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Unfolding Case Study

1.
a. 130 kcal/kg/day is the highest daily recommended amount for a preterm infant. 130 × 1 kg = 130 calories daily
2.
d. Carbohydrate is the preferred energy source for the body.
3.
a. Protein and calories will be the biggest concerns at this age because she will need them to develop and grow appropriately; however, she cannot take in so much that her kidneys will be overloaded and her glucose out of range.
4.
d. To prevent additional issues like UTIs, kidney stones, and hypertension, which can impact already-poor kidney health, the client should eat a low-sodium, heart-healthy, high-fiber diet, and Ramen noodles are extremely high in sodium.
5.
b. Education on preventing STIs should start at age 10 to help ensure renal health. UTIs resulting from STIs can spread silently and asymptomatically, depending on the cause, which could lead to pyelonephritis and damage Kayla’s already weakened kidneys.
6.
a. The requirement is 2,000 calories daily for an adolescent female.
7.
d. Fetal intrauterine growth restriction (IUGR) is a risk for a client with these health conditions.
8.
b. The client’s original CKD stage was stage 3, which is associated with the GFR range of 30 to 59 mL/min/1.73 m2. During pregnancy, the range is expected to increase, so a lower range would be something to address immediately. At 15 mL/min/1.73 m2, the client would require dialysis as an immediate intervention.

Review Questions

1.
a. The GFR increases in early pregnancy, causing a hyperfiltrative state, so a decreased GFR would be considered abnormal.
2.
c. The pregnant client should avoid or limit caffeine intake to promote fetal health.
3.
d. Protein is extremely important in growth and development and in repair of muscles and injury, but it is still restricted in the diet of clients with CKD.
4.
d. Females are at risk for anemia. The recommended daily iron intake for female adolescents aged 14 to 18 years, including those with CKD, is 15 mg.
5.
a. Coffee, tea, colas, energy drinks, and brown chocolate all contain caffeine, which contains an acid that acts as a bladder irritant and can aggravate OAB symptoms.
6.
b. The client with calcium stones should avoid foods high in oxalate, such as rhubarb, beets, and potatoes.
7.
c. Protein intake, particularly from red meat or canned sources, can increase the risk of kidney stone development.
8.
a. Increased intake of vegetables, especially cruciferous vegetables, decreases the risk of developing renal cancer.
9.
c. The client with stage 4 CKD should restrict intake of potassium as well as that of magnesium, phosphorus, and sodium.
10.
a. The Mediterranean diet, which includes an emphasis on fresh fruits, can decrease lower urinary tract symptoms.
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