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Nutrition for Nurses

15.3 Implement Nutritional Strategies to Impact Renal Wellness

Nutrition for Nurses15.3 Implement Nutritional Strategies to Impact Renal Wellness

Learning Outcomes

By the end of this section, you should be able to:

  • 15.3.1 Assess the client for readiness to learn.
  • 15.3.2 Teach nutritional strategies to optimize renal wellness.

Holistic Nursing Assessment of the Client

When providing holistic care, the nurse should address potential barriers the client may face in accessing healthy foods. According to the World Health Organization, 30–55% of health outcomes are influenced by social determinant health disparities such as economic stability, food security, social context, and environment, among others (Reinoso et al., 2022; World Health Organization, 2020). Many of the fresh foods recommended on a customized nutritional plan for renal disease are often more expensive and harder to obtain than packaged or processed foods. To set the client up for success in following the plan, the nurse should inquire about any food security issues the client has. The nurse should create a plan that addresses the client’s insecurities and further support the client by connecting them to the appropriate resources.

Helpful Programs

The nurse should refer clients to one of the multiple government programs available to help with food security issues.

Client Teaching

Client adherence to the nutritional plan may also be difficult if they are lacking education or fail to engage in a plan. If the client does not understand diet restrictions or the need to follow them, they are not likely to follow the prescribed diet. Client and family or caretaker engagement in the planning of their diet and in the active learning process is considered essential to success—engaged clients are more likely to be proactive in the management of their condition and they are more likely to make the needed behavior changes to improve their quality of life (Kariuki, 2022).

The nurse should use multiple educational strategies to increase client confidence and compliance. Educational strategies may include teach-back evaluation of understanding, programmed medication reminders, access to their medical records, easy communication with their provider, and condition-specific educational resources in multiple formats, including digital formats (Kariuki, 2022). The nurse should educate the client on some of the common difficulties they will face when following the nutritional plan and provide specific strategies to address them. The nurse should provide their client with some tips and tricks to help with some of the previously mentioned difficulties Table 15.3.

Electrolyte/Restrictions Substitutions/Hacks
Fluids
  • Use small glasses at meals, or do not fill large glasses completely.
  • Suck on hard, sugar-free candy, such as mints or sour balls, to help lubricate the mouth.
  • Take sips and not gulps to savor liquids.
  • Divide fluid intake into manageable amounts for each part of the day.
  • If going out in the evening, take in less during the day to save intake.
  • Use alcohol-free mouthwash and perform good oral hygiene.
Potassium
  • Avoid high-potassium foods.
  • Use herbs, but not salt substitutes.
  • Take diuretics or potassium binders when directed by the provider.
Sodium
  • Use salt substitutions (not salt substitutes) such as garlic or onion.
  • Make sauces, gravies, and snacks at home.
  • Do food prep and freeze meals instead of buying store-bought microwave meals.
  • Buy and cook fresh meats, not smoked, cured, luncheon, processed, or jerky meats.
Phosphorus
  • Use phosphorus binders when prescribed by the provider—take with meals.
  • Limit foods that are especially high in phosphorus, like dark colas, chocolate, chocolate drinks, cheese, milk, cream soups, ice cream, pudding, regular yogurt, oysters, beef liver, organ meats, sardines, caramels, and processed meats and foods.
  • Limit any store-bought food that contain phosphorus, phosphate, phosphoric, or pyrophosphate.
Magnesium
  • Avoid milk of magnesia to treat for heartburn.
  • Increase fiber intake, as it helps decrease magnesium absorption.
  • Eat Greek yogurt as a healthy alternative to help lower magnesium levels, increase calcium, and not raise phosphorus.
  • Exercise to the point of sweating to lower magnesium.
Fat
  • Avoid trans fats and saturated fat.
  • Avoid processed foods.
  • Make food at home.
  • Remove skin and fat from meat.
  • Bake foods instead of frying.
  • Use olive oil or avocado oil for cooking.
  • Avoid sugary desserts.
  • Read nutrition labels carefully to choose the least amount of trans fat and saturated fat.
Protein
  • Limit protein before dialysis—but eat enough to maintain health.
  • Use plant sources high in protein first, such as quinoa, edamame, lentils, fava beans, chickpeas, pinto beans, lima beans, mung beans, green peas, tofu, pumpkin seeds, soybeans, chia seeds, almond milk, and mycoprotein.
  • Use animal sources of protein sparingly, and choose lean sources such as skim milk, egg whites, skinless chicken, and fish.
Calcium
  • Increase calcium; raising calcium will help lower phosphorus levels as well.
  • Eat foods high in calcium and enriched with calcium; plant sources of calcium are a better option than dairy sources, as dairy also contains higher levels of phosphorus.
Table 15.3 Substitutions and Nutritional Hacks to Help with Nutritional Plan Adherence in CKD (sources: DaVita, 2023; National Kidney Foundation, 2022)

Unfolding Case Study

Part A

Read the following clinical scenario and then answer the questions that follow. This case study will evolve throughout the chapter.

Mr. Vasquez is in the clinic for a routine visit following his education session with the renal dietician 2 weeks prior. The nurse reviews his food recall report for the last 3 days (72 hours) to evaluate the need for further education. The client’s diagnoses include obesity, hypertension, diabetes mellitus type 2, and CKD stage 2, so his nutritional education would have included all these issues.

1.
Which dietary selection made by Mr. Vasquez suggests the need for further teaching by the nurse?
  1. Lunch meats
  2. Turkey off the bone
  3. Apples
  4. Hard-boiled eggs
2.
Mr. Vasquez has an upcoming celebration and asks the nurse for a suggestion for a dessert that he could eat. What suggestion is appropriate for the nurse to make?
  1. Cupcakes
  2. Fruit salad
  3. Ice cream
  4. Chocolate milk
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