Beruflich Dokumente
Kultur Dokumente
Clinical Dietitian
The
dietitian
You
To be able to
1. Recognize the role of the
dietitian as member in the
multidisciplinary medical
team.
2. Realize the importance of
optimized nutrition.
3. Understand the type of diet
given during all stages of the
kidney disease.
4. Identify foods to be avoided.
5. Be able to answer simple
patients questions about the
diet.
Hemodialysis
CKD
Stage
5
Peritoneal
Dialysis
Transplantation
Nurse
Doctor
Multidisciplinary
Team
Others
Social worker
Psychologist
Support
Motivate
Monitor
Vascular
Diseases
Catabolism
Malnutrition
&
Inflammation
Mineral
&Bone
Disorders
Protein
Energy
Wasting
Anemia
Albumin
It
Poor
appetite
Mortality
Hospitalization
Hypophagia
Whats the
nurses role?
Prevention of
Malnutrition
Identifying
anorexia
and poor appetite.
Nurses Role
Assess
patients
P.O. intake .
Identify
significant
weight loss.
Early
intervention
will delay or prevent
PEW
Consult
the
dietitian.
Weight loss of
5% during last
month.
No improvement
Tube feeding
Better
appetite &
nutritional
status
No improvement
MNT
Medical
history
Diet history
Anthropometric
measurements
Biochemical
Parameters
Nutrition
requirements
Anthropometric measurements
Height
Dry weight
Body
Mass Index=weight/height(m)2
Adjusted
Biochemical Parameters
Glycemic control
Protein-energy malnutrition
Inflammation
Kidney function
Mineral and bone disorders
Anemia
Dyslipidemia
Electrolyte disorders
Others as appropriate.
Nutritional laboratory
Outcome prevention focus
parameters
Serum bicarbonate
Metabolic acidosis
Serum albumin
Protein-energy malnutrition
Pre-dialysis serum
creatinine
Protein-energy malnutrition
Muscle loss
Serum cholesterol
Protein-energy malnutrition
Fat loss
Hyperlipidemia
Dialysis adequacy
PTH
Hyperparathyroidism
Serum phosphorus
Bone disease
Bone disease
Serum calcium-phosphorus
product
Bone disease
Hemoglobin
Anemia
Transferrin saturation
Anemia
Ferritin
Anemia
HbA1C
Diabetes control
Lipid profile
LDL
HDL
Triglycerides
Cardiovascular disease
Sufficient
in protein
Adequate
in calories
Restricted
in sodium, potassium,
phosphorus, and fluids(Dialysis).
Protein
Salt
Fluids
Phosphorus
Potassium
Predialysis
Underweight
Healthy
<18.5
20-25
Overweight
25-30
Obese
>30
Predialysis
Dialysis (HD,PD)
Underweight
<18.5
<18.5
Healthy
20-25
23-26
Overweight
25-30
26-32
Obese
>30
>32
Needs=60grams
protein
45 grams (HBV)
protein
=75%
Help
90
grams
90 grams meat
7*3=21 grams protein
Meat Group
60 grams
60 grams
60 grams
90
grams
60
grams
90
grams
Starch Group
cup
Blueberries
cup
Cranberry
cup
Lemon
1 medium
Persimmon
1 medium
Apple, canned
cup
Pears, canned
cup
1 medium
cup
1 cup
Peach, canned
cup
Peach, raw
1 medium
1 small
10
Pear, raw
Chestnut
Dates
Fruit cocktail, juice
3
cup
cup
Prunes, canned
Grapefruit, juice
Grapefruit
medium
Grapes
Jujube
cup
Quince
Raspberries, raw
10
75gr (15 each)
Strawberries, raw
Tangerine, raw
Kiwifruit, raw
medium
Watermelon, raw
Mango
medium
Yellow melon
3
1 medium
1 cup
cup
1 medium
1 cup
1/6 medium
Apricots, raw
3 medium
Custard Apple
Figs
Guava, raw
1 medium
Loquats, raw
6 medium
Plums, green
Pricklypear
Orange juice, fresh
1 medium
cup
Orange
1 medium
Pomegranate
1 medium
Raisins
2 Tbsp
Apricot, dried
Avocado
5
1 medium
Banana
1 medium
Cantaloupe/Honey dew
1 cup
Figs, dried
Papaya
1 medium
Peach, dried
Beans sprouts
cup
Eggplant, raw
cup
Garlic
cup
Cabbage, boiled
cup
cup
Cauliflower, boiled
cup
cup
Cucumber, raw
(slices)
Coriander, raw
cup
Lettuce
(shredded)
Rocket (rocca)
Radishes ,raw
5 medium
Green raw
Endive, raw
1 cup
cup
4 cloves
cup(100gr)
1 cup
cup
100-250mg K per
svg
Allow 2 Exchanges
daily
cup
Broccoli, raw
cup
cup Mint
Carrots, boiled
Cauliflower, raw
cup-slices
Mushroom, raw
1 cup
cup
Celery
cup
Onions, raw
cup
Eggplant, cooked
cup
Parsley, raw
cup
cup
cup
Turnip, cooked
cup
cup
Zucchini, raw
cup-slices
Artichoke, boiled
Broccoli, cooked
Purslane (bakleh)
Beets
Carrots, raw
Celery, raw
cooked
Corn yellow, cooked
French fries
Potato, boiled
Mushrooms, boiled
Palmito
Tomato, raw
Zucchini, boiled
Truffles (kema)
cup
cup
cup
cup
1 medium
2 stalks
cup
cup
10
cup
cup
cup (100gr)
1 small
cup
9 small
Legumes:
Lentils
Chick peas, boiled
Kidney beans, boiled
Fava beans
Swiss Chard (siliq), boiled
1 cup
1 cup
1 cup
1 cup
cup
cup-chopped
cup
1 potato
Spinach, boiled
cup
Sweet potato
1 small
Tomato juice
cup
cup
1 Tbsp=1 Tomato
* Tabbouli and Fattouch (as specified by dietitian)
Avoid
Milk
Limit
daily.
Grains and cereals: Products made from the whole grain such as: bran cereal
and muffins, Granola, whole wheat cereal or crackers, bread with oatmeal, dark
rye, or whole wheat, pancakes, waffles, and corn tortillas.
Beverages: Cola, chocolate drinks, beer, coffee drinks with milk.
Vegetables: Corn, green peas, mushrooms, okra, sweet potato, spinach,
asparagus.
Other: Dried fruits, avocado, halawi, tahini, chestnut, sardines, organ meats,
chocolate, cocoa powder, molasses, nuts & seeds, coconut, peanut butter, coffee
mate (if more than 1Tbsp), sour cream (if more than 2 Tbsp).
Alcohol
Coffee
Gelatin
Gravies
Ice cream
Ice cubes
Juices
Lemonade
Milk
Pudding
Sherbet/Sorbet
Sodas/Soft Drinks
Soups
Tea
Water
Yogurt
ESRD
ON HD
Breakfast
CKD
Lunch or Supper
ESRD
ON HD
CKD
Consult the
dietitian for
weight
management
and advise on a
healthy diet.
Inadequately
decreasing
portions might
cause fatigue
and muscle
breakdown.
30 grams of
chicken is
equivalent to one
meat serving. It
has 7 grams of
protein. Some
food items may
increase your
potassium or
creatinine levels.
Consult the doctor
for iron
supplementation.
Weight Change
Appetite
GI symptoms
Monitor
Patients
Consult the
dietitian
Change in electrolytes
Non-compliance to dietary
recommendations