Question

Case Study: 22 year old with ESRD DB is a 22 yo male who developed ESRD Secondary to glomerulonephritis as an IGA nephropathy. His comorbitidies include anemia secondary to chronic disease and HTN. He also suffers from chronic UTI's and does not feel well on some days. He states he is chronically tired but must work full time. He is an undocumented worker whose primary language is Spanish. He speaks and understands some English but processes information slowly and reads only Spanish. He works as a cook in a diner and supports and lives with his elderly father. He has very few friends and no girlfriend currently. He has an AV fistula in his left lower arm which is patent and has a positive thrill and bruit. He is scheduled to receive dialysis 3 times a week for 4.5 hrs but sometimes misses appoints and often leaves early (after 1.5 hrs of treatment). He is afraid to miss work or be late for work. He usually eats 1-2 meals a day at the diner and often forgets to take his Renvela with his meal at work. He has been given a free supply of Renvela and advised to take this with every meal but compliance is poor. As an alternative he is advised to carry Tums with him and take this if he does not have his Renvela with him. His current Vs are BP 170/100, P 104, R 18, T100 orally. EKG: Sinus Tachy CXR: Clear Current Labs: Serum albumin 3.4, Creatinine14.8, Hgb 5.2, Ca 6.8, PO4 10.9, K.5.8, WBC 12.2 Orders are as follows: 1. Diet 85 GM Protein 2 GM NA 2 Gm Kand 1140 mg Phosphorus 2. Fluid restriction 1000ml/24 hrs 3. Procardia XL 90 daily 4. Lisinopril 20 mg daily 5. Coreg 25mg every 12 hrs 6. Renagel 800mg TID 7. Phoslo 1 packet TID 8. Kayexalate 15 gms TID 9. Clonidine 1 mg BID 10. Labetalol 200mg BID

Answer 1

Teaching has an important role for the patient. The primary language of DB is Spanish and he have lower understanding of English. Moreover, he is not able to write and read English properly. This makes it difficult for him to understand the medicines and the diet recommended by the physicians. Teaching him about the medical procedure in a patient-centered procedure can help him gain greater understanding about the diet and the medicines. This can help him overcome his condition effectively and properly.

Nursing implications of the diet

The patient is recommended to have a diet containing 85GM protein, 2GM NA 2GM K and 1140 mg Phosphorous. A diet rich in electrolytes can maintain the body functions of the patient properly. Following the 2 GM sodium diet can help the patient in improving his health. 2GM K in the diet will maintain the electrolyte balance in the body. It can help control blood pressure and relax the blood vessels. A diet rich in proteins can lead to excessive intra-glomerular pressure and glomerular hyper-filtration. This can make the condition for CKD patients worse. Hence, a diet containing 85GM protein is recommended for the patient. A low phosphorous diet will help maintain the kidney function as unhealthy kidneys fails to remove extra phosphorous out of the body. A diet rich in phosphorous can induce the calcium to pull out from bones which can be very unhealthy so a diet low in phosphorous is recommended.

Nursing implications of fluid restrictions

The patient was asked to be on fluid restriction due to his dialysis. ESRD patients with dialysis are often asked to restrict their fluid intake in order to urinate less. Drinking water during dialysis can lead to hypervolemia or fluid overload which can be fatal for the patient. Fluid restriction is preferred for the patients on dialysis because their body is holding water. Fluid retention in the body can cause problems such as long-term swelling, tissue and blood vessel damage and stress on the heart.