causes lupus chronic htn prolonged urinary obstruction nephrotic syndrome pkd cystinosis diabetes
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Lab Evaluation of Kidney Function
Albumin Glomerular Filtration Rate Creatinine BUN Calcium Carbon Dioxide Chloride CBC Glucose Magnesium Phosphorus Potassium
Treatment
Non-Dialysis MNT: Stages 1-2: Focus on Comorbid conditions-DM, HTN,
Hyperlipidemia Stages 3-4 MNT intervention: Renal Diet
HEMODIALYSIS
http://www.kidney.niddk.nih.gov
Patient Information
Admission 7/16/2013 Chief Complaint:
Shortness of BreathPMH:
Diabetes Aortic insufficiency Chronic Renal
insufficiency Hypothyroidism Hx Breast CA CHF, Unknown Ejection
Fraction HTN
Hyperlipidemia Atrial fibrillation
Past Surgical Hx: Cholecystectomy Lumpectomy Arthroscopy Aortic Valve
Replacement Hysterectomy Rotator Cuff Repair
Social Hx: No smoking, drug, or
alcohol abuse hx
Diagnosis: 7/16/13 Impression
1)SOB, pt increased Lasix dose, pt has worsening Crea 2.7
2)Acute on chronic kidney disease stage IV3)Insulin dependent DM 4)Aortic valve replacement 5)Hypothyroidism 6)Hx of breast CA7)Hx od DVT 8)HTN, controlled9)Hyperlipidemia10) A fib
Diet Hx
7/17 diet hx and patient interview Patient reported “Regular, low sodium low
potassium, low protein” diet. Interview:
NAS Avoid potato and banana Label reading
PES Statement
Altered nutrition related labs related to change in ability to absorb and excrete as evidenced by elevated BUN/Crea, low glucose, CKD Stage IV.
Altered nutrition related lab values related to kidney dysfunction, as evidenced by BUN^ (56) Crea ^ (2.6) , GFR L (19.2), rapid weight changes (4.5# since admission), conditions associated with a diagnosis or treatment related to renal disease.
7/23
“No deterioration in condition” IV Steroids BUN slowly rising (61)Crea decreasing (2.0) D/d within 48 hours
7/25
“No deterioration in general condition” BUN 71^Crea 2.3 ^ Glucose 268Steriod + glucose Dr. Hongalgi on board
Care Plan
Interventions Nutrition education
Goals: Pt to follow a renal/carbohydrate consistent diet order
Indicators: Length of stay: 6 days
Resources
1. Role of a Registered Dietitian in your health care. Cleveland Clinic. http://my.clevelandclinic.org/healthy_living/prevention/hic_the_role_of_a_registered_dietitian_in_your_health_care.aspx. 14 August 2013.
2. Safety and efficacy of drug-eluting stents in older patients with chronic kidney disease," by Thomas T. Tsai, M.D., John C. Messenger, M.D., J. Mathew Brennan, M.D., and others in the Journal of the American College of Cardiology 58(180), pp. 1859-1869, 2011.
3. Nelms M, Sucha K, Lacey K, et al. Nutrition Therapy and Pathophysiology. Belmont, Ca: Wadsworth, Cengage Learning. 2007, 2011.
4. Escott-Stump S. Nutrition and Diagnosis-Related Care. Baltimore, MD. Wolters Kluwer. 2012.
5. "What Is Lupus." Lupus Foundation Of America. N.p., 2013. Web. 14 Aug. 2013. 6. United States Renal Data System. USRDS 2007 Annual Data Report. Bethesda, MD:
National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, U.S. Department of Health and Human Services; 2007.
7. Nickel, M.D., J Curtis. "Urinary Retention." National Institute Of Diabetes And Digestive And Kidney Diseases. N.p., 29 June 2012. Web. 14 Aug. 2013. <http://kidney.niddk.nih.gov/kudiseases/pubs/UrinaryRetention/#complications>.
8. Dugdale, III, David C., and Herbert Y. Lin, PhD, M.D.. "Nephrotic Syndrome." Medline Plus. National Institute Of Health, n.d. Web. 14 Aug. 2013. <http://www.nlm.nih.gov/medlineplus/ency/article/000490.htm>.
9. "Polycystic Kidney Disease- Overview." FamilyDoctor.org. N.p., 01 Jan. 2011. Web. 14 Aug. 2013.http://familydoctor.org/familydoctor/en/diseases-conditions/polycystic-kidney-disease.printerview.all.html
10. "Cystinosis." Genetics Home Reference. U.S. National Library Of Medicine, 01 May 2013. Web. 14 Aug. 2013. <http://ghr.nlm.nih.gov/condition/cystinosis>.
11. Pagana. Manual of Diagnostic and Laboratory Tests. Missouri: Mosby, 2010. Print.
12. Arora, M.D., Pradeep. "Medication Summary." Chronic Kidney Disease Medication. Medscape, 05 Aug. 2013. Web. 16 Aug. 2013. <http://emedicine.medscape.com/article/238798-medication#1>.