Page 599 - Nutrition Essentials for Nursing Practice

C H A P T E R 2 1 Nutrition for Patients with Kidney Disorders 587

access graft thrombosis, and decreasing the dose of erythropoietin needed to maintain
hemoglobin level within the goal range. The American Heart Association recommends
people with or at risk of heart disease to consume 1 g of EPA and DHA per day, but
people on dialysis may need as much as 2 g daily (Vergili, 2007). Because omega-3 fatty
acids decrease platelet aggregation, clients should talk to their physician before using
them, especially if they are taking anticoagulants. Fish oil supplements should be stored
in the refrigerator to prevent rancidity.

CASE STUDY

Dorothea is a 72-year-old black woman who is 5 ft 5 in tall and weighs 149 pounds. She
has coronary heart disease and a long-standing history of hypertension with progressive
loss of kidney function. She recently started receiving hemodialysis and is gaining about
4 pounds between treatments. She has convinced herself that because she is on dialysis,
she can eat and drink whatever she wants and “the machine will take care of it.”

Yesterday, she ate the following:

■ What risk factors does Dorothea

Breakfast: Grits with cheese have for CKD?
Bacon ■ Based on her age, weight, and use
Biscuit with butter
of hemodialysis, what should the

Coffee composition of her diet be (e.g.,

Lunch: Hamburger on bun with ketchup and number of calories, grams of pro-
mustard tein, grams of sodium)?
■ Why is she gaining 4 pounds be-
Potato chips tween treatments? What is a more
Banana reasonable goal? What would you
Sweetened tea suggest she do to achieve the goal?

Dinner: Fried chicken ■ Evaluate her protein intake and rec-

Macaroni and cheese ommend changes she could make
Collard greens to achieve her protein goals.
Pound cake ■ What foods is she eating that are
Sweetened tea not heart healthy? What substitu-

tions would you recommend?

■ Evaluate her sodium intake and recommend changes she could make to limit her so-

dium intake.

■ What foods is she eating that are high in potassium? What alternatives would you

suggest?

■ What foods is she eating that are high in phosphorus? Is her calcium intake adequate?

■ What would you tell Dorothea about the use of dialysis and her theory about eating

anything she wants?

■ Which is the lesser risk: getting enough calories and protein by eating non–heart-healthy

foods or adhering to the sodium and other restrictions but not getting enough calories

and protein?