Renal Disease Part 3 Flashcards by Sydney Perry

nutrition assessment for renal disease included…

Current _______, ______ of CKD, _______ of CKD, ________ plan, ________

PMHx, ____________

Medications=> food-drug interactions

Anthropometric assessment; _____

Nutrition-focused physical examination

Biochemical assessment

diagnosis
cause
stage
treatment
urine output

comorbid conditions

EDW

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Diet Interview:
Changes in ______
GI c/o; _________
Dietary restrictions – ___________&___________
Nutrition ___________

appetite
altered taste
comprehension & adherence
supplements

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Diet recall:

assessment of intake of _____, ______,
_______, _______, ________, ________,
______, _______, ________

Ability to ________________________

kcal, protein
Na, K+, Phos, Ca,
fluid, vitamins & minerals

shop and prepare meals

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Note: need to consider _____________ for patients in ESRD on dialysis.

“acceptable” ranges

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K+: ______ mEq/L
Higher level=> __________, __________

3.5 – 5.5

excessive intake
food-drug interactions

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Phos: ________ mg/dL

Higher level=> _____________, ______________

3.0 – 6.0

not taking Phos binders
excessive dietary intake

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BUN: __________ mg/dL

Higher level=> _____, ______, _____, _______, _______

Lower level=> ______, _______, ______

50-100

inadequate dialysis, excessive protein intake, GIB, hypercatabolism, dehydration

low protein intake, hypervolemia, liver failure

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Serum albumin

Not a good indicator of _______
Serum level is affected by many factors

Good predictor of ______________in CKD

________ is lost in dialysis
Goal for CKD patient: >_____ g/dL
If low=>___________

nutrition status
morbidity & mortality
Protein
4.0
increase intake of protein-rich foods

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Goals of MNT for CKD

Maintain or improve __________
Reduce the accumulation of __________=> minimize _________ symptoms

Slow _________ of renal disease
Control ____
Minimize _________ imbalances
Prevent _____________
Provide a healthy and palatable diet

nutritional status
metabolic byproducts
uremic

progression
HTN
fluid & electrolyte
renal osteodystrophy

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Nutritional Requirements Individualized based on:

_____ of CKD and treatment _____
Nutritional status

Use the______ of energy & protein ranges for patients with malnutrition
Comorbidities

Stage
modality

upper end

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Energy

Higher kcal to spare _______ and prevent _______
______ kcal/kg body weight
Weight to use is based on clinician judgement (EDW, IBW, current wt, or ABW)

Note: if on PD, consider ________
Dextrose can be absorbed from the dialysate and contribute up to ______ kcal/day

protein
catabolism
25-35

kcal from dialysate
400-800

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Calculating Calories Absorbed from PD Dialysate

Add the _______ from all exchanges in a day
Multiply by:
CAPD: ____% absorption
APD: ____% absorption
Multiply by ____ kcal/ gram

grams of dextrose

60
40

3.4

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Calories Absorbed from PD Dialysate - CAPD (calculate)

PD Prescription:
2 exchanges of 2L 1.5% dextrose
2 exchange of 2L 4.25% dextrose

4000 ml X 0.015= 60 grams
4000 ml X 0.0425= 170 grams
Total: 230 g of dextrose

230 g X 60% absorption=138 g CHO
138 g X 3.4 kcal/g= 469 kcal from CHO from PD dialysate

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Protein

Eating too much can contribute to ______
Eating too little contributes to _______________

uremia
muscle wasting and malnutrition

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Protein Recommendations

CKD, Stage 3-5 non-dialysis, who are metabolically stable:
_________ g/kg body wt

If the individual has DM:
________ g/kg body wt

HD & PD:
________ g/kg body wt

There are specially formulated supplements available for individuals with CKD
e.g., ________, __________

0.55-0.6
0.6 – 0.8
1.0-1.2

Nepro, Novasource Renal

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Protein Sources

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

Vegetarian protein diets may have possible clinical benefits (e.g., lower absorption of ______)

Also need to consider that some high protein foods are also high in ________________

phosphorus

phosphorus and sodium

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Fluid Recommendations

Patients cannot get rid of extra fluid if they are not _______
Fluid recommendations depend on ____, _____, ______

making urine
urine output, edema, & mode of treatment

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CKD, non-dialysis: _____________

HD: ___________
Goal is to prevent fluid gains of ____ kg between HD sessions (interdialytic weight gain)

PD: _____________

typically, no restriction

24-hour urine output + 1000 ml
>2

individualized, maintain balance

Assess for Fluid Overload

___________- remember many patients will not be making much, if any, urine

Examine ___________ for edema
Daily _______

____________ when patient breathes

Monitor I/O

ankles & hands
weights

Gurgling noises

Fluid
Determine fluid allowance;
educate on restriction (if needed)
Includes everything that is ___________

Beverage options:
* Need to consider ___________ content
______, _______, or _________
______ - limit to ____ cup per day due to high ________ content
_____ & ______

liquid at room temperature

K+, phosphorus, & Na

Water, Low K+ juices, Clear or fruit-flavored carbonated beverages

Milk
½
phosphorus

Coffee & tea

Tips to control fluid intake

____ beverages and beverages that are _____ will quench thirst better

Limit ________ foods
Drink from __________
_______ candies
Add _______ to water

Swish mouth with ______ (then spit out)
_______ gum

Cold
less sweet

high sodium
small glasses & cups
Sour hard
lemon juice

cold water
Sugar-free

Sodium

Limit sodium to:
reduce ____
improve ______
reduce _____
limit ___________
control_______
CKD, Stage 3-5 or on dialysis: <______ mg/d

BP
volume control
edema
interdialytic weight gain
thirst
2300

Sodium Recommendations

Educate on sodium _______, _______, and _________

Assess diet recall/food record for _______

restriction
rationale
foods to avoid/limit

sodium sources

Hyperkalemia can cause=> ___________

nausea
muscle weakness
fatigue
paralysis
arrhythmias
heart stoppage

Potassium Recommendations CKD Stage 3-5 or on dialysis: ______________ Lower dietary intake if _________ Note: Per previous 2000 KDOQI guidelines: CKD without dialysis: _____________ HD: _________ mg/d PD: _________ mg/d

Adjust dietary potassium intake to maintain serum level WNL hyperkalemia unrestricted unless hyperkalemia 2000-3000 3000-4000

Potassium: Converting mg to mEq Divide the ________ of potassium by the _________ of potassium to get milliequivalent's (mEq) Example: 2400 mg of K

milligrams atomic weight (39) 2400/39= 62 mEq K+

For those with hyperkalemia: Assess _______ for sources Inquire about ___________ Educate on limiting _________ foods and substitute with foods ______________ Consider ______

diet recall/food records salt substitutes high potassium foods lower in potassium food-drug interactions

higher potassium fruit choices > _____ mg K+ per serving (usually ____ cup) Examples?

200 ½ 1 orange; orange juice Banana Avocado Nectarine Dried fruit: raisins, dates Prunes & prune juice Honeydew melon, cantaloupe

Lower Potassium Fruit Choices <_____ mg K+ per serving Examples?

200 Apple, applesauce, & apple juice Grapefruit Grapes & grape juice Pineapple & pineapple juice Pears, peaches Cherries, blackberries, raspberries, strawberries, blueberries Fruit cocktail Cranberries & cranberry juice cocktail

High Potassium Vegetable Choices >______ mg K+ per serving (usually ____ cup) Examples ?

200 ½ Potatoes –white & sweet Tomatoes, tomato sauce, tomato juice Spinach and greens Artichokes Squash Zucchini Beets Brussel sprouts

Lower Potassium Vegetable Choices <____ mg K+ per serving Examples ?

200 Peppers Asparagus Broccoli, cauliflower Peas Green beans Lettuce Cucumber Carrots Mushrooms

Additional High Potassium Foods

Milk, yogurt Legumes

Phosphorous Hyperphosphatemia=> can contribute to _______& _______ CKD Stage 3-5: __________ ______________ if hyperphosphatemia Note: The 2020 KDOQI guideline ________ Per previous 2000 KDOQI guidelines: limit dietary phosphorus intake to ______ mg/day if hyperphosphatemia

renal osteodystrophy metastatic calcifications Adjust dietary phosphorus intake to maintain serum level WNL Lower dietary intake did NOT provide specific amount 800-1000

Phosphorus Recommendations Review serum levels _________ may be prescribed to help control serum phosphorus levels. - these can be taken ______ - Assess diet recall/food records - Provide diet education - Eat more ______ and decrease intake of _______ - _______ for phosphate additives

Phosphate binders with meals fresh foods processed foods Label reading

High Phosphorus Foods >____ mg/serving Examples ?

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

Possible deficiencies due to: Poor ______ Dietary _______ Altered _________ Losses during dialysis =>________ vitamins

appetite restrictions metabolism water-soluble

Vitamin Recommendations Vitamin ____and ___ are usually not supplemented for patients on dialysis due to risk of toxicity Vitamin____ given as active form __________ If at risk for vitamin ___ deficiency, consider supplementation to meet but not exceed the DRI (___ mg/d for women & ___ mg/d for men)

A & E D vitamin D3 C 75 90

For patients on ____, renal ______________ supplements may be considered Examples?

HD water-soluble vitamin Nephrocaps Dialyvite

Determining the Diet Prescription Estimate nutritional needs Avoid ordering the “Renal Diet” – need to individualize Include recommended amounts of key nutrients in diet order: _______________

protein K+ Na Phos fluid

Education & Counseling CKD is a chronic illness and a life-changing event May be a time of severe emotional upheaval and adjustment Must first assess ___________

readiness to learn

Factors that Affect Readiness to Learn

Feelings of disbelief Depression Uremia Health literacy

Suggestions for Education Sessions _________ recommendations and prioritize ________ Nutrition priorities may change from visit to visit _______ instructions and ____ education Use diet recall/food records Involve ___________

individualize nutrition problems Simplify pace significant other(s)