EDPNA Exam – ESRD Dietitian Preceptor/Preceptor Nursing Assessment Certification Practice

Nephrotic Syndrome? Caused by? Leads to? Glomerular damage (from lupus, autoimmune dx, DM, toxins, collagen vascular dx) Leads to proteinuria Proteinuria g/day, s/s (>3g/day SHOULD BE less than 150mg) fatigued ineffective healing lose muscle mass 3rd spacing (ascites, edema) Nephrotic Syndrome Tx: sodium, fluid, protein, calories, Deficiency repletion *Sodium: 2g restriction *Fluid restriction ONLY if RF *Protein: DONT PUT ON HIGH PROTEIN-only 24hr urine collection loss+RDA ( 0.7-0.8 g protein/kg) *Calories for healing *Replete Vit D, Ca, bicarb, iron deficiencies Protein requirement g/kg RDA 0.8 g/kg Protein requirement g/kg CKD (stages 3-5) Non-DM 0.55-0.6 g/kg DM 0.6-0.8 g/kg Protein requirement g/kg CKD (stage 5D: HD/PD) Non-DM or DM 1.0-1.2 g/kg CKD (all stages & dialysis) Energy Kcal/kg 25-35 Kcal/kg Phosphorus mg/day CKD (all stages) -Adjust dietary Phos intake to maintain serum P levels -Consider bioavailability of Phos sources -Posttransplant or Low Phos, Rx high phos diet and/or suppl Potassium mEq/d CKD (all stages and post transplant) Maintain normal serum range with diet and suppl prn Sodium mg/day CKD (all stages and post transplant) *<2300 mg/d for BP and volume control *CKD 3-5 w/ proteinuria, limit Na+ to <2300mg/d with use of diuretics/etc. Fiber g/day CKD (all stages) 20-30 g/day Fluids ml/day Hemodialysis 750-1500 Unstable patient criteria -extended or freq hospitalizations -marked deterioration of health status -psychosocial change or poor nutritional status -unmanaged anemia -inadequate dialysis Nutrition Care Process (NCP) advantages improves consistency & quality of individualized care; provides model & standard language; adoption of core nutrition measures ADIME Assessment, Diagnosis, Intervention, Monitoring/Evaluation NCP Diagnosis 3 domains Identify nutr problem/diagnosis: -Clinical -Intake -Behavioral/environmental Motivational Interviewing (MI): Stages of change Pre-contemplative, Contemplation, Preparation, Action, Maintenance