Dialysis
This Assignment needs to be at least 3 pages in length, with at least 3 high quality references in formal APA style included. The title page and reference page do not count towards length requirements.
1-Explain why Mr. Ds kidneys failed/requiring dialysis. Explain why his risk for ESRD was higher than that of other people with type 2 diabetes. (hints given in diabetes/hypertension area of help guide + during seminar)
2-What caused the significant weight loss from Mr. Ds weight 15 years ago to the time of dialysis initiation? What contributed to his 15% weight loss while on dialysis? (Remember, weight is based on dry weight- wt after a patient is done with a dialysis session ) So- think of weight loss while NOT on dialysis– when Diabetes was main concern +glucose mgt was main problem. THEN- think about patient starting dialysis + how focus shifted bc dialysis raises calorie/protein needs….
3- Choose several diagnosis phrases from Diagnosis PDF- in course resources that apply to Mr. Ds current nutritional problems. Choose one that is the most important and explain why. (Nutrition Diagnosis Phrase PDF ATTACHED for convenience
4- Calculate Mr. Ds current calorie and protein needs (dialysis/diabetes). Explain why protein needs are high for dialysis patients. (can use a calorie estimation equation from my intern file or do full calculation with equations-mifflin St jeor or Harris Benedict etc..see Intern notes attached)
5- Include any community resources/support programs that may benefit Mr. D. What motivational and counseling techniques Can be used to increase compliance? (community resources- outreach education- motivation techniques)
6- What types of nutrition assessment tools and methods can be used to monitor Mr. Ds medical and nutritional compliance? (think of ABCDs- nutrition assessment tools- listed at top of help guide)
Imagine that you are a nutrition education assistant who is working at the county health departments nutrition outreach program. You have received a patient referral from the local dialysis center. While all dialysis centers have nutrition professionals and nutrition education is reimbursed through insurance, Medicare, or Medicaid, this is a serious case of non-compliance and the dialysis center is trying to gather more support sources for the patient. The supervising nutrition director has assigned you to review the referral information to help prepare an appropriate intervention.
Referral Information: Mr. D is a 48 year old Caucasian male with poorly managed type 2 diabetes for over 15 years and has been on dialysis three times a week for 1 year. Medical records reveal that his diabetes was most likely obesity related and was never well controlled. Mr. D required insulin shots soon after his initial diagnosis. 1 year ago his friend found him unconscious in his apartment and took him to the hospital. Upon admission, his blood sugar was over 700 mg/dl. He was already in the pre-dialysis stages of kidney disease prior to this hospital stay. His friend reported that he rarely saw Mr. D check his blood sugar or administer insulin shots. His friend also informed the hospitals nurse that Mr. D once told him that he could lose weight fast by letting his blood sugars get really high and skipping insulin doses.
From Chart-Patient Summary:
Mr. D was 33 years old when he was first diagnosed with Type 2 Diabetes. Weight: 270 pounds (15 yrs ago)
Height: 510
Diet order: 1800 calorie diabetic diet
Clinical Progression of disease: Pancreatic function declined and insulin resistance increased due to Mr. Ds dietary and medical non-compliance.
Medical Intervention: Short and long acting insulin shots were added to his therapy about 10 years ago.
Hospital and Physician visits: Multiple recorded diabetic ketoacidosis (DKA) episodes are documented, including the DKA episode that ultimately caused his kidneys to fully fail when his friend found Mr. D unconscious in his apartment.
Hemodialysis Center reports:
12 months of hemodialysis on Mondays, Wednesdays & Fridays.
Weight one year ago (age 47): 185 pounds (dry weight measured after dialysis session) Current age: 48
Current weight: 158 pounds
Height: 510. The patient has lost 15% of his dry weight (commonly used with dialysis patients to obtain a more accurate weight due to fluid fluctuations).
Labs: His sodium, potassium, BUN, Cr, glucose are all out of range and very inconsistent (sometimes very high and sometimes very low, but rarely normal).
Urine output: Negligible
Dialysis Compliance: Only attends dialysis sessions about 75% of the time.
Dietary Information: Increased Calorie Renal diet, carbohydrate restrictions, high protein and a 1250 ml fluid restriction.
Dialysis nursing notes: Heavy alcohol (ETOH) consumption, often complains of (c/o) nausea/vomiting (N/V) after dialysis, and he usually appears very somber.
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