CHRONIC KIDNEY DISEASE STAGE III

GROUP #3 CASE STUDY

BY CHERYL SCHENDEL, VY DOAN, CARRIE MOODY, KASSIE
RIVERA, CAMILO ALBAN
CLASS OF 2017-CSUSB ISPP
PATIENT PROFILE

Age: 86
Sex: Male
NKDA/NKFA
PMHx: CKD III, Dementia, HTN,
COPD, Unspecified psychosis
 Chronic Kidney Disease III

Main Causes of CKD are Diabetes and HTN

Decreased GFR: (30-59 mL/min) =

kidney function
waste excretion
ability to maintain fluid/electrolyte homeostasis
anemia Photo: kidneysmart.com 8/15/16

Symptoms
Typically asymptomatic at this stage
May present with general ill feeling, muscle aches, fatigue, slight neurological impairment, change in appetite
CKD III Comorbidities

Chronic Obstructive Pulmonary Disease (COPD)

Airflow obstruction that is irreversible
Characterized by abnormal inflammatory response of the lungs
Prevalence r/t kidney function
COPD was present in 47% of patients with GFR <60
Strongest in patients with moderate CKD Photo: Lunginstitute.com, 8/24/2016

Hypertension (HTN)
Occurs in up to 85-95% of patients with CKD (stages 3-5)
Cyclic relationship between HTN and CKD
ASSESSMENT
ANTHROPOMETRICS

86 y.o M,
Ht: 67 (1.7m)
Current wt: 145lb (65.9kg)
IBW =148lb (98% IBW)
BMI = 22.8 (WNL)
Image source: www.acefitness.org 8-22-16
LABS
TE RE RE UNI
ST SU FE TS
LT RE
NC
E
RA
NG
E
K 4.4 3.5- mE
5.1 q/L
Na 143 136 mE
- q/L
145
 MEDICATIONS
M DF T Possib
ed or a le Side
ic se k Effects
ati eq e
o u n
n e F
n o
c r
y
P
R
N
M
ed
s:
MEDICATIONS (CONT.)
M DF T Possib
ed or a le Side
ic se k Effects
ati eq e
o u n
n e F
n o
c r
y
R
o
ut
in
e
MEDICATIONS CONT.
M DF T Possib
ed or a le Side
ic se k Effects
ati eq e
o u n
n e F
n o
c r
y
R
o
ut
in
e
DIAGNOSIS
PES STATEMENT

Altered nutrition-related lab values related to

CKD III as evidenced by protein 5.3 (low),
Albumin 3.3 (L), BUN 42 (H), Cr 21 (H).
Estimated Needs

Kcal: 1650-2000 (25-30 kcal/kg bw)

Pro (g): 50-65 (0.8-1.0 g/kg bw)
Fluid (mL): 1650-2000 (25-30 mL/kg bw)
INTERVENTION

1. Reinforce renal diet education to pt. and family,

2. Increase Suplena order to TID 8-oz. to increase PO
intake/stabilize weight
3. Introduce DASH diet to help decrease HTN and help control
COPD
MNT to Treat Medication Side Effects

Taste Dysfunction - mask the taste of a drug with food, pulpy fruits
(applesauce, crushed pineapple); use water, lemon juice, ice,
sugarless gum or candy as mouth rinses.
Dry Mouth - offer moist, soft foods (custards, puddings, fruit whips
or smoothies); avoid spicy or acidic foods
Nausea/Vomiting - offer small quantities of easily digestible foods,
at frequent intervals.
Diarrhea - focus on electrolyte replacement (Gatorade or Pedialyte);
restrict caffeine, alcohol, spicy foods, fatty foods.
Preventing Kidney Failure Through Diet
MONITORING

CBC panel
BP
Renal function Image source: www.choice.com.au 8-27-16

Other diet-related side effects from medication (N/V,

diarrhea, GI distress, dysphagia, dyspepsia, etc)
wt, PO intake, fluid status, I/Os
EVALUATION

Reassess patient
Evaluate pt wt, PO
MD: recommend to order current labs for
evaluation
 SUMMARY

Chronic kidney disease (CKD) refers to progressive loss of renal function.

Normal, healthy GFR (Glomerular filter rate) is about 125ml/min, while for patients
within stage 3 of kidney disease, their GFR is 30~59ml/min.

Most patients with CKD III can be asymptomatic; however labs can indicate
protein and albumin and BUN and creatinine

Proper intervention, monitoring, nutrition increased chance of improved overall health

and preserved kidney function
THE END

Questions or Comments?
 REFERENCES
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