Assignment
You are working in an outpatient nephrology clinic and today you have an appointment with AB, a 17-year-old female whose family is native to New Mexico. AB has lived her entire life on the reservation. AB reported falling on leg as a result of ruptured tendon. Per guidance from orthopedics, AB underwent an MRI which revealed hyperparathyroidism including diffuse abnormalities of bone in the right femur. Pt prior to this clinic visit had no medical history other than ear infections. Pt parents also reported no family history of renal disease on either side. Physician contacts the dietitian to assess patient nutritional status and to provide diet counseling.
• Patient Chart
1) Name: AB
2) Sex: Female
3) Ethnicity: American Indian
4) Weight: 43.7 kg
5) Height: 149.1 cm
6) Mid-parental height of 164 cm plotting at the 50th percentile
• Lab Results
1) Na 142
2) K 3.2
3) CO2 11
4) Albumin 3.1
5) Calcium 8.9
6) Phosphorus 8.6
7) Vitamin D25OH 19.0
8) PTH 1978
9) GFR Calculated 37
• 24-hour recall
1) Breakfast: sausage biscuit
2) Lunch: spaghetti o's with franks
3) Dinner - rice, beans, and peppers (veggie bowl)
4) Pt reports will eat carrots and a variety of fruits; drinks lemonade and 2-3 cans of coke per day
Leg: The client is wearing a brace and is utilizing a wheelchair for mobility. The left leg is swollen.
Hair: Long black hair
Fingernails: Opaque coloring and Brittle nails.
Eyes: Yellowing of the whites of the eyes.
Task
I. What is your assessment of this patient? Include reference to information gained when you were assessing lab values, NFPE, growth history, and food recall as necessary.
II. Write one PES statement and provide a suggested intervention based on your findings.
III. Why might Indigenous populations experience greater rates of CKD in the United States? (Hint: you may want for some general information. Additional research may be required)
IV. What culturally appropriate food recommendations would you make for this family? Why? (Hint: you may want for some general information. Additional research may be required)
V. What foods would be restricted for a low phosphorus diet? Which of these do you feel may show up in this individual's diet given the 24-hour recall?
VI. What advice might be helpful to support bone health? Why?
VII. Would you restrict protein for this child? Why or why not?