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Unfolding Case Study

1.
a. Lunch meats are high in sodium and fat which should be avoided in clients with CKD stage 2, hypertension, obesity, and diabetes.
2.
b. Fruit salad has the lowest added sugar and carbohydrates. It also is better for the client’s weight.
3.
c. Subjective and objective data illustrate that the client is doing what the plan requires, but the plan clearly is not adequate for the client’s needs. The client has advanced from stage 2 CKD to stage 3 CKD despite having lost weight, having blood pressure and blood sugar levels within defined limits, presenting no symptoms of fluid overload even with the advancement in CKD stage, and using a food log to demonstrate dietary adherence.
4.
a. The client does not have symptoms of heart failure, fluid overload, or edema, and will need a diet high in calcium and magnesium.
5.
b. Symptoms of heart failure create a need to change the plan. In stage 3, if heart failure is present, additional dietary measures are implemented. If they are not present, the same diet can be followed.
6.
a. Proteins should be restricted to plant-based proteins and lean, low-fat meat sources.

Review Questions

1.
a. Calcium levels are affected by the kidney through its relationship with the parathyroid gland and the production of calcitriol, but not from direct reabsorption.
2.
a. A serum creatinine level of 1.5 mg/dL is above the normal range of 0.74–1.35 mg/dL for adult males and requires prompt attention. The other laboratory values are within normal range.
3.
b. Since the PVR is the amount of urine left in the bladder after the client has urinated, the nurse should scan the bladder immediately after the client has urinated.
4.
d. Complex carbohydrates are found in foods such as whole grains, fruits, and vegetables.
5.
b. The client with CKD should be instructed to use plant sources of protein before animal sources.
6.
a. Engagement and participation in creating the plan is the single most important step toward client adherence to the plan because if the client has no desire or motivation to follow the plan it will not matter if they have the means to or not.
7.
c. The client with CKD who is on dialysis should restrict fluid intake.
8.
d. They should sip fluids slowly and savor them and not gulp them down quickly.
9.
a. Vanilla ice cream is low in phosphorus.
10.
a. Salt substitutes are dangerously high in potassium and should always be avoided when on a potassium restricted diet. Salt substitutions are acceptable.
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