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Nutrition for Nurses

15.4 Evaluate Nutritional Strategies to Impact Renal Wellness

Nutrition for Nurses15.4 Evaluate Nutritional Strategies to Impact Renal Wellness

Learning Outcomes

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

  • 15.4.1 Evaluate a nutritional plan for its effects on renal wellness.
  • 15.4.2 Modify a nutritional plan to promote renal wellness.

Evaluating the Effectiveness of a Nutritional Plan for Renal Wellness

Evaluation of the effectiveness of a nutritional plan involves evaluation of both client adherence to the plan and the effectiveness of the plan to reach the intended outcomes. Mr. Vasquez’s nutritional plan is considered in the following Unfolding Case Study feature. If the plan is ineffective in any way, the nurse should determine the cause—adherence or general ineffectiveness—so that they can make appropriate changes.

Unfolding Case Study

Part B

Read the following clinical scenario and then answer the questions that follow. This case study is a follow-up to Case Study Part A.

At the last visit, Jose Vasquez was educated on nutritional changes that will help preserve kidney function and manage comorbidities. At a recent physical examination, the following are noted:

Vital Signs Physical Examination
Temperature: 97.9°F (36.6°C)
  • No edema is present.
  • Lungs are clear to auscultation in all fields.
Blood pressure: 118/76 mm Hg
Heart rate: 98 beats/min
Respiratory rate: 14 breaths/min
Oxygen saturation: 97% on room air
Weight: Client has lost 3 lb (5.44 kg) since his last visit 3 months ago
Finger stick glucose level: 100 mg/dL
Table 15.4

Mr. Vasquez reports following the nutritional guidelines strictly, and his food diary reflects this to be the case. Lastly, the nurse receives the following lab results from the sample drawn 2 days ago as a preparation for this visit:

Lab Test Normal Range Mr. Vasquez’s Lab Results
GFR 90–120 mL/min/1.73 m2 52 mL/min/1.73 m2
Potassium 3.5–5.0 mEq/L 6.2 mEq/L
Sodium 135–145 mEq/L 122 mEq/L
Phosphorus 2.5–4.5 mg/dL 5.3 mg/dL
Table 15.5
3.
Based on these assessment findings, what would the nurse document about the success of the nutritional plan for Mr. Vasquez?
  1. Plan is effective.
  2. Plan is ineffective due to client nonadherence.
  3. Plan is ineffective despite client adherence.
  4. Unable to judge plan effectiveness with assessment presented.
4.
Which dietary change would Mr. Vasquez need to make if he progressed to stage 3 CKD?
  1. Increase calcium.
  2. Restrict fluids.
  3. Restrict magnesium.
  4. Increase fats.

Modifying a Nutritional Plan to Promote Renal Wellness

Unfortunately, renal disease may still progress even when the client follows an appropriate nutritional plan; the client’s nutritional plan may need to be modified.

Unfolding Case Study

Part C

Read the following clinical scenario and then answer the questions that follow. This case study is a follow-up to Case Study Parts A and B.

It is determined that, despite Mr. Vasquez following the nutritional plan, his condition has worsened. Although this disease process will progress regardless, it is still prudent to address the plan because the client’s disease is now in an advanced stage; the plan requires modifications to prevent further injury.

5.
Now that the client has advanced from stage 2 to 3 CKD, what assessment findings indicate a need to change the current nutritional plan?
  1. GFR of 51 mL/min/1.73 m2
  2. Symptoms of heart failure
  3. No dependent edema
  4. Glucose levels that are low
6.
Which selection is appropriate for the client to include in their diet?
  1. Quinoa
  2. Skin-on baked chicken
  3. Sirloin steak, well-done
  4. Fried fish
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