Key issues: Date identified

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Risk for Imbalanced nutrition: less than body requirements related to increased ammonia level secondary to bacterial break down of urea secondary to chronic kidney disease Cues: • lack of interest in food • decreased desire to eat as evidenced by verbalization of “Wala jud ko’y gana mo kaon.”

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BUN levels(N=7.0 – 18.0): November 10 , 2010=36.7 H, November 13, 2010=37.1 H Creatinine levels(N=0.6 – 1.5): November 10, 2010=3.74 H, November 12, 2010= 3.39 H November 15, 2010=1.9 mg/dL Uric acid levels(N=2.30 – 7.00 mg/dL): November 10, 2010=10.50 H, November 13, 2010=8.5H

SB: Every part of the GI system is affected as a result of inflammation of the mucosa caused by excessive urea. Mucosal ulcerations, found throughout the GI tract are caused by the increased ammonia produced by bacterial breakdown of urea. Anorexia, nausea and vomiting caused by irritation of the GI tract by waste products contribute to weight loss and malnutrition. (Source: Lewis: Medical-Surgical Nursing 7th Ed. Vol.2 p 1208) Dietary intervention is necessary with deterioration of renal function and includes careful regulation of protein intake, fluid intake to balance fluid losses, sodium intake to balance sodium losses, and some restriction of potassium. At the same time, adequate caloric intake and vitamin supplementation must be ensured. Protein is restricted because urea, uric acid, and organic acids—the breakdown products of dietary and tissue proteins—accumulate rapidly in the blood when there is impaired renal clearance. The allowed protein must be of high biologic value

Independent interventions: 1. Assessed dietary intake and discussed with client the possible causes of decreased appetite. R: Aids in identifying deficiencies and dietary needs. General physical condition, uremic symptoms (nausea, anorexia, altered taste), and multiple dietary restrictions affect food intake. 2. Discussed eating habits of client, including food preferences and intolerances appropriate for regimen treatment. R: To appeal to client’s likes and dislikes. 3. Assessed weight. R: To monitor changes in weight. 4. Encouraged client to rest before meals. R: Fatigue further reduces an anorectic client’s desire and ability to eat. 5. Offered frequent small meals instead of a few large ones. R: Evenly distributed caloric intake helps increasing appetite. 6. Encouraged to comply to low purine diet. R: To avoid accumulation of nitrogenous wastes in blood. 7. Encouraged high-calorie, low-protein, lowsodium, and low-potassium snacks between meals. R: Reduces source of restricted foods and proteins and provides calories for energy, sparing protein for tissue growth and healing. 8. Eliminated any offensive odors and sights from the eating area. R: To promote appetite 9. Encouraged to perform frequent mouth care. R: Mucous membrane may become dry and cracke. Mouth care soothes and lubricates and helps freshen mouth taste, which is often unpleasant because of uremia and restricted fluid intake. 10. Provided a relaxed atmosphere and encourage socialization during meals R: To promote appetite

Desired Outcome Within 8 hours of student nurse-patient interaction, client will be able to consume foods within dietary restrictions (low-purine, low salt, low cholesterol, low potassium), and will not be able to show signs of malnutrition such as lack of interest in food and weight loss. Actual Outcome November 15, 2010 After 8 hours of student nurse-patient interaction, client was able to follow to diet restrictions by not consuming any high-purine, high-sodium, highcholesterol foods such as chicken, ham, processed foods, peanuts, legumes and beans. Patient still showed loss of appetite as evidenced by 1/2 slice of bread during breakfast and 5 tablespoons of oatmeal and 1 glass of milk for lunch. November 16, 2010 After 8 hours of student nurse-patient interaction, client was able to follow to diet restrictions by not consuming any high-purine, high-sodium, highcholesterol foods such as chicken, ham, processed foods, peanuts, legumes and beans. Patient showed increase in appetite as evidenced by 2 slices of bread during breakfast and 1 cup or rice with 1 fried fish for lunch.

1329) There are clearly a number of contributing factors that lead to protein-energy malnutrition in patients with CKD. High-biologic-value proteins are those that are complete proteins and supply the essential amino acids necessary for growth and cell repair.medscape.2 p.com/viewarticle/ 545157) Risk for fluid and electrolyte imbalance related to upper G. (Source: William Finn. Vol.I.Management of Malnutrition: An Expert Interview With William F. leading the list is the presence of inadequate nutrient intake due to anorexia and dietary limitations.) Chronic Kidney Disease -. Recently. bleeding secondary to multiple antral ulcers . eggs.(dairy products. meats). However. Finn. 2010 from. MD. anorexia of CKD has been linked to a defect in the control of appetite by the central nervous system causing both a decrease in food intake and an increase in energy expenditure. (Source: Smeltzer and Bare: Brunner & Suddarth’s Textbook of Medical and Surgical Nursing 10th Ed. http://cme. (September 2006. Retrieved November 19.

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