3d%20Protocol%20for%20Nutritional%20Intervention

3d%20Protocol%20for%20Nutritional%20Intervention - PROTOCOL...

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HYPERCALCEMIA Due to : 1) Excessive dietary calcium intake 2) Hyperparathyroidism 3) Use of calcium-containing phosphate-binding agents Manifested by : serum calcium > 11 mg/dL Expected patient outcomes: 1) The patient will exhibit an understanding of the dietary modifications for calcium control in ESRD. 2) The patient will maintain serum calcium within a range of 8.5-11.0 mg/dL. 3) The patient will maintain a serum phosphorus level within a range of 4.0-6.0 mg/dL. Dietary interventions: 1) Collaborate with physician in planning appropriate intervention to: a) decrease dietary calcium intake b) evaluate use of phosphate-binding agents (type, dosage, timing of ingestion) c) evaluate the possibility of hyperparathyroidism d) decrease or discontinue vitamin D supplementation e) decrease or discontinue calcium supplementation. 2) Discuss with patient: a) function of calcium in body b) definition of hypercalcemia c) kidney's role in calcium regulation. 3) Inform patient of consequences of hypercalcemia (muscle weakness, fatigue, abdominal cramps, nausea/vomiting, coma, Ca-P Product > 70 [soft tissue and vascular calcification, itching]). 4) Translate phosphorus-binding agent prescription and dietary calcium requirements into individual meal plan. 5) Monitor serum calcium and phosphorus levels monthly, or as indicated. HYPOCALCEMIA Due to: 1) Inadequate dietary calcium intake 2) Hyperphosphatemia 3) Hypoalbuminemia 4) Altered calcium absorption and/or metabolism Manifested by: serum calcium levels < 8.5 mg/dL after adjustment for hypoalbuminemia (if applicable) Expected patient outcomes: 1) The patient will exhibit an understanding of the dietary modifications for calcium control in ESRD. 2) The patient will maintain serum calcium within a range of 8.5-11.0 mg/dL. 3) The patient will maintain a serum phosphorus level within a range of 4.0-6.0 mg/dL. Dietary interventions: 1) Collaborate with physician in planning appropriate intervention to: a) increase dietary calcium intake (within potassium and phosphorus restriction) b) use calcium supplementation (hypocalcemia with normal serum phosphorus) c) use of vitamin D supplementation (with normal serum phosphorus) d) use calcium-containing phosphorus-binding agents when appropriate e) manage hypocalcemia post parathyroidectomy. 2) Discuss with patient: a) function of calcium in body b) definition of hypocalcemia c) kidney's role in calcium regulation. 3) Inform patient regarding consequences of hypocalcemia (tetany, arrhythmia, seizures, hair loss, cataracts, conjunctivitis). 4) Translate phosphorus-binding agent prescription and dietary calcium requirements into individual meal plan. 5)
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3d%20Protocol%20for%20Nutritional%20Intervention - PROTOCOL...

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