MNT for Renal Disease Part 3 Flashcards by perjunke fibers

Nutrition assessment for someone with chronic kidney disease includes…

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

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

Acceptable

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

3.5-5.5 mEg/L

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A higher level of potassium may indicate…

-Excessive intake
-Food-drug interactions

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

3.0-6.0 mg/dL

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A higher level of phosphorus may indicate…

-Not taking phosphate binders
-Excessive dietary intake

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

50-100 mg/dL

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A higher level of BUN may indicate…

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

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A lower level of BUN may indicate…

-Low protein intake
-Hypervolemia
-Liver failure

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

Nutrition status

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

Morbidity and mortality

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

Protein

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

4.0

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

Protein-rich

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Goals of MNT for CKD:

-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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We should individualize nutrition requirements based on…

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

Higher

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Those with CKD should get ___-___ kcal/kg

25-35

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

Clinical judgment

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

Dialysate

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

400-800

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

Add the grams of dextrose from all exchanges in a day
Multiply by 60% for CAPD or 40% for CCPD
Multiply by 3.4 kcal/gram

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

1000

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Eating too much protein can contribute to ____

Uremia

Eating too little protein contributes to ___ ___

Muscle wasting

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

CKD stage and treatment

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

0.55-0.6

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

0.6-0.8

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

1.0-1.2

There are specially formulated ___ available fo individuals with CKD

Supplements

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

Protein

____ protein diets may have possible clinical benefits

Vegetarian

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

Phosphorus and sodium

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

Extra fluid

Fluid recommendations depend on...

-Urine output -Edema -Mode of treatment

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

Fluid restriction

Someone on hemodialysis should have a fluid intake of...

Their 24-hour urine out plus 1000 mL

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

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

Individualized

How should we assess for fluid overload?

-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

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

Restriction

What are examples of beverage options for people with CKD?

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

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

Potassium, phosphorus, and sodium

Tips to control fluid intake:

-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

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

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

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

2.3

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

Avoid/limit

Hyperkalemia can cause symptoms like...

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

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

Within normal levels

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

Potassium

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

2000-3000

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

3000-4000

How do you convert milligrams of potassium to mEq?

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

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

Food recall

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

200

What are examples of higher potassium foods?

-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

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

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

What are some lower-potassium fruit choices?

-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

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

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

What are some examples of lower potassium vegetable choices?

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

_____ can contribute to renal osteodystrophy and metastatic calcification

Hyperphosphatemia

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

Hyperphosphatemia

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

800-1000

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

Phosphate binders

Phosphate binders should be taken ___ ___

With meals

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

Phosphate additives

High phosphorus foods have over ____ mg/serving

100

Examples of high phosphorus foods:

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

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

800-1000

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

Hypercalcemia

People with CKD may have possible vitamin deficiencies due to...

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

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

A and E

Vitamin D is gen as the active form of vitamin ____

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

DRI of vitamin C for women:

75 mg/day

DRI of vitamin C for men:

90 mg/day

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

-Nephrocaps -Dialyvite

Determining the diet prescription involves...

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

Before educating, we should assess ___ ___ ___

Readiness to learn

What factors assess readiness to learn?

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

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

Individualize

We should ___ instructions and and pace education

Individualize

We should use ___ ____ to assess intake

Diet recall

MNT for Renal Disease Part 3 Flashcards

(84 cards)