Unit 5_ NS 335

Kaplan University School of Health Sciences

NS335 Unit 5 Assignment

Unit 5 Assignment

Unit outcomes addressed in this Assignment:

• List the nutrient requirements for adults with renal disease based on type of renal impairment.

• List the goals of medical nutrition therapy in the management of end stage renal disease.

Course outcomes addressed in this Assignment:

NS335-4: Explain how nutrition assessment results can impact the nutrition intervention plan in a patient with a chronic disease.

GEL-1.1: Demonstrate college-level communication through the composition of original materials in Standard American English.

Instructions:

Imagine that you are a nutrition education assistant who is working at the county health department’s nutrition outreach program. You have received a patient referral from the local dialysis center. While all dialysis centers have nutrition professionals and nutrition education is reimbursed through insurance, Medicare, or Medicaid, this is a serious case of non-compliance and the dialysis center is trying to gather more support sources for the patient. The supervising nutrition director has assigned you to review the referral information to help prepare an appropriate intervention.

Referral Information: Mr. D is a 48 year old Caucasian male with poorly managed type 2 diabetes for over 15 years and has been on dialysis three times a week for 1 year. Medical records reveal that his diabetes was most likely obesity related and was never well controlled. Mr. D required insulin shots soon after his initial diagnosis. 1 year ago his friend found him unconscious in his apartment and took him to the hospital. Upon admission, his blood sugar was over 700 mg/dl. He was already in the pre-dialysis stages of kidney disease prior to this hospital stay. His friend reported that he rarely saw Mr. D check his blood sugar or administer insulin shots. His friend also informed the hospital’s nurse that Mr. D once told him that he could lose weight fast by letting his blood sugars get really high and skipping insulin doses.

From Chart-Patient Summary:

Mr. D was 33 years old when he was first diagnosed with Type 2 Diabetes.

Weight: 270 pounds (15 yrs ago)

Height: 5’10”

Kaplan University School of Health Sciences

NS335 Unit 5 Assignment

Diet order: 1800 calorie diabetic diet

Clinical Progression of disease: Pancreatic function declined and insulin resistance increased due to Mr. D’s dietary and medical non-compliance.

Medical Intervention: Short and long acting insulin shots were added to his therapy about 10 years ago.

Hospital and Physician visits: Multiple recorded diabetic ketoacidosis (DKA) episodes are documented, including the DKA episode that ultimately caused his kidneys to fully fail when his friend found Mr. D unconscious in his apartment.

Hemodialysis Center reports:

12 months of hemodialysis on Mondays, W ednesdays & Fridays.

Weight one year ago (age 47): 185 pounds (dry weight measured after dialysis session)

Current age: 48

Current weight: 158 pounds

Height: 5’10. The patient has lost 15% of his “dry weight” (commonly used with dialysis patients to obtain a more accurate weight due to fluid fluctuations).

Labs: His sodium, potassium, BUN, Cr, glucose are all out of range and very inconsistent (sometimes very high and sometimes very low, but rarely normal).

Urine output: Negligible

Dialysis Compliance: Only attends dialysis sessions about 75% of the time.

Dietary Information: Increased Calorie Renal diet, carbohydrate restrictions, high protein and a 1250 ml fluid restriction.

Dialysis nursing notes: Heavy alcohol (ETOH) consumption, often complains of (c/o) nausea/vomiting (N/V) after dialysis, and he usually appears very somber.

Address the following questions in a paragraph-type format:

1. Why did Mr. D’s kidneys fail (requiring dialysis)? Why was Mr. D’s risk for developing End Stage Renal Disease (ESRD) higher compared to other type 2 diabetic patients?

2. What caused Mr. D’s excessive weight loss from age 33 to 47? (Diabetes diagnosis to the start of dialysis?) What contributed to the 15% weight loss in since he started dialysis? (one year ago)

Kaplan University School of Health Sciences

NS335 Unit 5 Assignment

3. Choose several applicable nutritional diagnoses phrases/ nutrition problems from the Nutrition diagnosis list in chapter 11 (Box 11-1). Which one do you think is the most important and why?

4. Why do dialysis patients require so much protein? What are Mr. D’s current estimated calorie and protein needs?

5. Are there any referrals to community programs that may help Mr. D? What can be done to increase his compliance with the dietary and medical therapies?

6. How can Mr. D’s compliance be assessed? Which assessment methods and tools should be utilized? (W eight monitoring, clinical/social referrals/background info, labs, etc.)

Requirements:

This Assignment needs to be at least 3 pages in length, with at least 3 high quality references in formal APA style included. The title page and reference page do not count towards length requirements.

Submitting your work:

Submit your Assignment to the appropriate Dropbox. For instructions on submitting your work, view the Dropbox Guide located under Academic Tools at the top of your unit page.

Please be sure to download the file “Writing Center Resources” from Doc Sharing to assist you with meeting APA expectations for written Assignments.

To view your graded work, come back to the Dropbox or go to the Gradebook after your instructor has evaluated it. Make sure that you save a copy of your submitted work.

Unit 5 Assignment Grading Rubric = 150 points

Assignment Requirements Points possible

Points earned by student

Explain why Mr. D’s kidneys failed/requiring dialysis. Explain why his risk for ESRD was higher than that of other people with type 2 diabetes.

0-25

What caused the significant weight loss from Mr. D’s weight 15 years ago to the time of dialysis initiation? What contributed to his 15% weight loss while on dialysis? (Remember, weight is based on dry weight.)

0-25

Choose several diagnosis phrases from Box 11-1 that apply to 0-25

Kaplan University School of Health Sciences

NS335 Unit 5 Assignment

Mr. D’s current nutritional problems. Choose the one that is the most important and explain why.

Calculate Mr. D’s current calorie and protein needs (dialysis/diabetes). Explain why protein needs are high for dialysis patients.

0-25

Include any community resources/support programs that may benefit Mr. D. What motivational and counseling techniques can be used to increase compliance?

0-25

What types of nutrition assessment tools and methods can be used to monitor Mr. D’s medical and nutritional compliance?

0-25

Total (Sum of points earned) 150

The Proposal is written in the most current version of APA format with no grammatical, spelling, copyright, plagiarism or proof reading errors.

Points deducted for spelling, grammar, and/or APA errors.

Adjusted total points earned

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