Mr. Cal E Fornia has been tolerating the tube feeding. Unfortunately he develops acute rental failure and his urine output decreased to approximately 500 mL/day. Hemodialysis is initiated. The nephrologist orders a 1200 mL fluid restriction/day and consults the RD to change the EN formula. You change the enteral formula to Nepro: • 1.8 kcal/mL • 82 gm protein/L • 161 gm carb/L • 96 gm fat/L • 12.6 gm fiber/L • 100% of RDIS met with 944 mL/day • 72.7% water • 1060 mg Na+/L • 1060 mg K+/L • 720 mg PO4/L a. What is your recommendation for the hourly rate and daily goal volume of Nepro? b. How many calories, grams of protein and mL of free water will the daily goal volume provide? c. How many mg of Na+, K+ and PO4 will the daily goal volume provide?
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- The prescriber ordered Aranesp (darbepoetin alfa) 0.75 mcg/kg subcut once every 2 weeks. The client has chronic kidney disease, weighs 110 pounds, and is receiving dialysis treatments. The label reads 40 mcg/mL. How many milliliters would you administer? Round your final answer to the nearest hundredth of a mL.Your laboratory supervisor asks you to determine a patient’s 24-hour creatinine clearance. The urinesample reported on the laboratory report is 580 mL. The plasma creatinine level is reported as 10 mg/L.In addition, the urine creatinine concentration was 820 mg/L.Use the information in the case and determine the 24-hour creatinine clearance of this patient. Takeinto consideration the 24-hour duration.Patient WY 58 y/o weighs 130 lbs is diagnosed with pneumonia. Her physician requested for serum creatinine test and the result is 8.5mg/dL. Because of her current condition, her attending physician prescribed Amoxicillin 500mg PO Q12. Is the order correct based on the renal function of the patient? If incorrect, what is your recommended regimen? CrCl 10 to 30 mL/min: 250 to 500 mg orally every 12 hours CrCl 9 mL/min or less: 250 to 500 mg orally every 24 hours The 875 mg tablets and the 775 mg extended-release tablets should not be given to patients with CrCl less than 30 mL/min
- In reviewing the patient’s current information, a concern exists that acute kidney injury has developed. Select to highlight the laboratory information that would support this concern.UrinalysisCasts - +++Cola-color to urineProteinuriaBlood ValuesRBC - 3.9 cells/L (4.0-4.9 cells/L)Hgb 10 g/dL (12-16 g/dL)Hct-40% (37%-48%)WBC 11.0 cells/L (4.0-10.0 cells/L)Platelets - 140 cells/L (150-450 cells/L)Sodium - 140 mEq/L (135-145 mEq/L)Potassium - 4.5 mEq/L (3.5-5.2 mEq/L)BUN - 32 mg/dL (5-20 mg/dL)Creatinine 1.8 mg/dL (0.5-1.5 mg/dL)Blood Glucose - 180 mg/dL (nonfasting) (<200 mg/dL)AST-40 Units/mL (5-40 Units/mL)ALT - 30 Units/mL (5-35 Units/mL)Bilirubin (total)- 0.8 mg/dL (<1.0 mg/dL)Albumin - 4.0 (3.5-5.5 g/dL)PT-22 (11.5-14 seconds)Mehmet Yavuz is 62 yo. He presented to the clinic and after having an HbA1c test (result 9%) was diagnosed with type 2 Diabetes mellitus His cardiovascular risk was > 15% http://www.cvdcheck.org.au/ His renal health screen showed an eGFR 90 mL/min/1.73m2 with microalbuminuria of 3.5 mg/mmol. http://www.kidney.org.au/HealthProfessionals/DetectingCKD/tabid/632/Default.aspx He attended a podiatry appointment which detected decreased dorsalis pedis and posterior tibialis pulses in both legs. Management of his condition now includes the following: Exercise: at least 150 minutes of aerobic and 60 minutes of resistance exercise each week Diet: a plan worked out with an accredited dietician based on the Australian Dietary Guidelines (2013). Drug use: smoking cessation plan to stop cigarette use; alcohol consumption reduction to 1 - 2 full strength beers every second day Weight loss: Mehmet aims to lose 5 kg over the first 6 - 8 weeks after diagnosis Medications: Jardiamet…Mehmet Yavuz is 62 yo. He presented to the clinic and after having an HbA1c test (result 9%) was diagnosed with type 2 Diabetes mellitus His cardiovascular risk was > 15% http://www.cvdcheck.org.au/ His renal health screen showed an eGFR 90 mL/min/1.73m2 with microalbuminuria of 3.5 mg/mmol. http://www.kidney.org.au/HealthProfessionals/DetectingCKD/tabid/632/Default.aspx He attended a podiatry appointment which detected decreased dorsalis pedis and posterior tibialis pulses in both legs. Management of his condition now includes the following: Exercise: at least 150 minutes of aerobic and 60 minutes of resistance exercise each week Diet: a plan worked out with an accredited dietician based on the Australian Dietary Guidelines (2013). Drug use: smoking cessation plan to stop cigarette use; alcohol consumption reduction to 1 - 2 full strength beers every second day Weight loss: Mehmet aims to lose 5 kg over the first 6 - 8 weeks after diagnosis Medications: Jardiamet…
- Mehmet Yavuz is 62 yo. He presented to the clinic and after having an HbA1c test (result 9%) was diagnosed with type 2 Diabetes mellitus His cardiovascular risk was > 15% http://www.cvdcheck.org.au/ His renal health screen showed an eGFR 90 mL/min/1.73m2 with microalbuminuria of 3.5 mg/mmol. http://www.kidney.org.au/HealthProfessionals/DetectingCKD/tabid/632/Default.aspx He attended a podiatry appointment which detected decreased dorsalis pedis and posterior tibialis pulses in both legs. Management of his condition now includes the following: Exercise: at least 150 minutes of aerobic and 60 minutes of resistance exercise each week Diet: a plan worked out with an accredited dietician based on the Australian Dietary Guidelines (2013). Drug use: smoking cessation plan to stop cigarette use; alcohol consumption reduction to 1 - 2 full strength beers every second day Weight loss: Mehmet aims to lose 5 kg over the first 6 - 8 weeks after diagnosis Medications: Jardiamet…Mehmet Yavuz is 62 yo. He presented to the clinic and after having an HbA1c test (result 9%) was diagnosed with type 2 Diabetes mellitus His cardiovascular risk was > 15% http://www.cvdcheck.org.au/ His renal health screen showed an eGFR 90 mL/min/1.73m2 with microalbuminuria of 3.5 mg/mmol. http://www.kidney.org.au/HealthProfessionals/DetectingCKD/tabid/632/Default.aspx He attended a podiatry appointment which detected decreased dorsalis pedis and posterior tibialis pulses in both legs. Management of his condition now includes the following: Exercise: at least 150 minutes of aerobic and 60 minutes of resistance exercise each week Diet: a plan worked out with an accredited dietician based on the Australian Dietary Guidelines (2013). Drug use: smoking cessation plan to stop cigarette use; alcohol consumption reduction to 1 - 2 full strength beers every second day Weight loss: Mehmet aims to lose 5 kg over the first 6 - 8 weeks after diagnosis Medications: Jardiamet…Mehmet Yavuz is 62 yo. He presented to the clinic and after having an HbA1c test (result 9%) was diagnosed with type 2 Diabetes mellitus. His cardiovascular risk was > 15% http://www.cvdcheck.org.au/ His renal health screen showed an eGFR 90 mL/min/1.73m2 with microalbuminuria of 3.5 mg/mmol. http://www.kidney.org.au/HealthProfessionals/DetectingCKD/tabid/632/Default.aspx He attended a podiatry appointment which detected decreased dorsalis pedis and posterior tibialis pulses in both legs. Management of his condition now includes the following: Exercise: at least 150 minutes of aerobic and 60 minutes of resistance exercise each week Diet: a plan worked out with an accredited dietician based on the Australian Dietary Guidelines (2013). Drug use: smoking cessation plan to stop cigarette use; alcohol consumption reduction to 1 - 2 full strength beers every second day Weight loss: Mehmet aims to lose 5 kg over the first 6 - 8 weeks after diagnosis Medications: Jardiamet…
- Mehmet Yavuz is 62 yo. He presented to the clinic and after having an HbA1c test (result 9%) was diagnosed with type 2 Diabetes mellitus. His cardiovascular risk was > 15% http://www.cvdcheck.org.au/ His renal health screen showed an eGFR 90 mL/min/1.73m2 with microalbuminuria of 3.5 mg/mmol. http://www.kidney.org.au/HealthProfessionals/DetectingCKD/tabid/632/Default.aspx He attended a podiatry appointment which detected decreased dorsalis pedis and posterior tibialis pulses in both legs. Management of his condition now includes the following: Exercise: at least 150 minutes of aerobic and 60 minutes of resistance exercise each week Diet: a plan worked out with an accredited dietician based on the Australian Dietary Guidelines (2013). Drug use: smoking cessation plan to stop cigarette use; alcohol consumption reduction to 1 - 2 full strength beers every second day Weight loss: Mehmet aims to lose 5 kg over the first 6 - 8 weeks after diagnosis Medications: Jardiamet…Mehmet Yavuz is 62 yo. He presented to the clinic and after having an HbA1c test (result 9%) was diagnosed with type 2 Diabetes mellitus. His cardiovascular risk was > 15% http://www.cvdcheck.org.au/ His renal health screen showed an eGFR 90 mL/min/1.73m2 with microalbuminuria of 3.5 mg/mmol. http://www.kidney.org.au/HealthProfessionals/DetectingCKD/tabid/632/Default.aspx He attended a podiatry appointment which detected decreased dorsalis pedis and posterior tibialis pulses in both legs. Management of his condition now includes the following: Exercise: at least 150 minutes of aerobic and 60 minutes of resistance exercise each week Diet: a plan worked out with an accredited dietician based on the Australian Dietary Guidelines (2013). Drug use: smoking cessation plan to stop cigarette use; alcohol consumption reduction to 1 - 2 full strength beers every second day Weight loss: Mehmet aims to lose 5 kg over the first 6 - 8 weeks after diagnosis Medications: Jardiamet…Mehmet Yavuz is 62 yo. He presented to the clinic and after having an HbA1c test (result 9%) was diagnosed with type 2 Diabetes mellitus. His cardiovascular risk was > 15% http://www.cvdcheck.org.au/ His renal health screen showed an eGFR 90 mL/min/1.73m2 with microalbuminuria of 3.5 mg/mmol. http://www.kidney.org.au/HealthProfessionals/DetectingCKD/tabid/632/Default.aspx He attended a podiatry appointment which detected decreased dorsalis pedis and posterior tibialis pulses in both legs. Management of his condition now includes the following: Exercise: at least 150 minutes of aerobic and 60 minutes of resistance exercise each week Diet: a plan worked out with an accredited dietician based on the Australian Dietary Guidelines (2013). Drug use: smoking cessation plan to stop cigarette use; alcohol consumption reduction to 1 - 2 full strength beers every second day Weight loss: Mehmet aims to lose 5 kg over the first 6 - 8 weeks after diagnosis Medications: Jardiamet…