Page 596 - Nutrition Essentials for Nursing Practice

584 U N I T 3 Nutrition in Clinical Practice

NURSING PROCESS: Chronic Kidney Disease

C arlos is 66 years old and has had type 2 diabetes for 20 years. He is 5 ft 7 in tall and weighs
172 pounds. His hemoglobin A1c is 8.2; he takes insulin twice a day. He has a history of
hypertension and mild anemia and complains of sudden weight gain and “swelling.” His blood urea nitrogen
(BUN) and creatinine have been steadily increasing over the last several years, and his GFR is currently 63.
During his last appointment, the doctor told Carlos to watch his protein intake and avoid salt. At this visit,
Carlos’ chief complaint is that he does not have an appetite anymore; he attributes his change in taste to not
salting his food. The doctor has asked you to talk to Carlos about his diet.

Assessment

Medical–Psychosocial History ■ Medical history including cardiovascular disease, hypertension,
diabetes, and renal disease
Anthropometric Assessment
Biochemical and Physical Assessment ■ Medications that affect nutrition such as diuretics, insulin, and lipid-
lowering medications
Dietary Assessment
■ Physical complaints such as fatigue, taste changes, anorexia,
nausea, vomiting, diarrhea, muscular twitches, and muscle cramps

■ Psychosocial and economic issues such as living situation, cooking
facilities, financial status, employment, and education

■ Understanding of the relationship between diet and renal function
■ Motivation to change eating style
■ Current height, weight, and body mass index (BMI)
■ Recent weight history
■ Blood values of

■ BUN and creatinine
■ Sodium, potassium, and other electrolytes
■ Phosphorus and calcium
■ Glucose
■ Lipid profile
■ Hemoglobin and hematocrit
■ eGFR
■ Urinalysis for volume, urea, protein, etc.
■ Blood pressure
■ What kind of nutrition counseling have you had in the past?
■ How many meals and snacks do you usually eat?
■ What is a typical day’s intake for you?
■ Do you follow a diet for diabetes? What gives you the most difficulty?
■ How is your appetite?
■ Do you have any food allergies or intolerances?
■ Do you have any feeding issues, such as difficulty chewing or
swallowing?
■ What kind of protein do you eat most often? What is a typical
serving size? Is it spread out over the day?