Question

MODULE 1: PATIENT WITH CHRONIC RENAL FAILURE

Mrs. Chang, age 41, is a thin Chinese woman who lives with her husband, their teenage son and daughter and Mr. Chang’s mother in a small 4 room apartment in a low income area of Los Angeles. Mr. Chang is a cook in a hotel. Mrs. Chang has not been able to work because of poor health and a limited knowledge of English.

She has recurring symptoms of nausea, anorexia, hematuria, and swollen ankles. She has been hospitalized once for chronic renal failure, but a diet controlled in protein, sodium, and potassium was prescribed. She found the diet hard to accept, especially the sodium restriction.

Because the family has no medical insurance, she could not afford to return for follow-up care and her symptoms grew steadily worse, with severe headaches, failing vision, dyspnea, abdominal pain and confusion occurring. Her husband finally took her to a University Hospital where she was admitted because of her need for kidney dialysis. Her blood pressure was 160/98 and temperature was 37.5oC (99.6oF). Laboratory analysis showed albumin and red blood cells in her urine, an elevated BUN and reduced filtration rate, and a diagnosis of chronic renal failure was made.

The medical team, consisting of an M.D., R.N., R.D., and medical social worker planned her medical management. Hemodialysis, diet and medications were used to treat the renal failure. Dialysis was scheduled for 3 times a week. Hemodialysis relieved many of her symptoms, but she continued to lose weight. It was determined that she would need to be maintained on dialysis and plans were developed to teach Mr. and Mrs. Chang how to do home dialysis. Instructions regarding diet, drug intake, and the dialysis procedure were begun. Two major problems exist in this treatment mode. The apartment is too small to accommodate the kidney dialysis unit and they do not have the finances to cover the treatment.

The social worker is helping them obtain federal funding to defray the cost of treating chronic renal disease and assistance will be provided to help Mr. Chang learn how to do the dialysis procedure and choose acceptable nutrition for his wife.

Study questions

1.List the metabolic imbalances caused by renal failure that might account for Mrs. Chang’s symptoms.

2.In addition to the symptoms Mrs. Chang experienced, what other symptoms are characteristic of chronic renal failure?

3.What are the objectives of care for chronic renal failure?

4.What factors affect the amount of protein needed by persons with chronic renal failure? What is the usual amount of protein permitted?

5.How much sodium is usually recommended in the diet of persons with chronic renal failure?

6.Why is it important to control potassium levels? How much is recommended?

7.Why is phosphate intake controlled in the diet?

8.What factors affect fluid balance in chronic renal failure? What is the usual amount allowed?

9. Taking into consideration the food habits of this ethnic group, outline a general teaching plan for diet therapy for Mrs. Chang.

Answer 1