Care Conference

ANDY CROTTY
9/27/16
UCONN HEALTH CENTER
Pt. Description

Patient initials: F.H. BEE x 1.2 AF= 1839

Male
Age: 52 1 cal/cc= 1839 cc
Ht: 55
Wt: 166 lbs (no change) Pro= 1.5 g/kg (CKD
BMI: 27.7 on PD)
IBW (131lbs)
Pt. History

Medical Hx: Diet Hx

ESRD - One large meal
Anemia per day
Hyperthyroidism - Nighttime
AFIB sweets
DM 2
HTN
Medications

Lantus- Basal insulin

Humalog- meal time

Lasix- K depleting diuretic

Labs

A1c: 12.2 (high since 2007) and GLU

- DM poorly managed

K: typically concern with PD

H/H: low due to anemia of CKD

I&O: -1475 (24hr)

Assessment

Well nourished
On CAPD
mL x Dextrose % = g carbohydrates x 3.4 cal/g =
Calories present in dialysate x 0.6 = calories absorbed
from dialysate x exchanges per day= calories from
dialysis

2000 mL x 2.5% = 50g carb x 3.4cal/g= 170 cal x 0.6=

102 calories x 5 daily exchanges = 510 calories per
day coming from dialysate
Diagnosis

PES: Patient is assessed with inconsistent

carbohydrate intake related to food and nutrition
related knowledge deficit as evidenced by Hbg A1c of
12.2H and patients report of consuming only one meal
per day.
Intervention

Renal CCHO -> CCHO 2G NA diet (>75% 3 meals)

Additional Restrictions: 4g K+, 1200mg Phos

Supplementation: Folate, Fe, Ca, Vit C, D, and B

complex
Renal MVI + IV Fe
Intervention (Cont.)

Nutrition Education
Purpose of restrictions
Dietary modifications to abide by restrictions
CCHO explanation
Importance of supplementation for nutritional wellbeing
Coordination of care
Recommend restrictions to MD
Discuss possible supplementation with MD
Have nursing staff monitor BG and Wt. as well as
compliance to supplementations, diet, and restrictions
Monitoring & Evaluation

Nutrition Outcomes: compliance toward dietary

modification
Anthropometrics: weight
Biochemical:
Ferritin, Fe, RBC, HCT
Glu, A1c
Ca, PTH
Na, K, I & Os
Monitoring & Evaluation (cont.)

Nutrition-Focused Physical Findings

Reduction in edema
Appetite should adjust to accompany 3 meals

Nutrition Education Outcomes

Pt. able to name 3 high sodium food items.
Pt. able to name 3 high potassium food items.
Pt. able to name 3 high phosphate food items.
Pt. able to state 2 steps that can be taken to follow
CCHO diet
Questions?
Refrences

Krause
Mahan, L. Kathleen., Sylvia Escott-Stump, Janice L Raymond, and Marie
V Krause. Krause's Food & the Nutrition Care Process. 13th ed. St. Louis,
Mo.: Elsevier/Saunders, 2012.

FMI
Pronsky, Zaneta M., and Jeanne P. Crowe. Food Medication Interactions.
Birchrunville, Penn.: Food-Medication Interactions, 2010. Print.

Nutrition Care Manual

Nutrientdata.com