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.
Address the following questions in a paragraph-type format:
1. Why did Mr. Ds kidneys fail (requiring dialysis)? Why was Mr. Ds risk for developing End Stage Renal Disease (ESRD) higher compared to other type 2 diabetic patients?
2. What caused Mr. Ds excessive weight loss from age 33 to 47? (Diabetes diagnosis to the start of dialysis?) What contributed to the 15% weight loss in since he started dialysis? (one year ago)
3. Choose several applicable nutritional diagnoses phrases/ nutrition problems from the Nutrition diagnosis list in chapter 11 (Box 11-1). Which one do you think is the most important and why?
4. Why do dialysis patients require so much protein? What are Mr. Ds current estimated calorie and protein needs?
5. Are there any referrals to community programs that may help Mr. D?What can be done to increase his compliance with the dietary and medical therapies?
6. How can Mr. Ds compliance be assessed? Which assessment methods and tools should be utilized? (Weight monitoring, clinical/social referrals/background info, labs, etc.)