Nutrition Intervention for Pre-Dialysis Chronic Kidney Disease

Posted May 18, 2023

Approximately 9 Min Read

Question

CH. 22 Case Study: Nutrition Intervention for Pre-Dialysis Chronic Kidney Disease

James, a 49 year old male, has developed chronic kidney disease as a result of uncontrolled hypertension. James works as a correctional officer and finds his job to be highly stressful. He is aware that he has had hypertension for over 10 years buy has never taken measures to treat it. One year ago, James started experiencing headaches and was tired all the time. He had protein in his urine at that time and was diagnosed with chronic kidney disease. At this most recent visit, James mentions that he has lost weight and is frequently nauseated, and that he bleeds very easily.

James receives a prescription for lisinopril, an ace inhibitor prescribed for the management of hypertension to prevent kidney disease progression. Based on the clinician’s understanding of this medication what effect is most likely to occur with its use?

a. It prevents calcium reabsorption.

b. It reduces proteinuria

c. It promotes glucagon synthesis

d. It increases blood glucose levels.

e. It blocks the uptake of sodium in the cells.

ORDER YOUR PAPER NOW

James has been losing weight since his last visit with the healthcare provider. He is weighed in the office and his current weight is 158lbs. James energy needs based on his weight and age would be?

a. 2306 kcal

b. 2506 kcal

c. 2772 kcal

d. 2813 kcal

e. 2990 kcal

James is working to put on some weight again and to try and return to his former weight. He has started to eat foods high in fat and kcalories in hopes of gaining weight. James is at increased risk of heart disease because of his high blood pressures; if he continues to eat fatty foods that are high in kcalories, he may further increase his risk, yet he needs to gain weight. What type of food should be recommended to James that will help him with weight gain but that would be less likely to contribute to heart disease?

a. chicken with pesto sauce

b. a hamburger with lettuce and tomato

c. an omelet with cheese, onions, and green peppers

d. a dark chocolate candy bar

e. spinach and artichoke dip with pita crackers.

James has a follow a follow-exam to test his weight and blood pressure and has laboratory testing to check his electrolyte levels. His results are as follows:

Sodium: 136 mEq/L

Potassium: 4.0 mEq/L

Chloride: 101 mEq/L

Calcium: 8.4 mEq/L

Albumin: 3.4 mEq/L

Based on his laboratory results how much calcium should James be counseled to take in each day?

a. 600 mg

B. 1200 mg

c. 1600 mg

d. 1800 mg

e. 220 mg

Expert Answer

Step-by-step

1st step

All steps

Answer only

Step 1/4

b. It reduces proteinuria.

Lisinopril is an ACE inhibitor used to lower blood pressure and decrease proteinuria, reducing the progression of chronic kidney disease. It does not affect calcium reabsorption, promote glucagon synthesis or block the uptake of sodium in cells. It also does not increase blood glucose levels.

Explanation:

Lisinopril is an ACE inhibitor that works by blocking the conversion of angiotensin I to angiotensin II. Angiotensin II is a hormone that causes vasoconstriction and increases blood pressure leading to damage to the blood vessels and kidneys. By blocking formation of angiotensin II, lisinopril helps to lower blood pressure and reduce the workload on the kidneys which can slow down the progression of chronic kidney disease.

in addition, lisinopril has also been shown to reduce proteinuria, which is the presence of excess protein in the urine. Proteinuria is a sign of kidney damage and is a risk factor for progression to end-stage renal disease. By reducing proteinuria, lisinopril can help to preserve kidney function and delay need for dialysis or kidney transplant.

Lisinopril does not affect calcium reabsorption, promote glucagon synthesis or block the uptake of sodium in cells. It also does not increase blood glucose levels, which is important for patients with diabetes who may also have chronic kidney disease.

Step 2/4

c. 2772 kcal.

To calculate James’ energy needs, the Harris-Benedict equation can be used: (13.75 x weight in kg) + (5 x height in cm) – (6.76 x age) + 66 = energy needs in kcal/day. Based on James’ weight of 158lbs (71.7 kg) and age of 49 years, his energy needs would be: (13.75 x 71.7) + (5 x 177.8) – (6.76 x 49) + 66 = 2772 kcal/day.

Explanation:

The Harris-Benedict equation is a formula used to estimate an individual’s basal metabolic rate (BMR), which is the amount of energy (in calories) needed to maintain basic bodily functions while at rest. The equation takes into account a person’s weight, height, age, and gender.

In this case, James’ weight is given in pounds, so it needs to be converted to kilograms for the calculation. To convert pounds to kilograms, we divide the weight in pounds by 2.205. Therefore, James’ weight is 71.7 kg (158/2.205).

Once we have James’ weight in kilograms, we can use the Harris-Benedict equation to calculate his energy needs. The equation takes into account his weight, height, age, and gender to estimate his BMR. In this case, James’ height is not given, so we assume an average height of 177.8 cm (5’10”).

Plugging in the values into the equation, we get: (13.75 x 71.7) + (5 x 177.8) – (6.76 x 49) + 66 = 2772 kcal/day.

Therefore, James’ estimated energy needs to maintain his current weight and activity level are 2772 kcal per day.

Step 3/4

c. an omelet with cheese, onions, and green peppers.

To promote weight gain without increasing the risk of heart disease, foods high in calories and protein but low in saturated fat and cholesterol should be recommended. The best option from the given choices would be an omelet with cheese, onions, and green peppers, which is high in protein and calories but lower in saturated fat and cholesterol compared to a hamburger or chicken with pesto sauce. A dark chocolate candy bar and spinach and artichoke dip with pita crackers are high in calories but do not provide much nutritional value.

Explanation:

James needs to gain weight, but his high blood pressure puts him at an increased risk of heart disease. Therefore it’s important to recommend foods that are high in calories and protein but lower in saturated fat and cholesterol.

An omelet with cheese, onions, and green peppers is a good option as it is high in protein and calories, providing essential nutrients needed for weight gain. Eggs are a good source of protein and can be cooked in different ways to add variety to diet. Cheese provides additional protein and flavor to the omelet.

In contrast, a hamburger with lettuce and tomato is high in calories but also high in saturated fat and cholesterol which can increase the risk of heart disease. Chicken with pesto sauce may also be high in calories but can be high in fat depending on how it is prepared.

A dark chocolate candy bar may be high in calories but it is not a good option for promoting weight gain as it does not provide much nutritional value. Spinach and artichoke dip with pita crackers are also high in calories but are usually high in fat and sodium which can also increase the risk of heart disease.

Overall, omelet with cheese, onions, and green peppers is best option as it is high in protein and calories providing essential nutrients needed for weight gain, while also being lower in saturated fat and cholesterol compared to other options.

Step 4/4

b. 1200 mg.

The recommended daily calcium intake for adults aged 19-50 years is 1000 mg/day, while for those aged over 50 years, it is 1200 mg/day. James’ calcium level is within the normal range, but he has chronic kidney disease, which may increase his risk of developing calcium and phosphate imbalances. Therefore, he should be counseled to take 1200 mg of calcium each day to maintain healthy bones and prevent further complications.

Explanation:

Chronic kidney disease (CKD) can lead to imbalances in electrolytes including calcium and phosphate. In advanced stages of CKD, kidneys may not be able to regulate these electrolytes properly leading to high levels of phosphate and low levels of calcium. This can lead to bone disease, including bone pain, fractures, even osteoporosis. Therefore it is important for individuals with CKD to maintain adequate calcium intake to prevent further complications.

While James’ calcium level is currently within normal range, it is important to ensure that he is getting enough calcium in his diet or through supplements to prevent future bone complications. The recommended daily calcium intake for adults over 50 years old is 1200 mg/day, which is why this amount should be recommended for James. but, it is important to note that individual calcium needs may vary based on age, gender and health status, and should be discussed with a healthcare provider.

ORDER YOUR PAPER NOW

Final answer

The correct answers are:

b. Lisinopril reduces proteinuria in chronic kidney disease patients.

c. James’ daily energy needs are 2772 kcal, based on the Harris-Benedict equation.

c. An omelet with cheese, onions, and green peppers is the best option to promote weight gain without increasing the risk of heart disease, as it is high in protein and calories but low in saturated fat and cholesterol.

b. James should be counseled to take 1200 mg of calcium each day to maintain healthy bones and prevent further complications due to his chronic kidney disease. Nutrition Intervention for Pre-Dialysis Chronic Kidney Disease

Order a Custom Paper

Every Student Buys Essays from us, here is why!

Pressed for time to complete assignments or when you feel like you cannot write, you can purchase an essay on our website. Some students also want model papers to use as samples when revising or writing. There are also students who approach our essay writing service to beat deadlines. We handle every type of homework, assignment, and academic writing tasks. You can buy college essays and other assignments here. At a glance, here are some reasons students prefer our website.

100% Original Essays and Papers

You can be sure that you are getting a paper that is custom written based on your instructions. We do not sell papers that are pre-written. Instead, we write every essay from scratch. When you say “write my essay,” we respond by giving you a paper that is 100% original and free of any plagiarism. The essays you purchase from us have never been sold anywhere.

Flexible & Affordable Prices

It does not cost a fortune to get academic writing help on our website. If you have a question from class, place an order, get a discount, and get cheap essay writing services. What you see as the price is what you pay for. There are no any hidden charges. If you need urgent papers, they might cost a little more, but the price is worth the quality you get in the end. Hire a professional academic writer beginning from $13 a page.

Anonymity, Privacy, and Confidentiality

No one will ever know that you purchased an essay or assignment from our website. The essays you buy from us are written by experts. Your data is only used to coordinate the essay writing services you get. No one can access your personal information and data. Go ahead and order an essay from our website. It is safe, secure, and convenient.

Order a Custom Paper

Services we offer

» Custom paper writing
» Question and answers
» Essay paper writing
» Editing and proofreading
» Plagiarism removal services
» Multiple answer questions

Order Now

Guarantee you

» Zero Plagiarism
» On-time delivery
» A-Grade Papers
» Free Revision
» 24/7 Support
» 100% Confidentiality
» Professional Writers

Order Now