3. Socio-Economic HistorySocio-Economic History
Married with 5 children
High school graduate
Permanent residence in Taguig
Works as a security guard
◦ Wakes up early and prefer foods that are
easy to prepare (ex; noodles, canned
goods, fried)
Smoker (quitted a year ago)
Alcoholic for 28 years (17-45 yrs of age)
4. Medical HistoryMedical History
Present Illness: CKD stage 5
secondary to Hypertensive
Nephrosclerosis
Anemia
Hyperkalemia
Metabolic Acidosis
UGIB
Chief Complaint: Generalized weakness
5. Medical HistoryMedical History
Past Illness: known hypertensive for
more than 20 years.
◦ One month prior to admission
Gradual onset of on and off epigastric, burning
in character.
Nausea
Occasional vomiting of previously ingested
food
Progressive body weakness and myalgia
6. Medical HistoryMedical History
◦ Two days Prior to Admission
Gradual onset of on and off epigastric, burning
in character.
Vomiting (coffee-ground material)
Epistaxis
Increased sleeping time.
◦ Past surgeries: None
◦ Allergies: None
◦ Past Hospitalization: Yes
7. Medical HistoryMedical History
Physical State of Health
◦ Loss of appetite PTA
◦ Gastric pain caused by UGIB (resolving)
◦ No elimination/ excretion problem
Family Medical History
◦ The patient’s mother is hypertensive
8. Theoretical considerationTheoretical consideration
Chronic Kidney disease
is a progressive and
irreversible damage of
the functioning unit of
kidneys, the nephrons.
◦ Function of Nephrons;
Filtration
Iso-osmotic reabsorption
Osmotic concentrator
Electrolyte reabsorption
Water reabsorption
9. EtiologyEtiology
Immunological, metabolic, renal vascular.
Primary tubular and congenital disorders.
Vascular lesions that can lead to renal
ischemia and kidney tissue.
Chronic Glomerular disease, such as
glomerulonephritis.
Chronic infections, such as chronic
pyelonephritis
11. Stages of CKDStages of CKD
Stage Description GFR, mL/min
per 1.73m2
Action
1 Kidney damage with
normal or high GFR
>90 Diagnosis and
treatment, slowing
progression, CVD
risk reduction
2 Kidney damage with
mild decrease in
GFR
60-89 Estimating
progression
3 Moderate decrease
GFR
30-59 Evaluating and
treating
complications
4 Severe decrease in
GFR
15-29 Preparation for
kidney replacement
therapy
5 Kidney failure <15 or dialysis Kidney replacement
(if uremia present)
The patients GFR is 2.9 thus, belongs to stage 5
14. What is Dialysis?What is Dialysis?
is a way of maintaining the patients’
regular excretion of the body’s waste
products.
Works on the principles of the
diffusion and osmosis of solutes and
fluid across a semi-permeable
membrane.
Examples are Hemodialysis and
Peritoneal Dialysis
16. Assessment of NutritionalAssessment of Nutritional
StatusStatus
Anthropometry
◦ % Standard weight= (69 kg/ 63 kg) x 100
=109.5%
◦ BMI= 69/ 1.702
=23.88
◦ % weight change= 1.5% less
17. Assessment of NutritionalAssessment of Nutritional
StatusStatus
Biochemical Assessment
Laboratory Results Normal Values Actual Values Variance Rationale for
Variance
BUN 2.60-6.48 mmol/L 94.13 mmol/L 87.65 mmol/L or
higher
Failure in kidney
functions
Creatinine 53.00-115.00
umol/L
3202 umol/L 3087 umol/L or
higher
Failure in kidney
functions
RBC 4.3-5.9 x 106
/mm3
2.25 x 106
/mm3
3.65 x 106
/mm3
or
less
Anemia (reduced
EPO roduction)
Hemoglobin 13.6-17 g/L 6 g/L 11 g/L or lower Anemia (reduced
EPO roduction)
Hematocrit 39-49% 19% 30% or lower Anemia (reduced
EPO roduction)
GFR <greater than 130
mL/min per
1.73m2
2.9 mL/min per
1.73m2
127.1 L/min per
1.73m2
Renal Failure
(CKD stage 5)
Potassium 3.8- 5 mmol/L 6.9 mmol/L 1.9 mmol/L or
higher
Hyperkalemia
18. Assessment of NutritionalAssessment of Nutritional
StatusStatus
Clinical Assessment
Body parts Clinical sign Possible
Nutrient
Deficiency
Others
Conjunctivae pale Vitamin A Low
hemoglobin/RBC
Nailbeds pale Zinc Low
hemoglobin/RBC
Tongue
(posterior)
Blackish
discoloration
Riboflavin/Niacin Presence of
infection
Mouth Uremic
Breathe
- Caused by uremia
Vascular system High blood
pressure
- Caused by alcohol
and smoking
Muscular system Weakness - Low
hemoglobin/RBC
19. Dietary AssessmentDietary Assessment
DBW= (170-100) -10%
= 70 - 7= 63 kg
TER= 63 x 35 (method II)= 2205 kcal or
2200 kcal
CPF distribution (60-15-25)
CHO= 2200 x 0.6=1323/4= 330.75 g or 330 g
PRO= 2200 x 0.15= 330/4= 82.5 or 85g
FAT= 2200 x 0.25= 550/9= 61.1 or 60 g
20. Dietary AssessmentDietary Assessment
Prior to Admission
◦ Kcal=2240, CHO=334g, PRO=74g, FAT=
67.5g
• CHO % Adequacy= 334/330 x 100
= 101.21%
• PRO % Adequacy= 74/85 x 100
= 87.1%
• FAT % Adequacy= 67.5/60 x 100
=112.5%
• Energy % Adequacy= 2240/2200 x 100
= 101.18
21. Dietary AssessmentDietary Assessment
During Confinement
◦ Kcal=1900, CHO=334g, PRO=74g, FAT=
67.5g
TER= 63 x 30= 1900 kcal
PRO= 63 x 1.1= 70 g
PRO kcal= 70 x 4= 280 kcal
Non PRO kcal= 1900-280= 1620 kcal
CHO: 1620 x 0.7= 1134 - 148 (dialysate)=
986/ 4=246.5 or 245 g
FAT: 1620 x 0.3= 486/9= 55 g
22. Dietary AssessmentDietary Assessment
CHO % adequacy= 164/245 x 100
=66.94%
PRO % adequacy= 56/70 x 100
= 80%
FAT % adequacy= 30/55 x 100
= 54.5%
Calorie % adequacy= 946/1900 x 100
= 49.8%
During Confinement % adequacy
23. Nutrient-Drug InteractionNutrient-Drug Interaction
Name of Drug Indication Possible Interactions
NaHCO3 Metabolic acidosis Neutralizing gastric acid
Amlodipine Osteodystrophy Inhibit the transport of calcium into
myocardial and vascular smooth
muscles
Clonidine Hypertension Inhibits cadioacceleration and
vasoconstriction
Kalimate Hyperkalemia Exchanges sodium ions for
potassium
Lactulose Q8 Uremia inhibits diffusion of ammonia from
the colon , lowers pH
Furosemide Uremia Inhibits the reabsorption of sodium
and chloride from the loop of Henle
and distal renal tube.
Erythropoetin 4000 ‘u Anemia Stimulates erythropoesis
Vitamin K tablets Hypokalemia Synthesis of blood coagulation
factors
24. Nutritional Care PlanNutritional Care Plan
Identification of Problem
Parameters Medical Problems Nutritional Problem
Anthropometry None None (Normal BMI)
Biochemical Accumulation of BUN
and Creatinine
Anemia
Hyperkalemia
Uremic syndrome
Dietary Metabolic acidosis Gastric pain
Drug and Nutrient
Interaction
Furosemide causes
hypokalemia
Weakness
Others Hypertensive
UGIB
Nausea, Vomiting
25. Nutrient Implications andNutrient Implications and
ReccomendationsReccomendations
Should have enough energy and
protein to maintain the patients DBW.
Two thirds of the protein must come
from sources of High Biological Value
(HBV) to assure the essential amino
acid requirements.
Regular monitoring of lab results is
essential to evaluate the patient’s
condition while in hemodialysis
26. Diet PrescriptionDiet Prescription
TER= 63 x 30= 1900 kcal
PRO= 63 x 1.1= 70 g
PRO kcal= 70 x 4= 280 kcal
Non PRO kcal= 1900-280= 1620 kcal
CHO: 1620 x 0.7= 1134 - 148 (dialysate)=
986/ 4=246.5 or 245 g
FAT: 1620 x 0.3= 486/9= 55 g