pl Dietetic F ES Tools Window Help Module 4 - Interpreting Labs.pd X CB CastleBranch Login zm X Merged-TDL-Files--2024103012280X Bda1k6uo8tbjf.cloudfront.net/68f85c32-16e5-11ef-925e-aaa4f1cd8999?response-content-disposition=inlin + 90% CASE STUDIES - DISCUSSION Case 1 His lower BUN, K+ and phosphorus are consistent with his reported decrease in intake due to the flu. His high calcium level is a consequence of taking his prescribed amount of PhosLo while eating less food. Thus, he absorbed more calcium from his phosphate binder. In this patient, with adynamic bone disease (low PTH without IV vitamin D therapy), he is unable to deposit calcium in his bones, so serum level rose quickly. PhosLo was held and the next week his calcium was 11.0 and phosphorus 5.8. Other possibilities for a rise in calcium might be that patient took Tums (or another calcium-containing antacid) because of the flu or heartburn; took phosphate binders between meals rather than with meals; was consuming calcium-fortified foods in fairly large amounts or, if patient was on active Vitamin D, that the dose needed to be reduced or discontinued. Case 2 Her URR and Kt/V appear adequate. However, the concurrent rise in BUN, creatinine, K+ and PO4 along with decline in CO2 indicate access recirculation. It is likely that the post-BUN sample was drawn without waiting the designated time (15 seconds for a graft or fistula; 30 seconds for a catheter) for the recirculated blood to clear. Because this patient's labs were elevated despite no significant change in the URR or Kt/V, it is especially important for the dietitian to bring it to the attention of the charge nurse and/or physician so the patient can be evaluated for access recirculation. The patient was referred for a fistulagram and had angioplasty of two stenosed areas. These chemistry changes might also be seen if the patient had missed a treatment prior to having the blood tests. Case 3 The significant increases in BUN, K+ and PO4 in conjunction with the dramatic decline in hemoglobin indicate the likelihood of a GI bleed. The symptoms of weakness and SOB can be caused by the decrease in Hb. Case 4 Possible reasons for higher BUN, K+ and PO4 might be: • Increased intake of high potassium, high phosphorus food(s) Increased intake of low biological protein food Snacking on high phosphorus food(s) without taking binder Ran out of binders a few days prior to blood tests in conjunction with drinking milk or a milkshake (high in phosphorus and potassium) FEB 5
pl Dietetic F ES Tools Window Help Module 4 - Interpreting Labs.pd X CB CastleBranch Login zm X Merged-TDL-Files--2024103012280X Bda1k6uo8tbjf.cloudfront.net/68f85c32-16e5-11ef-925e-aaa4f1cd8999?response-content-disposition=inlin + 90% CASE STUDIES - DISCUSSION Case 1 His lower BUN, K+ and phosphorus are consistent with his reported decrease in intake due to the flu. His high calcium level is a consequence of taking his prescribed amount of PhosLo while eating less food. Thus, he absorbed more calcium from his phosphate binder. In this patient, with adynamic bone disease (low PTH without IV vitamin D therapy), he is unable to deposit calcium in his bones, so serum level rose quickly. PhosLo was held and the next week his calcium was 11.0 and phosphorus 5.8. Other possibilities for a rise in calcium might be that patient took Tums (or another calcium-containing antacid) because of the flu or heartburn; took phosphate binders between meals rather than with meals; was consuming calcium-fortified foods in fairly large amounts or, if patient was on active Vitamin D, that the dose needed to be reduced or discontinued. Case 2 Her URR and Kt/V appear adequate. However, the concurrent rise in BUN, creatinine, K+ and PO4 along with decline in CO2 indicate access recirculation. It is likely that the post-BUN sample was drawn without waiting the designated time (15 seconds for a graft or fistula; 30 seconds for a catheter) for the recirculated blood to clear. Because this patient's labs were elevated despite no significant change in the URR or Kt/V, it is especially important for the dietitian to bring it to the attention of the charge nurse and/or physician so the patient can be evaluated for access recirculation. The patient was referred for a fistulagram and had angioplasty of two stenosed areas. These chemistry changes might also be seen if the patient had missed a treatment prior to having the blood tests. Case 3 The significant increases in BUN, K+ and PO4 in conjunction with the dramatic decline in hemoglobin indicate the likelihood of a GI bleed. The symptoms of weakness and SOB can be caused by the decrease in Hb. Case 4 Possible reasons for higher BUN, K+ and PO4 might be: • Increased intake of high potassium, high phosphorus food(s) Increased intake of low biological protein food Snacking on high phosphorus food(s) without taking binder Ran out of binders a few days prior to blood tests in conjunction with drinking milk or a milkshake (high in phosphorus and potassium) FEB 5
Chapter23: Mental Health
Section: Chapter Questions
Problem F1CRE
Related questions
Question
last two please (3 and 4)
Transcribed Image Text:pl Dietetic F
ES
Tools Window Help
Module 4 - Interpreting Labs.pd X CB CastleBranch Login
zm
X Merged-TDL-Files--2024103012280X
Bda1k6uo8tbjf.cloudfront.net/68f85c32-16e5-11ef-925e-aaa4f1cd8999?response-content-disposition=inlin
+ 90%
CASE STUDIES - DISCUSSION
Case 1
His lower BUN, K+ and phosphorus are consistent with his reported decrease in intake
due to the flu. His high calcium level is a consequence of taking his prescribed amount
of PhosLo while eating less food. Thus, he absorbed more calcium from his phosphate
binder. In this patient, with adynamic bone disease (low PTH without IV vitamin D
therapy), he is unable to deposit calcium in his bones, so serum level rose quickly.
PhosLo was held and the next week his calcium was 11.0 and phosphorus 5.8.
Other possibilities for a rise in calcium might be that patient took Tums (or another
calcium-containing antacid) because of the flu or heartburn; took phosphate binders
between meals rather than with meals; was consuming calcium-fortified foods in fairly
large amounts or, if patient was on active Vitamin D, that the dose needed to be
reduced or discontinued.
Case 2
Her URR and Kt/V appear adequate. However, the concurrent rise in BUN, creatinine,
K+ and PO4 along with decline in CO2 indicate access recirculation. It is likely that the
post-BUN sample was drawn without waiting the designated time (15 seconds for a
graft or fistula; 30 seconds for a catheter) for the recirculated blood to clear. Because
this patient's labs were elevated despite no significant change in the URR or Kt/V, it is
especially important for the dietitian to bring it to the attention of the charge nurse and/or
physician so the patient can be evaluated for access recirculation. The patient was
referred for a fistulagram and had angioplasty of two stenosed areas. These chemistry
changes might also be seen if the patient had missed a treatment prior to having the
blood tests.
Case 3
The significant increases in BUN, K+ and PO4 in conjunction with the dramatic decline
in hemoglobin indicate the likelihood of a GI bleed. The symptoms of weakness and
SOB can be caused by the decrease in Hb.
Case 4
Possible reasons for higher BUN, K+ and PO4 might be:
•
Increased intake of high potassium, high phosphorus food(s)
Increased intake of low biological protein food
Snacking on high phosphorus food(s) without taking binder
Ran out of binders a few days prior to blood tests in conjunction with drinking
milk or a milkshake (high in phosphorus and potassium)
FEB
5
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