPD or 40% for CCPD
  3. Multiply by 3.4 kcal/gram
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24
Q

To calculate grams of dextrose, convert liters to milliliters by multiplying by ____, then multiplying by the decimal form of the percent dextrose

A

1000

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25
Q

Eating too much protein can contribute to ____

A

Uremia

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26
Q

Eating too little protein contributes to ___ ___

A

Muscle wasting

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27
Q

We need to consider ___ ___ and ___ when determining protein needs

A

CKD stage and treatment

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28
Q

For people with CKD stages 3-5 who are not on dialysis yet and are metabolically stable, recommend ___-___ g/kg body weight

A

0.55-0.6

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29
Q

If someone with CKD stages 3-5 who is not on dialysis has diabetes, recommend ___-___ g/kg of body weight

A

0.6-0.8

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30
Q

For those on hemodialysis or peritoneal dialysis, recommend ___-___ g/kg body weight

A

1.0-1.2

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31
Q

There are specially formulated ___ available fo individuals with CKD

A

Supplements

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32
Q

For individuals with CKD, there is inadequate evidence to recommend a particular ____ type (plant vs animal)

A

Protein

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33
Q

____ protein diets may have possible clinical benefits

A

Vegetarian

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34
Q

We also need to consider that some high-protein foods are also high in ___ and ___

A

Phosphorus and sodium

35
Q

Patients can not get rid of ___ ___ if they are not making urine

A

Extra fluid

36
Q

Fluid recommendations depend on…

A

-Urine output
-Edema
-Mode of treatment

37
Q

If someone has CKD but is not on dialysis, they do not need a ___ ___

A

Fluid restriction

38
Q

Someone on hemodialysis should have a fluid intake of…

A

Their 24-hour urine out plus 1000 mL

39
Q

The goal with fluid intake is to prevent fluid weight gains of over ___ kg between hemodialysis sessions (interdialytic weight gain)

A

2

40
Q

With peritoneal dialysis, fluid recommendations are ____ and the goal is to maintain balance

A

Individualized

41
Q

How should we assess for fluid overload?

A

-Monitor intake/output (remember many patients will not be making much, if any, urine)
-Examine ankles and hands for edema
-Daily weights
-Gurgling noises when patient breaths

42
Q

After determining fluid allowance, we should educate patient on the ___ and what is counted as a fluid

A

Restriction

43
Q

What are examples of beverage options for people with CKD?

A

-Water
-Fruit drinks and lemonade
-Low-potassium juices
-Clear or fruit-flavored carbonated beverages
-Milk
-Coffee and tea

44
Q

We need to consider ___, ___ and ___ content of fluid

A

Potassium, phosphorus, and sodium

45
Q

Tips to control fluid intake:

A

-Cold beverages and beverages that are less sweet will quench thirst better
-Limit high-sodium foods
-Drink from small glasses and cups
-Sour hard candies
-Add lemon juice to water
-Swish mouth with cold water (then spit it out)
-Sugar-free gum

46
Q

We should recommend those with CKD to limit sodium in order to…

A

-Reduce blood pressure
-Improve volume control (reduce edema, limit interdialytic weight gain)
-Control thirst

47
Q

With CKD stages 3-5 or on dialysis, people should limit sodium to less than ___ g/day

A

2.3

48
Q

We should educate people on appropriate sodium restriction, rationale, and foods to ___/___

A

Avoid/limit

49
Q

Hyperkalemia can cause symptoms like…

A

-Nausea
-Muscle weakness
-Fatigue
-Paralysis
-Arrhythmias
-Heart stoppage

50
Q

With CKD stages 3-5 or on dialysis, adjust dietary potassium intake to maintain serum levels __ ___ ___

A

Within normal levels

51
Q

Per previous 2000 KDOQI guidelines, those with CKD without dialysis do not need to have restricted ____ intake unless they are hyperkalemic

A

Potassium

52
Q

Per the 2000 KDOQI guidelines, someone on hemodialysis should restrict potassium intake to ___-___ mg/day

A

2000-3000

53
Q

Per the 2000 KDOQI guidelines, someone on peritoneal should restrict potassium intake to ___-___ mg/day

A

3000-4000

54
Q

How do you convert milligrams of potassium to mEq?

A

Divide the milligrams of potassium by the atomic weight of potassium (39)

55
Q

For those with hyperkalemia, assess ___ ___ for sources and be sure to inquire about salt substitutes

A

Food recall

56
Q

Higher potassium foods have ___ mg of potassium or more per serving

A

200

57
Q

What are examples of higher potassium foods?

A

-Milk, yogurt
-Oranges and orange juice
-Tomatoes and tomato products
-Potatoes (white and sweet)
-Bananas
-Beets, spinach, artichokes, squash
-Legumes
-Avocado, mango, prunes, dried fruits

58
Q

What are some higher potassium fruit choices (serving is 1/2 cup)?

A

-1 orange, orange juice
-Banana
-Avocado
-Nectarine
-Dried fruit: raisins and dates
-Prune juice
-Honeydew melon, cantaloupe

59
Q

What are some lower-potassium fruit choices?

A

-Apple, applesauce, and apple juice
-Apricots (1)
-Grapefruit
-Grapes and grape juice
-Pineapple and pineapple juice
-Pear
-Cherries, blackberries, raspberries, strawberries, blueberries
-Fruit cocktail
-Cranberries and cranberry juice cocktail
-Peaches

60
Q

What are some examples of high-potassium vegetable choices (serving 1/2 cup)?

A

-Potatoes (white and sweet)
-Tomatoes, tomato sauce, tomato juice
-Spinach and greens
-Artichokes
-Squash
-Zucchini
-Beets
-Brussels sprouts

61
Q

What are some examples of lower potassium vegetable choices?

A

-Peppers
-Asparagus
-Broccoli
-Peas
-Green beans
-Lettuce
-Cucumbers
-Carrots
-Mushrooms
-Cauliflower

62
Q

_____ can contribute to renal osteodystrophy and metastatic calcification

A

Hyperphosphatemia

63
Q

For someone with CKD stage 3-5, we should adjust dietary phosphorus intake to maintain serum levels within normal range, or lower intake is ____

A

Hyperphosphatemia

64
Q

Per previous 2000 KDOQI guidelines, those with hyperphosphatemia should limit phosphorus intake to ___-___ mg/day

A

800-1000

65
Q

If phosphorus levels are high, ___ ___ may be prescribed to help control levels

A

Phosphate binders

66
Q

Phosphate binders should be taken ___ ___

A

With meals

67
Q

We should provide diet education for looking for ___ ___ on food labels as these are absorbed better

A

Phosphate additives

68
Q

High phosphorus foods have over ____ mg/serving

A

100

69
Q

Examples of high phosphorus foods:

A

-Dairy products
-Meat and poultry
-Dried beans and peas
-Seeds, nuts, and nut butters
-Bran cereal, oatmeal, granola
-Soybeans, soy milk, tofu

70
Q

If someone has CKD stage 3-4 and is not taking an active vitamin D supplement, recommend total elemental calcium intake of ___-___ mg/day to maintain neutral calcium balance

A

800-1000

71
Q

For those on hemodialysis or peritoneal dialysis, adjust total calcium intake with consideration of concurrent use of active vitamin D to avoid ____

A

Hypercalcemia

72
Q

People with CKD may have possible vitamin deficiencies due to…

A

-Poor appetite
-Dietary restrictions
-Altered metabolism
-Losses during dialysis (water-soluble vitamins)

73
Q

Vitamins ___ and ___ are usually not supplemented for patients on dialysis due to risk of toxicity

A

A and E

74
Q

Vitamin D is gen as the active form of vitamin ____

A

D3

75
Q

If at risk for vitamin ___ deficiency, consider supplementation to meet but not exceed the DRI

A

C

76
Q

DRI of vitamin C for women:

A

75 mg/day

77
Q

DRI of vitamin C for men:

A

90 mg/day

78
Q

Water-soluble vitamin supplements that are specific for those on dialysis can be given; some examples are…

A

-Nephrocaps
-Dialyvite

79
Q

Determining the diet prescription involves…

A

-Estimating nutritional needs
-Specifying recommended amounts of key nutrients like protein, potassium, sodium, phosphorus, and fluid

80
Q

Before educating, we should assess ___ ___ ___

A

Readiness to learn

81
Q

What factors assess readiness to learn?

A

-Feelings of disbelief
-Depression
-Uremia
-Time commitments
-Health literacy

82
Q

We should first prioritize nutrition problems and ____ recommendations (nutrition priorities may change from visit to visit)

A

Individualize

83
Q

We should ___ instructions and and pace education

A

Individualize

84
Q

We should use ___ ____ to assess intake

A

Diet recall

Advanced Medical Nutrition Therapy (14 decks)

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